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Kurebayashi Y, Otaki J. Neurocognitive Functions in Patients With Remitted and Nonremitted Schizophrenia: A Cross-Sectional Study. Perspect Psychiatr Care 2018; 54:25-30. [PMID: 27808414 DOI: 10.1111/ppc.12195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/03/2016] [Accepted: 09/30/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE We aimed to clarify the neurocognitive features of outpatients with remitted and nonremitted schizophrenia. DESIGN AND METHODS The neurocognitive functions of 22 remitted and 41 nonremitted outpatients with schizophrenia and age-matched healthy controls were compared, after controlling for demographic and psychiatric variables. FINDINGS The spatial attention scores of both groups were lower than those of age-matched healthy controls. The processing speed and visual attention of remitted patients were better than those of nonremitted patients. PRACTICE IMPLICATIONS Psychiatric nurses should place patients with nonremitted schizophrenia in environments that facilitate patient vigilance and limit the need for quick responses.
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Affiliation(s)
- Yusuke Kurebayashi
- Faculty of Nursing, Kansai University of Health Science, Kumatori, Sennan, Osaka, Japan
| | - Junichi Otaki
- Graduate School of Health Science, Kyorin University, Hachioji City, Tokyo, Japan
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152
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Zhang Z, Zhang R, Qin P, Tan L. Cognitive dysfunction and negative symptoms in patients with schizophrenia and their first-degree relatives from simplex and multiplex families. Neuropsychiatr Dis Treat 2018; 14:3339-3348. [PMID: 30584307 PMCID: PMC6287416 DOI: 10.2147/ndt.s179534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to investigate cognitive functioning, negative symptoms, and the relationships in schizophrenia (SP) pedigrees and to explore the effect of genetic loading on those endophenotypes. PATIENTS AND METHODS Forty-four patients with SP, 81 first-degree non-psychotic relatives of patients from simplex and multiplex families, 14 matched control probands, and 29 first-degree relatives of the patients from communities were assessed by the vocabulary subtest (VS) of Wechsler Adult Intelligence Scale, memory span subtests of the Multiple Memory Assessment Scale (MMAS), Wisconsin Card Sorting Test (WCST), Continuous Performance Test (CPT), and Negative Scale of Positive and Negative Syndrome Scale. RESULTS Compared with controls, patients with SP and their relatives had worse performances in WCST and CPT, and more serious negative symptoms. Patients from multiple families performed poorly on most tests while patients from simplex families had impairments only on the parameters of CPT and WSCT as compared to control probands. Patients from multiple families differed significantly from the patients from simplex families in the digit span and word span of MMAS. After controlling for education, in comparison with relatives of control probands, relatives from multiple families showed impairments in VS, multiple domains of CPT, whereas relatives from simplex families had lower scores on the VS and more total cards and random errors in WSCT. The performances of most tests were linked to negative symptoms in patients with SP. For patients with SP, VS, correct numbers and categories in the WCST, and visual and acoustic errors in the CPT predicted 68.8% of the variability in negative symptoms. CONCLUSION Our findings support that cognitive deficits and negative symptoms may be markers of hereditary susceptibility of SP and aggravate as the degree of genetic load increases. There are certain relationships between cognitive deficits and negative symptoms in patients with SP.
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Affiliation(s)
- Zhikun Zhang
- Mental Health Center, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Rong Zhang
- Department of Psychiatry, Staff Hospital of Zhongyuan Oil Field Company, Puyang, Henan, China
| | - Peng Qin
- Department of Psychiatry, Changde Rehabilitation Hospital, Changde, Hunan, China
| | - Liwen Tan
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,
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153
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Sellers R, Wells A, Parker S, Morrison AP. Do people with psychosis engage in unhelpful metacognitive coping strategies? A test of the validity of the Cognitive Attentional Syndrome (CAS) in a clinical sample. Psychiatry Res 2018; 259:243-250. [PMID: 29091823 DOI: 10.1016/j.psychres.2017.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 10/14/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
The Self-Regulatory Executive Function (S-REF) model assumes that unhelpful metacognitive coping strategies characterised by worry, rumination, threat monitoring and attempts to control thoughts, have a central role in psychological disorders and prolonged negative affect. Collectively, these strategies constitute the Cognitive Attentional Syndrome (CAS). This research aims to test whether a questionnaire designed to capture these responses (the CAS-1: Wells, 2009, p. 268) is a valid assessment tool in clinical psychosis, and to test whether activation of the CAS is associated with positive and negative outcomes. A sample of 60 people with psychosis completed a semi-structured interview about psychotic symptoms, the CAS-1 self-report measure and validated self-report measures of metacognitive beliefs, negative affect, quality of life and recovery. The CAS-1 demonstrated good internal consistency, concurrent validity and predictive validity. Hierarchical multiple regression analyses revealed that negative metacognitive beliefs predict negative affect, perceptions of recovery and quality of life in people with psychosis over and above psychotic symptoms. CAS-1 scores did not contribute additional variance in the final regression models. Implications for theory and clinical practice are discussed.
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Affiliation(s)
- Rachel Sellers
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom.
| | - Adrian Wells
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Sophie Parker
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
| | - Anthony P Morrison
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
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154
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Mezquida G, Cabrera B, Bioque M, Amoretti S, Lobo A, González-Pinto A, Espliego A, Corripio I, Vieta E, Castro-Fornieles J, Bergé D, Escartí MJ, Ibañez Á, Penadés R, Sánchez-Torres AM, Bernardo M. The course of negative symptoms in first-episode schizophrenia and its predictors: A prospective two-year follow-up study. Schizophr Res 2017; 189:84-90. [PMID: 28185786 DOI: 10.1016/j.schres.2017.01.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 12/13/2022]
Abstract
AIMS This study aimed to investigate the course of negative symptoms and its stability over a two-year period following a first-episode schizophrenia (FES) and the possible predictors of higher severity in this symptomatology after this period. METHODS In this longitudinal two-year prospective follow-up study we included 268 patients with a FES, according to DSM-IV. Analysis of variance was conducted in patients who completed the full follow-up to study changes in negative symptoms over three visits. Regression analyses were conducted to show correlates and potential predictors of negative symptoms at two-year follow-up. RESULTS There was a significant effect for time in negative symptomatology, which was less severe at one-year follow-up after a FES and remained stable up to two years (Time 1>Time 2>Time 3); F(2,151)=20.45, p<0.001. Poorer premorbid adjustment (p=0.01) and higher negative symptoms at baseline (p<0.001) made a significant contribution to the changes in the negative symptoms severity at two-years after a FES (R2=0.21, p<0.001). CONCLUSIONS We found a reduction in the negative symptomatology at one-year after a FES. This change remained stable at two-year. Our results suggested that the presence of this symptomatology early in the course of the illness, together with a poorer premorbid adjustment, predict more severe negative symptoms at mid-term outcome.
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Affiliation(s)
- Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain
| | - Bibiana Cabrera
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Miquel Bioque
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Antonio Lobo
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), University of Zaragoza, Spain
| | - Ana González-Pinto
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Araba University Hospital, Bioaraba Research Institute, Spain; University of the Basque Country (UPV-EHU), Spain
| | - Ana Espliego
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Psychology, Clinical Institute for the Neurosciences (ICN), Hospital Clinic of Barcelona, Spain; Department of Medicine, University of Barcelona, Spain
| | - Josefina Castro-Fornieles
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Spain
| | - Daniel Bergé
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Hospital del Mar Medical Research Institute (IMIM) - UAB, Neurosciences, Psychiatry, Barcelona, Spain
| | - Maria J Escartí
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Valencia Clinic Hospital, Valencia, Spain
| | - Ángela Ibañez
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Rafael Penadés
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit (BCSU), Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Spain.
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155
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Pelletier-Baldelli A, Strauss GP, Visser KH, Mittal VA. Initial development and preliminary psychometric properties of the Prodromal Inventory of Negative Symptoms (PINS). Schizophr Res 2017; 189:43-49. [PMID: 28189529 PMCID: PMC5548645 DOI: 10.1016/j.schres.2017.01.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
In the psychosis prodrome, sub-threshold positive symptoms are often preceded by negative symptoms. Individuals exhibiting these attenuated symptoms are primarily adolescents and young adults at clinical high-risk (CHR) for developing a psychotic disorder. In the CHR state, negative symptoms are highly predictive of the transition to diagnosable illness, making the assessment of these symptoms very important. Existing scales used to evaluate negative symptoms in this critical population are informative but have conceptual and psychometric limitations and/or were not designed according to modern conceptions delineated in the 2005 NIMH Negative Symptom Consensus Conference. The current study reports the development of the Prodromal Interview of Negative Symptoms (PINS) - a next-generation scale designed in accordance with the consensus conference recommendations. Preliminary data on the psychometric properties of the PINS is reported as part of ongoing scale development that will use a data-driven, iterative process to generate a final scale. Analysis of data from 53 CHR cases, 30 of whom were re-evaluated at 12months, indicated that the beta version of the PINS demonstrated good internal consistency, inter-rater reliability, convergent validity, and discriminant validity. These preliminary findings provide direction for a revision of this measure, which resulted in the PINS-2, a promising new measure for the assessment of negative symptoms in CHR populations. This manuscript presents both the initial scale and resulting untested instrument, as well as a series of plans and recommendations for future development.
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Affiliation(s)
- Andrea Pelletier-Baldelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, 1905 Colorado Ave., Boulder, CO 80309, United States; Center for Neuroscience, University of Colorado Boulder, 1905 Colorado Ave., Boulder, CO 80309, United States.
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, Georgia, United States of America, 30602
| | - Katherine H. Visser
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, Georgia, United States of America, 30602
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, Illinois, United States of America, 60208,Department of Psychiatry, Northwestern University, 446 E Ontario St., Chicago, Illinois, United States of America, 60611,Institute for Policy Research, Northwestern University, 2029 Sheridan Rd., Evanston, Illinois, United States of America, 60208,Department of Medical Social Sciences, Northwestern University, 446 E Ontario St., Chicago, Illinois, United States of America, 60611
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156
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Managò F, Papaleo F. Schizophrenia: What's Arc Got to Do with It? Front Behav Neurosci 2017; 11:181. [PMID: 28979198 PMCID: PMC5611489 DOI: 10.3389/fnbeh.2017.00181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023] Open
Abstract
Human studies of schizophrenia are now reporting a previously unidentified genetic convergence on postsynaptic signaling complexes such as the activity-regulated cytoskeletal-associated (Arc) gene. However, because this evidence is still very recent, the neurobiological implication of Arc in schizophrenia is still scattered and unrecognized. Here, we first review current and developing findings connecting Arc in schizophrenia. We then highlight recent and previous findings from preclinical mouse models that elucidate how Arc genetic modifications might recapitulate schizophrenia-relevant behavioral phenotypes following the novel Research Domain Criteria (RDoC) framework. Building on this, we finally compare and evaluate several lines of evidence demonstrating that Arc genetics can alter both glutamatergic and dopaminergic systems in a very selective way, again consistent with molecular alterations characteristic of schizophrenia. Despite being only initial, accumulating and compelling data are showing that Arc might be one of the primary biological players in schizophrenia. Synaptic plasticity alterations in the genetic architecture of psychiatric disorders might be a rule, not an exception. Thus, we anticipate that additional evidence will soon emerge to clarify the Arc-dependent mechanisms involved in the psychiatric-related dysfunctional behavior.
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Affiliation(s)
- Francesca Managò
- Department of Neuroscience and Brain Technologies, Istituto Italiano di TecnologiaGenova, Italy
| | - Francesco Papaleo
- Department of Neuroscience and Brain Technologies, Istituto Italiano di TecnologiaGenova, Italy
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157
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Changes in Tryptophan Catabolite (TRYCAT) Pathway Patterning Are Associated with Mild Impairments in Declarative Memory in Schizophrenia and Deficits in Semantic and Episodic Memory Coupled with Increased False-Memory Creation in Deficit Schizophrenia. Mol Neurobiol 2017; 55:5184-5201. [PMID: 28875464 DOI: 10.1007/s12035-017-0751-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
Abstract
Evidence indicates that schizophrenia and in particular negative symptoms and deficit schizophrenia are accompanied by neurocognitive impairments and changes in the patterning of the tryptophan catabolite (TRYCAT) pathway. This cross-sectional study was carried out to examine the associations between cognitive functions (as measured with Consortium to Establish a Registry for Alzheimer's disease (CERAD)) and TRYCAT pathway patterning in patients with (n = 40) and without (n = 40) deficit schizophrenia and normal controls (n = 40). Cognitive measures were assessed with the Verbal Fluency Test (VFT), Boston Naming Test (BNT), Mini-Mental State Examination (MMSE), Word List Memory (WLM), Constructional Praxis, Word List Recall (WLRecall), and Word List Recognition (WLRecognition), while TRYCAT measurements assessed the IgA/IgM responses to noxious TRYCATs, namely quinolinic acid (QA), 3-OH-kynurenine (3HK), picolinic acid (PA), and xanthurenic (XA) acid, and more protective (PRO) TRYCATs, including kynurenic acid (KA) and anthranilic acid (AA). IgA NOX/PRO, IgM KA/3HK, and IgA/IgM NOX/PRO ratios were computed. Schizophrenia was accompanied by lower VFT and WLM, while BNT (dysnomia) and MMSE are significantly lower in multiple- than first-episode schizophrenia. Deficit schizophrenia is strongly associated with worse outcomes on VFT, MMSE, WLM, WLRecall, WLRecognition, and delayed recall savings and increased false memories. Around 40-50% of the variance in negative symptoms' scores was explained by VFT, WLM, WLRecall, and MMSE. Increases in IgA NOX/PRO, IgM KA/3HK, and/or IgA/IgM NOX/PRO ratios were associated with impairments in VFT, BNT, MMSE, WLM, WLRecall, WLRecognition, and false-memory creation. In conclusion, nondeficit schizophrenia is accompanied by mild memory impairments, while disease progression is accompanied by broader cognitive impairments. Deficit schizophrenia and negative symptoms are strongly associated with deficits in working memory, delayed recall and recognition, and increased false-memory creation. These cognitive impairments and memory deficits are in part explained by increased production and/or attenuated regulation of TRYCATs with neurotoxic, excitotoxic, immune-inflammatory, oxidative, and nitrosative potential, which may contribute to neuroprogression.
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158
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Lee RSC, Hermens DF, Scott J, O'Dea B, Glozier N, Scott EM, Hickie IB. A transdiagnostic study of education, employment, and training outcomes in young people with mental illness. Psychol Med 2017; 47:2061-2070. [PMID: 28393749 DOI: 10.1017/s0033291717000484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Optimizing functional recovery in young individuals with severe mental illness constitutes a major healthcare priority. The current study sought to quantify the cognitive and clinical factors underpinning academic and vocational engagement in a transdiagnostic and prospective youth mental health cohort. The primary outcome measure was 'not in education, employment or training' ('NEET') status. METHOD A clinical sample of psychiatric out-patients aged 15-25 years (n = 163) was assessed at two time points, on average, 24 months apart. Functional status, and clinical and neuropsychological data were collected. Bayesian structural equation modelling was used to confirm the factor structure of predictors and cross-lagged effects at follow-up. RESULTS Individually, NEET status, cognitive dysfunction and negative symptoms at baseline were predictive of NEET status at follow-up (p < 0.05). Baseline cognitive functioning was the only predictor of follow-up NEET status in the multivariate Bayesian model, while controlling for baseline NEET status. For every 1 s.d. deficit in cognition, the probability of being disengaged at follow-up increased by 40% (95% credible interval 19-58%). Baseline NEET status predicted poorer negative symptoms at follow-up (β = 0.24, 95% credible interval 0.04-0.43). CONCLUSIONS Disengagement with education, employment or training (i.e. being NEET) was reported in about one in four members of this cohort. The initial level of cognitive functioning was the strongest determinant of future NEET status, whereas being academically or vocationally engaged had an impact on future negative symptomatology. If replicated, these findings support the need to develop early interventions that target cognitive phenotypes transdiagnostically.
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Affiliation(s)
- R S C Lee
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - D F Hermens
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - J Scott
- Academic Psychiatry,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne,UK
| | - B O'Dea
- Faculty of Medicine,Black Dog Institute, UNSW,Sydney, NSW,Australia
| | - N Glozier
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - E M Scott
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - I B Hickie
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
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159
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Lincoln TM, Dollfus S, Lyne J. Current developments and challenges in the assessment of negative symptoms. Schizophr Res 2017; 186:8-18. [PMID: 26960948 DOI: 10.1016/j.schres.2016.02.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
Reliable and valid assessment of negative symptoms is crucial to further develop etiological models and improve treatments. Our understanding of the concept of negative symptoms has undergone significant advances since the introduction of quantitative assessments of negative symptoms in the 1980s. These include the conceptualization of cognitive dysfunction as separate from negative symptoms and the distinction of two main negative symptom factors (avolition and diminished expression). In this review we provide an overview of existing negative symptom scales, focusing on both observer-rated and self-rated measurement of negative symptoms. We also distinguish between measures that assess negative symptoms as part of a broader assessment of schizophrenia symptoms, those specifically developed for negative symptoms and those that assess specific domains of negative symptoms within and beyond the context of psychotic disorders. We critically discuss strengths and limitations of these measures in the light of some existing challenges, i.e. observed and subjective symptom experiences, the challenge of distinguishing between primary and secondary negative symptoms, and the overlap between negative symptoms and related factors (e.g. personality traits and premorbid functioning). This review is aimed to inform the ongoing development of negative symptom scales.
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Affiliation(s)
- Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Sonia Dollfus
- CHU de Caen, Service universitaire de Psychiatrie, Centre Esquirol, Avenue Côte de Nacre, Caen F-14000, France; UNICAEN, UFR Médecine, F-14074 Caen, France
| | - John Lyne
- Royal College of Surgeons in Ireland, North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team, Avila House, Blackrock Business Park, Blackrock, Co. Dublin, Ireland
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160
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Mucci A, Merlotti E, Üçok A, Aleman A, Galderisi S. Primary and persistent negative symptoms: Concepts, assessments and neurobiological bases. Schizophr Res 2017; 186:19-28. [PMID: 27242069 DOI: 10.1016/j.schres.2016.05.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 02/01/2023]
Abstract
Primary and persistent negative symptoms (PPNS) represent an unmet need in the care of people with schizophrenia. They have an unfavourable impact on real-life functioning and do not respond to available treatments. Underlying etiopathogenetic mechanisms of PPNS are still unknown. The presence of primary and enduring negative symptoms characterizes deficit schizophrenia (DS), proposed as a separate disease entity with respect to non-deficit schizophrenia (NDS). More recently, to reduce the heterogeneity of negative symptoms by using criteria easily applicable in the context of clinical trials, the concept of persistent negative symptoms (PNS) was developed. Both PNS and DS constructs include enduring negative symptoms (at least 6months for PNS and 12months for DS) that do not respond to available treatments. PNS exclude secondary negative symptoms based on a cross-sectional evaluation of severity thresholds on commonly used rating scales for positive symptoms, depression and extrapyramidal side effects; the DS diagnosis, instead, excludes all potential sources of secondary negative symptoms based on a clinical longitudinal assessment. In this paper we review the evolution of concepts and assessment modalities relevant to PPNS, data on prevalence of DS and PNS, as well as studies on clinical, neuropsychological, brain imaging electrophysiological and psychosocial functioning aspects of DS and PNS.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy.
| | | | - Alp Üçok
- Department of Psychiatry, Psychotic Disorders Research Program, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and Department of Psychology, Groningen, The Netherlands
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161
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Blanchard JJ, Bradshaw KR, Garcia CP, Nasrallah HA, Harvey PD, Casey D, Csoboth CT, Hudson JI, Julian L, Lentz E, Nuechterlein KH, Perkins DO, Skale TG, Snowden LR, Tandon R, Tek C, Velligan D, Vinogradov S, O'Gorman C. Examining the reliability and validity of the Clinical Assessment Interview for Negative Symptoms within the Management of Schizophrenia in Clinical Practice (MOSAIC) multisite national study. Schizophr Res 2017; 185:137-143. [PMID: 28087270 DOI: 10.1016/j.schres.2017.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Abstract
The current study sought to expand on prior reports of the validity and reliability of the CAINS (CAINS) by examining its performance across diverse non-academic clinical settings as employed by raters not affiliated with the scale's developers and across a longer test-retest follow-up period. The properties of the CAINS were examined within the Management of Schizophrenia in Clinical Practice (MOSAIC) schizophrenia registry. A total of 501 participants with a schizophrenia spectrum diagnosis who were receiving usual care were recruited across 15 national Patient Assessment Centers and evaluated with the CAINS, other negative symptom measures, and assessments of functioning, quality of life and cognition. Temporal stability of negative symptoms was assessed across a 3-month follow-up. Results replicated the two-factor structure of the CAINS reflecting Motivation and Pleasure and expression symptoms. The CAINS scales exhibited high internal consistency and temporal stability. Convergent validity was supported by significant correlations between the CAINS subscales with other negative symptom measures. Additionally, the CAINS was significantly correlated with functioning and quality of life. Discriminant validity was demonstrated by small to moderate associations between the CAINS and positive symptoms, depression, and cognition (and these associations were comparable to those found with other negative symptom scales). Findings suggest that the CAINS is a reliable and valid tool for measuring negative symptoms in schizophrenia across diverse clinical samples and settings.
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Affiliation(s)
| | | | | | - Henry A Nasrallah
- Saint Louis University, 1438 S. Grand Boulevard, Saint Louis, MO 63104 3, USA
| | - Philip D Harvey
- University of Miami, Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Daniel Casey
- Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | | | - James I Hudson
- Harvard Medical School/McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Laura Julian
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Ellen Lentz
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Keith H Nuechterlein
- University of California, Los Angeles, 300 UCLA Medical Plaza, Los Angeles, CA 90095-6968, USA
| | | | - Tracey G Skale
- Greater Cincinnati Behavioral Health Services, 1501 Madison Road, Walnut Hills, OH 45206, USA
| | | | - Rajiv Tandon
- University of Florida, Gainesville, FL 32611, USA
| | - Cenk Tek
- Yale University/Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, USA
| | - Dawn Velligan
- University of Texas Health Science Center, 7703 Floyd Curl Dr. San Antonio, San Antonio, TX 78240, USA
| | - Sophia Vinogradov
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA; San Francisco Veterans Administration Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Cedric O'Gorman
- Formerly of Genentech. Currently at Intra-Cellular Therapies, Inc., 430 East 29th Street, New York City, NY 10016, USA
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162
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Sabharwal A, Kotov R, Szekely A, Leung HC, Barch DM, Mohanty A. Neural markers of emotional face perception across psychotic disorders and general population. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:663-678. [PMID: 28557508 PMCID: PMC5695570 DOI: 10.1037/abn0000279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
There is considerable variation in negative and positive symptoms of psychosis, global functioning, and emotional face perception (EFP), not only in schizophrenia but also in other psychotic disorders and healthy individuals. However, EFP impairment and its association with worse symptoms and global functioning have been examined largely in the domain of schizophrenia. The present study adopted a dimensional approach to examine the association of behavioral and neural measures of EFP with symptoms of psychosis and global functioning across individuals with schizophrenia spectrum (SZ; N = 28) and other psychotic (OP; N = 29) disorders, and never-psychotic participants (NP; N = 21). Behavioral and functional MRI data were recorded as participants matched emotional expressions of faces and geometrical shapes. Lower accuracy and increased activity in early visual regions, hippocampus, and amygdala during emotion versus shape matching were associated with higher negative, but not positive, symptoms and lower global functioning, across all participants. This association remained even after controlling for group-related (SZ, OP, and NP) variance, dysphoria, and antipsychotic medication status, except in amygdala. Furthermore, negative symptoms mediated the relationship between behavioral and brain EFP measures and global functioning. This study provides some of the first evidence supporting the specific relationship of EFP measures with negative symptoms and global functioning across psychotic and never-psychotic samples, and transdiagnostically across different psychotic disorders. Present findings help bridge the gap between basic EFP-related neuroscience research and clinical research in psychosis, and highlight EFP as a potential symptom-specific marker that tracks global functioning. (PsycINFO Database Record
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Affiliation(s)
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University
| | - Akos Szekely
- Department of Psychology, Stony Brook University
| | | | - Deanna M. Barch
- Departments of Psychology, Psychiatry, and Radiology, Washington University in St. Louis
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163
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Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthøj B, Gattaz WF, Thibaut F, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia - a short version for primary care. Int J Psychiatry Clin Pract 2017; 21:82-90. [PMID: 28498090 DOI: 10.1080/13651501.2017.1291839] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Schizophrenia is a severe mental disorder and many patients are treated in primary care settings. Apart from the pharmacological management of disease-associated symptoms, the detection and treatment of side effects is of the utmost importance in clinical practice. The purpose of this publication is to offer relevant evidence-based recommendations for the biological treatment of schizophrenia in primary care. METHODS This publication is a short and practice-oriented summary of Parts I-III of the World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. The recommendations were developed by the authors and consented by a task force of international experts. Guideline recommendations are based on randomized-controlled trials and supplemented with non-randomized trials and meta-analyses where necessary. RESULTS Antipsychotics of different chemical classes are the first-line pharmacological treatments for schizophrenia. Specific circumstances (e.g., suicidality, depression, substance dependence) may need additional treatment options. The pharmacological and non-pharmacological management of side effects is of crucial importance for the long-term treatment in all settings of the healthcare system. CONCLUSIONS This summary of the three available evidence-based guidelines has the potential to support clinical decisions and can improve treatment of schizophrenia in primary care settings.
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Affiliation(s)
- Alkomiet Hasan
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Peter Falkai
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Thomas Wobrock
- b Centre of Mental Health, Darmstadt-Dieburg Clinics , Groß-Umstadt , Germany.,c Department of Psychiatry and Psychotherapy , Georg-August-University , Goettingen , Germany
| | - Jeffrey Lieberman
- d Department of Psychiatry , College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, Lieber Center for Schizophrenia Research , New York , NY , USA
| | - Birte Glenthøj
- e Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Psychiatric Center Glostrup , Copenhagen , Denmark
| | - Wagner F Gattaz
- f Department of Psychiatry , University of Sao Paulo , Sao Paulo , Brazil
| | - Florence Thibaut
- g University Hospital Cochin-Tarnier, Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Hans-Jürgen Möller
- a Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
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164
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Mazhari S, Ghafaree-Nejad AR, Soleymani-Zade S, Keefe RSE. Validation of the Persian version of the Schizophrenia Cognition Rating Scale (SCoRS) in patients with schizophrenia. Asian J Psychiatr 2017; 27:12-15. [PMID: 28558882 DOI: 10.1016/j.ajp.2017.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 02/06/2017] [Accepted: 02/12/2017] [Indexed: 11/30/2022]
Abstract
The Schizophrenia Cognition Rating Scale (SCoRS) is an interview-based assessment of cognition that involves interviews with patients and informants. The SCoRS has shown good reliability, validity, and sensitivity to cognitive impairment in schizophrenia, with the advantage of brief administration and scoring time. The present study aimed to test the concurrent validity of the Persian version of the SCoRS. A group of 35 patients with schizophrenia and a group of 35 healthy controls received the Persian-SCoRS in the first session, and a standardized performance-based cognitive battery, the Brief Assessment of Cognition in Schizophrenia (BACS), in the second session.Our results indicated that the Persian version of the SCoRS was sensitive to cognitive impairment in the patients. The Persian SCoRS global rating was significantly associated with the composite score generated from the Persian version of the BACS and predicted functional outcomes as measured by Global Assessment of Functioning (GAF) and World Health Organization Quality of Life (WHO QOL). A Persian version of the SCoRS, an interview based measure of cognition that included informants, is related to cognitive performance and global functioning.
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Affiliation(s)
- Shahrzad Mazhari
- Neuroscience Research Centre, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
| | - Ali R Ghafaree-Nejad
- Neuroscience Research Centre, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
| | - Somayeh Soleymani-Zade
- Neuroscience Research Centre, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
| | - Richard S E Keefe
- Department of Psychiatry, Duke University Medical Center, Box 3270, Durham, USA.
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165
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Minichino A, Francesconi M, Carrión RE, Delle Chiaie R, Bevilacqua A, Parisi M, Rullo S, Bersani FS, Biondi M, Cadenhead K. From neurological soft signs to functional outcome in young individuals in treatment with secondary services for non-psychotic disorders: a path analysis. Psychol Med 2017; 47:1192-1203. [PMID: 28052777 DOI: 10.1017/s0033291716003056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Functional decline among patients with mental illness is not unique to individuals with psychotic disorders. Despite this, research on early predictors of functional outcome mainly focused on individuals thought to have an 'at risk mental state' (ARMS) for psychosis. There is evidence suggesting that certain early vulnerability markers, such as neurological soft signs (NSS), may explain variability in functional outcomes independent of the level of psychosis risk and the traditional diagnostic classification. METHOD Structural equation modeling was applied to baseline data from a prospective longitudinal study of 138 young individuals in treatment with secondary services for non-psychotic disorders. We evaluated theoretically based models of pathways to functional outcome starting from NSS. The intervening variables were established according to previous evidence and drawn from two general categories: cognition (neuro- and social-) and negative symptoms (expressive and experiential). RESULTS A final trimmed model was a single path running from NSS to neurocognition to experiential negative symptoms to outcome. It could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from NSS to outcome was significant. The validity of the model was independent of the ARMS status and the psychiatric diagnosis. CONCLUSIONS Our results provide evidence for a single pathway model in which the starting and intervening variables represent modifiable trans-diagnostic therapeutic targets to improve functional trajectories in young individuals with a recent-onset psychiatric diagnosis and different levels of psychosis risk.
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Affiliation(s)
- A Minichino
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - M Francesconi
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - R E Carrión
- Division of Psychiatry,Zucker Hillside Hospital,Long Island,NY,USA
| | - R Delle Chiaie
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - A Bevilacqua
- Research Center in Neurobiology,Daniel Bovet (CRiN),Rome,Italy
| | | | - S Rullo
- Casa di Cura Villa Letizia,Rome,Italy
| | - F S Bersani
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - M Biondi
- Department of Neurology and Psychiatry,Sapienza University of Rome,Rome,Italy
| | - K Cadenhead
- Department of Psychiatry,UCSD,La Jolla,CA,USA
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166
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Schneider M, Van der Linden M, Menghetti S, Debbané M, Eliez S. Negative and paranoid symptoms are associated with negative performance beliefs and social cognition in 22q11.2 deletion syndrome. Early Interv Psychiatry 2017; 11:156-164. [PMID: 25726949 DOI: 10.1111/eip.12224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 10/28/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
Abstract
AIMS 22q11.2 deletion syndrome (22q11.2DS) is a neurogenetic condition associated with an increased risk of developing schizophrenia. Previous studies have shown that negative symptoms represent the most specific clinical characteristic of psychosis in 22q11.2DS and are strongly associated with outcome. However, the psychological mechanisms associated with these symptoms in this population are poorly understood. In accordance with recent conceptualizations in the field of schizophrenia, the present study aims at investigating whether negative symptoms are associated with the presence of negative performance beliefs and cognitive deficits. METHODS Thirty-five participants with 22q11.2DS and 24 typically developing individuals aged between 11 and 24 years were included in the study. Self-reported schizotypal symptoms (cognitive-perceptual, paranoid, negative and disorganization symptoms) and dysfunctional beliefs (negative performance beliefs and need for approval) were assessed. Measures of processing speed, verbal memory, working memory, executive functioning and face recognition were also extracted from a broad cognitive evaluation protocol. RESULTS Adolescents with 22q11.2DS reported significantly higher score on the negative dimension of the Schizotypal Personality Questionnaire than controls, even when controlling for the influence of anxiety/depression and intellectual functioning. Negative and paranoid symptoms were associated with the severity of negative performance beliefs and lower face recognition abilities. Mediation analyses revealed that negative performance beliefs significantly mediated the association between face recognition and negative/paranoid symptoms. CONCLUSIONS These findings suggest that negative performance beliefs and basic social cognitive mechanisms are associated with negative and paranoid symptoms in individuals with 22q11.2DS. Implications for intervention are discussed in this article.
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Affiliation(s)
- Maude Schneider
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.,Cognitive Psychopathology and Neuropsychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Martial Van der Linden
- Cognitive Psychopathology and Neuropsychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Sarah Menghetti
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Martin Debbané
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.,Adolescence Clinical Psychology Research Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Stephan Eliez
- Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.,Department of Genetic Medicine and Development, University of Geneva School of Medicine, Geneva, Switzerland
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167
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Mitra S, Nizamie SH, Goyal N, Tikka SK. Electroencephalogram alpha-to-theta ratio over left fronto-temporal region correlates with negative symptoms in schizophrenia. Asian J Psychiatr 2017; 26:70-76. [PMID: 28483096 DOI: 10.1016/j.ajp.2017.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/27/2016] [Accepted: 01/16/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Negative symptoms impair outcomes on occupational functioning, social interaction and interpersonal relationships in patients with schizophrenia. Past researchers have reported reduced alpha and increased theta and delta spectral powers on quantitative EEG recordings in those with prominent negative symptoms. AIM Present analysis aimed at exploring the relationships between lower-frequency EEG powers and negative symptoms, in schizophrenia, over a period of naturalistic antipsychotic treatment. METHOD Fifteen right-handed drug-free/drug-naïve schizophrenia patients (N=15;M=12,F=3) were recruited and assessed on PANSS. Spontaneous 192-channel resting-state EEG was recorded at baseline, and PANSS rating was repeated at 4 weeks. Baseline EEGs of patients were compared to 15 age-sex-handedness matched controls. RESULTS Non-significant differences emerged between patient and controls in terms of socio-demographic characteristics. Over left frontal and left temporal regions, baseline ratio of alpha/theta power (bATR) was significantly lower (p<0.001) in patients, correlated negatively with baseline PANSS negative score (PNS) (p<0.05); and over 4-weeks of antipsychotic treatment, left temporal bATR correlated positively with relative improvements in PNS. CONCLUSION Reduced alpha power over frontal regions might imply altered arousal and/or impaired attentional process, while abnormal theta range oscillations may relate to impairments in working memory via their influences on theta-gamma coupling. Our findings suggest left-predominant deficiencies in these processes might mediate negative symptoms. Further, since ATR might reflect integrity of certain cognitive processes, those with a higher bATR might possess better cognitive resource at baseline and therefore experience greater improvement in negative symptoms with antipsychotic treatments, at least during the first 4 weeks.
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Affiliation(s)
- Sayantanava Mitra
- Department of Psychiatry and Non Invasive Brain Stimulation Laboratory, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | | | - Nishant Goyal
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, India
| | - Sai Krishna Tikka
- Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, India
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168
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High Incidence and Prevalence of Drug-Related Movement Disorders in Young Patients With Psychotic Disorders. J Clin Psychopharmacol 2017; 37:231-238. [PMID: 28141621 DOI: 10.1097/jcp.0000000000000666] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Drug-related movement disorders (DRMDs) reduce quality of life and contribute to medication noncompliance of patients with psychotic disorders. Little is known about the epidemiology of DRMDs in relatively young patients a few years after onset of psychosis. This is an important period to study, as the impact of the antipsychotic treatment on the long-term potentiation of the neural pathways associated with psychotic disorders and DRMDs is still minimal. This study investigated the prevalence, incidence, persistence, and clinical correlates of DRMDs in patients during their first years after disease onset. METHODS The Genetic Risk and Outcome of Psychosis study is a longitudinal study of 1120 relatively young patients with nonaffective psychosis and a mean age and illness duration of 27 and 4 years, respectively. The following drug-related movement disorders were assessed at baseline and at the 3-year follow-up: parkinsonism, akathisia, tardive dyskinesia, and tardive dystonia. We determined prevalence, incidence, and persistence and investigated clinical correlates at and over the baseline and follow-up assessment. RESULTS Patients' mean age and illness duration at baseline were 27.1 and 4.3 years, respectively. In 4 patients, 1 developed a DRMD over the 3-year study period. Prevalence, incidence, and persistence rates were highest for parkinsonism (32%, 21%, and 53%) followed by akathisia (9%, 5%, and 17%) and tardive dyskinesia (4%, 3%, and 20%). Significant associations were found between DRMDs and the patients' age, IQ, and psychopathology. CONCLUSIONS The prevalence, persistence, and incidence of DRMDs in this sample were high despite the relatively young age, recent onset of the disorder, and treatment primarily with second-generation antipsychotics. These findings emphasize that screening, diagnosis, and treatment of DRMDs are still important.
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169
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EPICOG-SCH: A brief battery to screen cognitive impact of schizophrenia in stable outpatients. SCHIZOPHRENIA RESEARCH-COGNITION 2017; 8:7-20. [PMID: 28740826 PMCID: PMC5514304 DOI: 10.1016/j.scog.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/01/2017] [Accepted: 03/04/2017] [Indexed: 11/21/2022]
Abstract
Brief batteries in schizophrenia, are needed to screen for the cognitive impact of schizophrenia. We aimed to validate and co-norm the Epidemiological Study of Cognitive Impairment in Schizophrenia (EPICOG-SCH) derived brief cognitive battery. A cross-sectional outpatient evaluation was conducted of six-hundred-seventy-two patients recruited from 234 centers. The brief battery included well-known subtests available worldwide that cover cognitive domains related to functional outcomes: WAIS-III-Letter-Number-Sequencing-LNS, Category Fluency Test-CFT, Logical-Memory Immediate Recall-LM, and Digit-Symbol-Coding-DSC. CGI-SCH Severity and WHO-DAS-S were used to assess clinical severity and functional impairment, respectively. Unit Composite Score (UCS) and functional regression-weighted Composite Scores (FWCS) were obtained; discriminant properties of FWCS to identify patients with different levels of functional disability were analyzed using receiver-operating characteristic (ROC) technique. The battery showed good internal consistency, Cronbach's alpha = 0.78. The differences between cognitive performance across CGI-SCH severity level subscales ranged from 0.5 to 1 SD. Discriminant capacity of the battery in identifying patients with up to moderate disability levels showed fair discriminant accuracy with areas under the curve (AUC) > 0.70, p < 0.0001. An FWCS mean cut-off score ≥ 100 showed likelihood ratios (LR) up to 4.7, with an LR + of 2.3 and a LR - of 0.5. An FWCS cut-off ≥ 96 provided the best balance between sensitivity (0.74) and specificity (0.62). The EPICOG-SCH proved to be a useful brief tool to screen for the cognitive impact of schizophrenia, and its regression-weighted Composite Score was an efficient complement to clinical interviews for confirming patients' potential functional outcomes and can be useful for monitoring cognition during routine outpatient follow-up visits.
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170
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Chang WC, Kwong VWY, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach. Psychol Med 2017; 47:755-765. [PMID: 27869058 DOI: 10.1017/s0033291716003044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Better understanding of the complex interplay among key determinants of functional outcome is crucial to promoting recovery in psychotic disorders. However, this is understudied in the early course of illness. We aimed to examine the relationships among negative symptoms, neurocognition, general self-efficacy and global functioning in first-episode psychosis (FEP) patients using structural equation modeling (SEM). METHOD Three hundred and twenty-one Chinese patients aged 26-55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing symptom profiles, functioning, perceived general self-efficacy and a battery of neurocognitive tests were conducted. Negative symptom measurement was subdivided into amotivation and diminished expression (DE) domain scores based on the ratings in the Scale for the Assessment of Negative Symptoms. RESULTS An initial SEM model showed no significant association between functioning and DE which was removed from further analysis. A final trimmed model yielded very good model fit (χ2 = 15.48, p = 0.63; comparative fit index = 1.00; root mean square error of approximation <0.001) and demonstrated that amotivation, neurocognition and general self-efficacy had a direct effect on global functioning. Amotivation was also found to mediate a significant indirect effect of neurocognition and general self-efficacy on functioning. Neurocognition was not significantly related to general self-efficacy. CONCLUSION Our results indicate a critical intermediary role of amotivation in linking neurocognitive impairment to functioning in FEP. General self-efficacy may represent a promising treatment target for improvement of motivational deficits and functional outcome in the early illness stage.
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Affiliation(s)
- W C Chang
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - V W Y Kwong
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - C L M Hui
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - S K W Chan
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - E H M Lee
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - E Y H Chen
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
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171
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Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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172
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Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. WORLD PSYCHIATRY : OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA) 2017. [PMID: 28127915 DOI: 10.1002/wps.20385.] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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173
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Acupuncture in the Treatment of a Female Patient Suffering from Chronic Schizophrenia and Sleep Disorders. Case Rep Psychiatry 2017; 2016:6745618. [PMID: 28101392 PMCID: PMC5213811 DOI: 10.1155/2016/6745618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background. The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation. We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The patient was treated with manual acupuncture weekly for 12 weeks, and a psychological assessment was performed before, immediately after, and three months after the acupuncture treatment period. In addition, actiwatch data were collected for 14 days both before and after the acupuncture treatment period. Conclusion. Acupuncture treatment led to a decrease in general psychopathology, less severe sleep problems, and markedly improved cognitive functioning (working memory) in the patient; however, the positive and the negative symptoms remained stable. The actiwatch data revealed a beneficial effect of acupuncture, showing better sleep latency, a trend towards better sleep efficiency, and a decrease in the number of minutes that the patient was awake during the night after acupuncture treatment. In sum, this study showed that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized (placebo), controlled, clinical trials are needed in order to replicate the present preliminary findings.
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174
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Barnes TRE, Leeson VC, Paton C, Costelloe C, Simon J, Kiss N, Osborn D, Killaspy H, Craig TKJ, Lewis S, Keown P, Ismail S, Crawford M, Baldwin D, Lewis G, Geddes J, Kumar M, Pathak R, Taylor S. Antidepressant Controlled Trial For Negative Symptoms In Schizophrenia (ACTIONS): a double-blind, placebo-controlled, randomised clinical trial. Health Technol Assess 2017; 20:1-46. [PMID: 27094189 DOI: 10.3310/hta20290] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Negative symptoms of schizophrenia represent deficiencies in emotional responsiveness, motivation, socialisation, speech and movement. When persistent, they are held to account for much of the poor functional outcomes associated with schizophrenia. There are currently no approved pharmacological treatments. While the available evidence suggests that a combination of antipsychotic and antidepressant medication may be effective in treating negative symptoms, it is too limited to allow any firm conclusions. OBJECTIVE To establish the clinical effectiveness and cost-effectiveness of augmentation of antipsychotic medication with the antidepressant citalopram for the management of negative symptoms in schizophrenia. DESIGN A multicentre, double-blind, individually randomised, placebo-controlled trial with 12-month follow-up. SETTING Adult psychiatric services, treating people with schizophrenia. PARTICIPANTS Inpatients or outpatients with schizophrenia, on continuing, stable antipsychotic medication, with persistent negative symptoms at a criterion level of severity. INTERVENTIONS Eligible participants were randomised 1 : 1 to treatment with either placebo (one capsule) or 20 mg of citalopram per day for 48 weeks, with the clinical option at 4 weeks to increase the daily dosage to 40 mg of citalopram or two placebo capsules for the remainder of the study. MAIN OUTCOME MEASURES The primary outcomes were quality of life measured at 12 and 48 weeks assessed using the Heinrich's Quality of Life Scale, and negative symptoms at 12 weeks measured on the negative symptom subscale of the Positive and Negative Syndrome Scale. RESULTS No therapeutic benefit in terms of improvement in quality of life or negative symptoms was detected for citalopram over 12 weeks or at 48 weeks, but secondary analysis suggested modest improvement in the negative symptom domain, avolition/amotivation, at 12 weeks (mean difference -1.3, 95% confidence interval -2.5 to -0.09). There were no statistically significant differences between the two treatment arms over 48-week follow-up in either the health economics outcomes or costs, and no differences in the frequency or severity of adverse effects, including corrected QT interval prolongation. LIMITATIONS The trial under-recruited, partly because cardiac safety concerns about citalopram were raised, with the 62 participants recruited falling well short of the target recruitment of 358. Although this was the largest sample randomised to citalopram in a randomised controlled trial of antidepressant augmentation for negative symptoms of schizophrenia and had the longest follow-up, the power of statistical analysis to detect significant differences between the active and placebo groups was limited. CONCLUSION Although adjunctive citalopram did not improve negative symptoms overall, there was evidence of some positive effect on avolition/amotivation, recognised as a critical barrier to psychosocial rehabilitation and achieving better social and community functional outcomes. Comprehensive assessment of side-effect burden did not identify any serious safety or tolerability issues. The addition of citalopram as a long-term prescribing strategy for the treatment of negative symptoms may merit further investigation in larger studies. FUTURE WORK Further studies of the viability of adjunctive antidepressant treatment for negative symptoms in schizophrenia should include appropriate safety monitoring and use rating scales that allow for evaluation of avolition/amotivation as a discrete negative symptom domain. Overcoming the barriers to recruiting an adequate sample size will remain a challenge. TRIAL REGISTRATION European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2009-009235-30 and Current Controlled Trials ISRCTN42305247. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 29. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Thomas R E Barnes
- Centre for Mental Health, Imperial College London, London, UK.,West London Mental Health NHS Trust, London, UK
| | - Verity C Leeson
- Centre for Mental Health, Imperial College London, London, UK
| | - Carol Paton
- Centre for Mental Health, Imperial College London, London, UK.,Oxleas NHS Foundation Trust, Dartford, UK
| | - Céire Costelloe
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Noemi Kiss
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - David Osborn
- Division of Psychiatry, University College London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Helen Killaspy
- Division of Psychiatry, University College London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Tom K J Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shôn Lewis
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Patrick Keown
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Shajahan Ismail
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Mike Crawford
- Centre for Mental Health, Imperial College London, London, UK
| | - David Baldwin
- Mental Health Group, University of Southampton Faculty of Medicine, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Manoj Kumar
- South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Stafford, UK
| | - Rudresh Pathak
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Simon Taylor
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
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175
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Vila-Rodriguez F, Lang DJ, Baitz H, Gicas K, Thorton AE, Ehmann TS, Smith GN, Barr AM, Torres IJ, Kopala LC, MacEwan GW, Müller DJ, Kennedy JL, Honer WG. Verbal memory improvement in first-episode psychosis APOE-ε4 carriers: a pleiotropic effect? Neuropsychiatr Dis Treat 2017; 13:2945–2953. [PMID: 29263671 PMCID: PMC5727104 DOI: 10.2147/ndt.s150488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Verbal memory impairment is a core feature in schizophrenia even at early stages of the disease, but its etiopathogenesis is not fully understood. The APOE-ε4 is the main genetic risk factor for late-onset Alzheimer's disease. Our primary goal was to ascertain whether APOE-ε4 status had a pleiotropic effect in early stages of the illness. PARTICIPANTS AND METHODS A total of 86 first-episode psychosis (FEP) outpatients and 39 healthy volunteers were recruited. Demographic and clinical data, APOE genotyping, and a neuropsychological test battery including the California Verbal Learning Test - second edition (CVLT-II) were administered and assessed at study entry and at 1-year follow-up. Data were analyzed using mixed-model repeated measures, where the dependent variable was verbal memory indexed by California Verbal Learning Test (CVLT) Trials 1-5 total recall score. RESULTS FEP-APOE-ε4 carriers and FEP-APOE-ε4 noncarriers had similar symptom severity, clinical outcomes, premorbid and current intelligence quotient, and exposure to antipsychotics. There was a main effect of group on CVLT 1-5 (FEP =43.30 vs control =58.25; F[1, 119.7]=42.97; P<0.001) as well as an APOE-ε4 by group by time (F[4, 116.2]=2.73, P=0.033) interaction with only FEP-APOE-ε4 carriers showing improved verbal memory at follow-up. CONCLUSION Our study is the first to report improvement in verbal memory in persons afflicted by FEP who are APOE-ε4 carriers and replicates the prominent verbal memory deficits present in FEP. Our work provides further evidence pointing to an antagonistic pleiotropic effect of APOE-ε4 in neuropsychiatric disorders. Our results merit further research into antagonistic pleiotropic effects in schizophrenia.
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Affiliation(s)
| | - Donna J Lang
- Division of Neuroradiology, Department of Radiology, The University of British Columbia, Vancouver
| | - Heather Baitz
- Department of Psychology, Simon Fraser University, Burnaby
| | - Kristina Gicas
- Department of Psychology, Simon Fraser University, Burnaby
| | | | | | | | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC
| | | | | | | | - Daniel J Müller
- Department of Psychiatry, Centre for Mental Health and Addictions, University of Toronto, Toronto, ON, Canada
| | - James L Kennedy
- Department of Psychiatry, Centre for Mental Health and Addictions, University of Toronto, Toronto, ON, Canada
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176
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Sánchez-Torres AM, Elosúa MR, Lorente-Omeñaca R, Moreno-Izco L, Peralta V, Cuesta MJ. Lifetime psychopathological dimensions, cognitive impairment and functional outcome in psychosis. Schizophr Res 2017; 179:30-35. [PMID: 27733302 DOI: 10.1016/j.schres.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 09/23/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
Abstract
Psychopathological symptoms and cognitive impairment are related to psychosocial functioning. However, the nature of the association of cognitive impairment with psychosocial functioning still remains under scrutiny. We aimed to examine the relationships of premorbid adjustment, lifetime psychopathological dimensions, and cognitive performance with the typical level of psychosocial functioning during the previous year. We assessed ninety patients with schizophrenia spectrum disorders and affective disorders with psychotic symptoms to collect data on premorbid adjustment, lifetime psychopathological dimensions, cognitive performance and psychosocial functioning. Sixty-five healthy volunteers were included as controls. Pearson's correlations and hierarchical regression analyses were performed to ascertain to what extent the aforementioned variables predicted psychosocial functioning. Functional domains were significantly correlated with most of the premorbid features, lifetime psychopathological dimensions and cognitive domains. However, lifetime negative symptoms were the best predictors of psychosocial functioning in the hierarchical regression analyses (explaining between 47 and 64% of the variance). For psychosocial outcome in patients with psychoses, lifetime negative symptoms showed a stronger predictive validity than cognitive impairment or premorbid adjustment.
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Affiliation(s)
- Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Basic Psychology I, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - M Rosa Elosúa
- Department of Basic Psychology I, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Basic Psychology I, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Victor Peralta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
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177
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Akiyama K, Saito S, Saito A, Ozeki Y, Watanabe T, Fujii K, Honda G, Shimoda K. Predictive value of premorbid IQ, negative symptoms, and age for cognitive and social functions in Japanese patients with schizophrenia: A study using the Japanese version of the Brief Assessment of Cognition in Schizophrenia. Psychiatry Res 2016; 246:663-671. [PMID: 27838018 DOI: 10.1016/j.psychres.2016.10.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/30/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
Enduring cognitive impairment in patients with schizophrenia represents a global health burden. The Japanese-language version of the Brief Assessment of Cognition in Schizophrenia (BACS) and the Japanese Adult Reading Test were administered to 288 patients with chronic schizophrenia and 308 unrelated healthy control subjects. The Japanese version of self-reported Social Functioning Scale (SFS) was administered to a subpopulation of 157 patients with schizophrenia. In patients with schizophrenia, premorbid IQ and age were significantly related to most of the BACS subdomains, composite score, and intra-individual variability of BACS subdomains, whereas negative symptoms were significantly related to all BACS indices. Dosages of the first-generation antipsychotics had a significant negative impact on Tower of London task and intra-individual variability of BACS subdomains. The relationship of symbol coding with age was significantly lower in patients than in healthy control subjects. Multiple regression analysis revealed that negative symptoms were significantly negatively related to the total SFS scale, whereas better performance of token motor task was associated with higher total SFS. The present study revealed the role of premorbid IQ, age, and negative symptoms in predicting cognitive performance, and the significant correlation of negative symptoms and token motor task with social function in patients with schizophrenia.
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Affiliation(s)
- Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan.
| | - Satoshi Saito
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan
| | - Atsushi Saito
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street/Meyer 3-146, Baltimore, MD 21287, USA
| | - Yuji Ozeki
- Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan
| | - Takashi Watanabe
- Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan
| | - Kumiko Fujii
- Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan
| | - Gyo Honda
- Seiseido Kohseikai, Mori Hospital, 419 Iidamachi, Utsunomiya, Tochigi 3210347, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 3210293, Japan
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178
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Anda L, Brønnick KS, Johnsen E, Kroken RA, Jørgensen H, Løberg EM. The Course of Neurocognitive Changes in Acute Psychosis: Relation to Symptomatic Improvement. PLoS One 2016; 11:e0167390. [PMID: 27977720 PMCID: PMC5157988 DOI: 10.1371/journal.pone.0167390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cognitive impairment is a core aspect of psychosis, but the course of cognitive functioning during acute psychosis remains poorly understood, as does the association between symptom change and neurocognitive change. Some studies have found cognitive improvement to be related to improvement in negative symptoms, but few have examined cognitive changes in the early acute phase, when clinical improvement mainly happens. This study's aim was to investigate the relation between cognitive and symptomatic change in clinically heterogeneous patients during the early acute phase of psychosis. METHOD Participants (n = 84), including both first-episode and previously ill patients, were recruited from consecutive admissions to the acute psychiatric emergency ward of Haukeland University Hospital, Bergen, Norway, as part of the Bergen Psychosis Project (BPP). The RBANS neurocognitive test battery was administered on admission and again at discharge from the acute ward (mean time 4.1 weeks, SD 1.86 weeks). Symptomatic change was measured by PANSS. RESULTS The proportion of subjects with cognitive impairment (t < 35) was 28.6% in the acute phase and 13.1% at follow-up. A sequential multiple linear regression model with RBANS change as the dependent variable found PANSS negative symptoms change to significantly predict total RBANS performance improvement (beta = -.307, p = .016). There was no significant difference between subjects with schizophrenia and those with other psychotic disorders in terms of cognitive change. CONCLUSION The proportion of subjects with mild to moderate impairment in cognitive test performance is reduced across the acute phase of psychosis, with improvement related to amelioration of negative symptoms.
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Affiliation(s)
- Liss Anda
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Kolbjørn S. Brønnick
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Institute of Health, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo Jørgensen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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179
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Identifying a system of predominant negative symptoms: Network analysis of three randomized clinical trials. Schizophr Res 2016; 178:17-22. [PMID: 27617414 DOI: 10.1016/j.schres.2016.09.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reasons for the recent mixed success of research into negative symptoms may be informed by conceptualizing negative symptoms as a system that is identifiable from network analysis. We aimed to identify: (I) negative symptom systems; (I) central negative symptoms within each system; and (III) differences between the systems, based on network analysis of negative symptoms for baseline, endpoint and change. METHODS Patients with chronic schizophrenia and predominant negative symptoms participated in three clinical trials that compared placebo and amisulpride to 60days (n=487). Networks analyses were computed from the Scale for the Assessment of Negative Symptoms (SANS) scores for baseline and endpoint for severity, and estimated change based on mixed models. Central symptoms to each network were identified. The networks were contrasted for connectivity with permutation tests. RESULTS Network analysis showed that the baseline and endpoint symptom severity systems formed symptom groups of Affect, Poor responsiveness, Lack of interest, and Apathy-inattentiveness. The baseline and endpoint networks did not significantly differ in terms of connectivity, but both significantly (P<0.05) differed to the change network. In the change network the apathy-inattentiveness symptom group split into three other groups. The most central symptoms were Decreased Spontaneous Movements at baseline and endpoint, and Poverty of Speech for estimated change. CONCLUSIONS Results provide preliminary evidence for: (I) a replicable negative symptom severity system; and (II) symptoms with high centrality (e.g., Decreased Spontaneous Movement), that may be future treatment targets following replication to ensure the curent results generalize to other samples.
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180
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Strauss GP, Gold JM. A Psychometric Comparison of the Clinical Assessment Interview for Negative Symptoms and the Brief Negative Symptom Scale. Schizophr Bull 2016; 42:1384-1394. [PMID: 27174556 PMCID: PMC5049528 DOI: 10.1093/schbul/sbw046] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 2005, the National Institute of Mental Health held a consensus development conference on negative symptoms of schizophrenia. Among the important conclusions of this meeting were that there are at least 5 commonly accepted domains of negative symptoms (blunted affect, alogia, avolition, anhedonia, asociality) and that new rating scales were needed to adequately assess these constructs. Two next-generation negative symptom scales resulted from this meeting: the Brief Negative Symptom Scale (BNSS) and Clinical Assessment Interview for Negative Symptoms (CAINS). Both measures are becoming widely used and studies have demonstrated good psychometric properties for each scale. The current study provides the first direct psychometric comparison of these scales. Participants included 65 outpatients diagnosed with schizophrenia or schizoaffective disorder who completed clinical interviews, questionnaires, and neuropsychological testing. Separate raters completed the BNSS and CAINS within the same week. Results indicated that both measures had good internal consistency, convergent validity, and discriminant validity. High correspondence was observed between CAINS and BNSS blunted affect and alogia items. Moderate convergence occurred for avolition and asociality items, and low convergence was seen among anhedonia items. Findings suggest that both scales have good psychometric properties, but that there are important distinctions among the items related to motivation and pleasure.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY;
| | - James M Gold
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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181
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Fakra E, Belzeaux R, Azorin JM, Adida M. [Negative symptoms, emotion and cognition in schizophrenia]. Encephale 2016; 41:6S18-21. [PMID: 26776386 DOI: 10.1016/s0013-7006(16)30005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
For a long time, treatment of schizophrenia has been essentially focussed on positive symptoms managing. Yet, even if these symptoms are the most noticeable, negative symptoms are more enduring, resistant to pharmacological treatment and associated with a worse prognosis. In the two last decades, attention has shift towards cognitive deficit, as this deficit is most robustly associated to functional outcome. But it appears that the modest improvement in cognition, obtained in schizophrenia through pharmacological treatment or, more purposely, by cognitive enhancement therapy, has only lead to limited amelioration of functional outcome. Authors have claimed that pure cognitive processes, such as those evaluated and trained in lots of these programs, may be too distant from real-life conditions, as the latter are largely based on social interactions. Consequently, the field of social cognition, at the interface of cognition and emotion, has emerged. In a first part of this article we examined the links, in schizophrenia, between negative symptoms, cognition and emotions from a therapeutic standpoint. Nonetheless, investigation of emotion in schizophrenia may also hold relevant premises for understanding the physiopathology of this disorder. In a second part, we propose to illustrate this research by relying on the heuristic value of an elementary marker of social cognition, facial affect recognition. Facial affect recognition has been repeatedly reported to be impaired in schizophrenia and some authors have argued that this deficit could constitute an endophenotype of the illness. We here examined how facial affect processing has been used to explore broader emotion dysfunction in schizophrenia, through behavioural and imaging studies. In particular, fMRI paradigms using facial affect have shown particular patterns of amygdala engagement in schizophrenia, suggesting an intact potential to elicit the limbic system which may however not be advantageous. Finally, we analysed facial affect processing on a cognitive-perceptual level, and the aptitude in schizophrenia to manipulate featural and configural information in faces.
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Affiliation(s)
- E Fakra
- Service de Psychiatrie adultes, CHU Saint-Étienne, 5 Chemin de la Marandière, 42055 Saint-Étienne cedex 2, France.
| | - R Belzeaux
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - J-M Azorin
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
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182
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Fervaha G, Takeuchi H, Foussias G, Agid O, Remington G. Using poverty of speech as a case study to explore the overlap between negative symptoms and cognitive dysfunction. Schizophr Res 2016; 176:411-416. [PMID: 27242067 DOI: 10.1016/j.schres.2016.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/17/2016] [Accepted: 05/21/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Negative symptoms and cognitive impairment are both regarded as important prognostic markers in schizophrenia. Although these two domains are viewed as distinct and separable, conceptual overlap exists. We sought to illustrate this overlap using speech deficits among patients with schizophrenia. METHOD Reductions in verbal output were rated by a clinician following an interview, and these ratings were taken to represent negative symptoms (i.e., alogia). Patients were also asked to recount words from specific categories in a standardized manner, and the number of words was recorded as per standard protocol for verbal fluency tests. These scores were taken to represent cognitive impairment. The cross-sectional and longitudinal relationships between these two variables were then examined. RESULTS Patients with more severe alogia produced significantly less words on the verbal fluency tests. This relationship was stronger than that observed with other negative symptoms, and also held after controlling for a number of sociodemographic and clinical variables (e.g., severity of illness). Prospective increases in the number of words produced during the verbal fluency test were associated with improvements in clinical alogia ratings, a longitudinal relationship that was not observed with other negative symptoms. CONCLUSIONS Some negative symptoms are conceptually related and therefore not fully distinct from cognitive impairments. Here, we demonstrate that clinical ratings of alogia and words produced during a cognitive test are tapping into a similar construct. Whether a specific deficit is classified as a negative versus cognitive symptom may be matter of semantics rather than reflective of divisible underlying processes.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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183
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Impaired error processing in late-phase psychosis: Four-year stability and relationships with negative symptoms. Schizophr Res 2016; 176:520-526. [PMID: 27234344 PMCID: PMC5026891 DOI: 10.1016/j.schres.2016.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 01/28/2023]
Abstract
Error processing is impaired in psychosis, and numerous event-related potential studies have found reductions in the error-related negativity (ERN) and, more recently, the error positivity (Pe). The stability of reduced ERN/Pe in psychosis, however, is unknown. In a previous cross-sectional report, reduced ERN was associated with negative symptom severity and reduced Pe with a diagnosis of schizophrenia versus other psychosis. Here, we test the stability of impaired error processing over a four-year follow-up and relationships with subdimensions of negative symptoms. The ERN and Pe were recorded from individuals with psychotic disorders twice: 79 individuals were assessed 15years after first hospitalization, and 69 were assessed at 19years; 59 (26 with schizophrenia, 33 with other psychotic disorders) had data at both assessments. At 19years the Pe was blunted in schizophrenia. The ERN and Pe exhibited temporal stability over the four years (r=0.59 and 0.60, respectively). Reduced ERN and Pe correlated with the negative symptom subdimensions of inexpressivity and avolition, respectively, and not with psychotic or disorganized symptoms. Moreover, 15-year ERN predicted an increase in inexpressivity by year 19. No evidence was found for the reverse: negative symptoms did not predict change in ERN/Pe. Similar to non-clinical samples, the ERN and Pe show impressive four-year stability in late-phase psychosis. The ERN and Pe are promising neural measures for capturing individual differences in psychotic disorders, particularly with regard to negative symptomatology. They may prove to be useful clinically for forecasting illness course and as treatment targets.
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184
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Hasan A, Wobrock T, Palm U, Strube W, Padberg F, Falkai P, Fallgatter A, Plewnia C. [Non-invasive brain stimulation for treatment of schizophrenic psychoses]. DER NERVENARZT 2016; 86:1481-91. [PMID: 26341690 DOI: 10.1007/s00115-015-4323-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite many different available pharmacological and psychosocial treatment options, an optimal control of symptoms is only partly possible for most schizophrenia patients. Especially, persistent auditory hallucinations, negative symptoms and cognitive impairment are difficult to treat symptoms. Several non-invasive brain stimulation techniques are increasingly being considered as new therapeutic add on options for the management of schizophrenia, targeting these symptom domains. The technique which has been available for the longest time and that is best established in clinical care is electroconvulsive therapy (ECT). New stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) allow a more pathophysiological-based approach. This review article introduces various non-invasive brain stimulation techniques and discusses recent treatment studies on schizophrenia. In total, the novel brain stimulation techniques discussed here can be considered relevant add on therapeutic approaches for schizophrenia. In this context, the best evidence is available for the application of rTMS for the treatment of negative symptoms and persistent auditory hallucinations; however, negative studies have also been published for both indications. Studies using other non-invasive brain stimulation techniques showed promising results but further research is needed to establish the clinical efficacy. Based on a growing pathophysiological knowledge, non-invasive brain stimulation techniques provide new treatment perspectives for patients with schizophrenia.
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Affiliation(s)
- A Hasan
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland.
| | - T Wobrock
- Zentrum für seelische Gesundheit, Kreiskliniken Darmstadt-Dieburg, Darmstadt-Dieburg, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - U Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - W Strube
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - F Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - A Fallgatter
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - C Plewnia
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Tübingen, Tübingen, Deutschland
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185
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Palm U, Keeser D, Hasan A, Kupka MJ, Blautzik J, Sarubin N, Kaymakanova F, Unger I, Falkai P, Meindl T, Ertl-Wagner B, Padberg F. Prefrontal Transcranial Direct Current Stimulation for Treatment of Schizophrenia With Predominant Negative Symptoms: A Double-Blind, Sham-Controlled Proof-of-Concept Study. Schizophr Bull 2016; 42:1253-61. [PMID: 27098066 PMCID: PMC4988747 DOI: 10.1093/schbul/sbw041] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Negative symptoms are highly relevant in the long-term course of schizophrenia and are an important target domain for the development of novel interventions. Recently, transcranial direct current stimulation (tDCS) of the prefrontal cortex has been investigated as a treatment option in schizophrenia. In this proof-of-concept study, 20 schizophrenia patients with predominantly negative symptoms were randomized to either 10 sessions of add-on active (2 mA, 20min) or sham tDCS (anode: left DLPFC/F3; cathode: right supraorbital/F4). Primary outcome measure was the change in the Scale for the Assessment of Negative Symptoms (SANS) sum score; secondary outcomes included reduction in Positive and Negative Syndrome Scale (PANSS) scores and improvement of depressive symptoms, cognitive processing speed, and executive functioning. Sixteen patients underwent 4 functional connectivity magnetic resonance imaging (fcMRI) scans (pre and post 1st and pre and post 10th tDCS) to investigate changes in resting state network connectivity after tDCS. Per-protocol analysis showed a significantly greater decrease in SANS score after active (-36.1%) than after sham tDCS (-0.7%). PANSS sum scores decreased significantly more with active (-23.4%) than with sham stimulation (-2.2%). Explorative analysis of fcMRI data indicated changes in subgenual cortex and dorsolateral prefrontal cortex (DLPFC) connectivity within frontal-thalamic-temporo-parietal networks. The results of this first proof-of-concept study indicate that prefrontal tDCS may be a promising intervention for treatment of schizophrenia with predominant negative symptoms. Large-scale randomized controlled studies are needed to further establish prefrontal tDCS as novel treatment for negative symptoms in schizophrenia.
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Affiliation(s)
- Ulrich Palm
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany;
| | - Daniel Keeser
- Institute for Clinical Radiology, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Michael J Kupka
- Institute for Clinical Radiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Janusch Blautzik
- Institute for Clinical Radiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Nina Sarubin
- Hochschule Fresenius, University of Applied Sciences, Psychology School, Munich, Germany
| | | | | | | | - Thomas Meindl
- Institute for Clinical Radiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute for Clinical Radiology, Ludwig Maximilian University Munich, Munich, Germany
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186
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Wang MY, Ho NF, Sum MY, Collinson SL, Sim K. Impact of duration of untreated psychosis and premorbid intelligence on cognitive functioning in patients with first-episode schizophrenia. Schizophr Res 2016; 175:97-102. [PMID: 27146474 DOI: 10.1016/j.schres.2016.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/29/2016] [Accepted: 04/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The neurotoxic hypothesis suggests that psychosis is toxic to the brain leading to clinical consequences. In this study, we hypothesized that a longer duration of untreated psychosis (DUP) in first episode schizophrenia (FES) patients is associated with poorer cognitive functioning, and that higher premorbid intelligence buffers against DUP-related cognitive impairment. METHOD Eighty-one FES patients completed a neuropsychological battery, the Brief Assessment of Cognition in Schizophrenia (BACS). Composite scores of the BACS, which were normalized to a matched healthy control of seventy-three subjects, were used as an index of general cognition. A median split using the Wide Range Achievement Test-Reading Test scores was used to divide the patients into low versus high premorbid IQ groups. Hierarchical linear regression was performed to examine predictors of general cognition, including DUP. RESULTS Longer DUP was found to be a significant predictor of poorer general cognition. In addition, DUP predicted general cognition in the low premorbid IQ group but not in the high premorbid IQ group. CONCLUSIONS Our findings demonstrate that longer DUP in FES patients is associated with worse cognitive scores, and that this association is more pronounced in a subgroup of patients who have lower premorbid intelligence. Our results suggest the importance of earlier identification and management of patients with low premorbid IQ, given that their cognition may be more vulnerable to the toxicity of psychosis.
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Affiliation(s)
- M Y Wang
- Research Division, Institute of Mental Health, Singapore
| | - N F Ho
- Research Division, Institute of Mental Health, Singapore
| | - M Y Sum
- Research Division, Institute of Mental Health, Singapore
| | - S L Collinson
- Department of Psychology, National University of Singapore, Singapore
| | - K Sim
- Research Division, Institute of Mental Health, Singapore; General Psychiatry, Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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187
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Kane MJ, Meier ME, Smeekens BA, Gross GM, Chun CA, Silvia PJ, Kwapil TR. Individual differences in the executive control of attention, memory, and thought, and their associations with schizotypy. J Exp Psychol Gen 2016; 145:1017-1048. [PMID: 27454042 PMCID: PMC4965188 DOI: 10.1037/xge0000184] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A large correlational study took a latent-variable approach to the generality of executive control by testing the individual-differences structure of executive-attention capabilities and assessing their prediction of schizotypy, a multidimensional construct (with negative, positive, disorganized, and paranoid factors) conveying risk for schizophrenia. Although schizophrenia is convincingly linked to executive deficits, the schizotypy literature is equivocal. Subjects completed tasks of working memory capacity (WMC), attention restraint (inhibiting prepotent responses), and attention constraint (focusing visual attention amid distractors), the latter 2 in an effort to fractionate the "inhibition" construct. We also assessed mind-wandering propensity (via in-task thought probes) and coefficient of variation in response times (RT CoV) from several tasks as more novel indices of executive attention. WMC, attention restraint, attention constraint, mind wandering, and RT CoV were correlated but separable constructs, indicating some distinctions among "attention control" abilities; WMC correlated more strongly with attentional restraint than constraint, and mind wandering correlated more strongly with attentional restraint, attentional constraint, and RT CoV than with WMC. Across structural models, no executive construct predicted negative schizotypy and only mind wandering and RT CoV consistently (but modestly) predicted positive, disorganized, and paranoid schizotypy; stalwart executive constructs in the schizophrenia literature-WMC and attention restraint-showed little to no predictive power, beyond restraint's prediction of paranoia. Either executive deficits are consequences rather than risk factors for schizophrenia, or executive failures barely precede or precipitate diagnosable schizophrenia symptoms. (PsycINFO Database Record
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Affiliation(s)
| | - Matt E Meier
- Department of Psychology, Western Carolina University
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188
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Abstract
The negative symptoms have been described in association with schizophrenia since the early days of it being recognized as an entity. However, their elusive nature kept them unacknowledged until there was a revival of interest in them following the development of specific quantifying measures. Over the past three decades, there has been a tremendous surge in research on their types, measurements, status in the present classificatory system, and their implications. The developments in modern investigatory methods have provided the researchers with fresh insights into the underlying mechanisms, and a distributed functioning of the neuronal networks has emerged as the major abnormality. Accordingly, a variety of pharmacological and other treatment modalities have been developed which go beyond the traditional. Nevertheless, a lot remain unanswered. The present paper summarizes important concepts with regard to negative symptoms in schizophrenia.
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Affiliation(s)
- Sayantanava Mitra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Tathagata Mahintamani
- Department of Psychiatry, Vidyasagar Institute of Mental Health, Government Mental Hospital, Amritsar, Punjab, India
| | - Anjana Rao Kavoor
- Department of Psychiatry, Fortis Hospital, Bengaluru, Karnataka, India
| | - S Haque Nizamie
- Department of Psychiatry and K.S. Mani Centre for Cognitive Neurosciences, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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189
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Jung SI, Woo J, Kim YT, Kwak SG. Validation of the Korean-Version of the Clinical Assessment Interview for Negative Symptoms of Schizophrenia (CAINS). J Korean Med Sci 2016; 31:1114-20. [PMID: 27366011 PMCID: PMC4901005 DOI: 10.3346/jkms.2016.31.7.1114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/04/2016] [Indexed: 12/05/2022] Open
Abstract
The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed to overcome the limitations of existing instruments and reflect the current view of negative symptoms. The aim of the present study was to evaluate the reliability and validity of the Korean version of the Clinical Assessment Interview for Negative Symptoms (K-CAINS). Inpatients (n = 49) and outpatients (n = 70) with schizophrenia were recruited from three institutions. The confirmative factor analysis, test-retest reliability, inter-rater reliability, convergent validity, and discriminant validity were assessed. The study group consisted of 71 males (59.7%) and 48 females (40.3%). Their mean age was 42.15 years (SD = 12.2). The K-CAINS was confirmed to be divided into two subscales of 9 items related to "motivation/pleasure" and 4 items related to "expression" in concordance with the original version of the CAINS. The results showed that the K-CAINS had a good inter-rater reliability (ICC = 0.84-0.94), test-retest reliability (r = 0.90, P < 0.001). Convergent validity was proven by demonstrating a significant correlation with the Positive and Negative Syndrome Scale (PANSS) negative subscale, and the Scale for the Assessment of Negative Symptoms (SANS). Discriminant validity was proven by the lack of a significant correlation with the PANSS positive subscale, the Korean version of the Beck depression inventory (BDI), the Korean version of the Calgary depression scale for schizophrenia (K-CDSS), and the Modified Simpson Angus scale (MSAS). The K-CAINS could be a reliable and valid tool to assess the negative symptoms of Korean schizophrenia patients.
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Affiliation(s)
- Sung Il Jung
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jungmin Woo
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Yang-Tae Kim
- Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang Gyu Kwak
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu, Korea
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190
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Longitudinal change in neurocognition and its relation to symptomatic and functional changes over 2years in individuals at clinical high-risk for psychosis. Schizophr Res 2016; 174:50-57. [PMID: 27068568 DOI: 10.1016/j.schres.2016.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Negative symptoms and functional disability represent the core of schizophrenia and both are associated with cognitive impairments. We explored the course of cognitive change and its relation to symptomatic and functional changes in individuals at clinical high-risk (CHR) for psychosis to identify cognitive indicators of long-term course. Such attempts may offer insight into the pathological changes associated with the development of illness in the prodromal state. METHODS Forty-seven CHR individuals completed neurocognitive, clinical, and functional assessments at baseline and 2-year follow-up; twenty-eight healthy controls were assessed for neurocognitive and functional measures at baseline and 2-year follow-up. The delta values of CHR individuals in neurocognitive, clinical, and functional domains were determined from differences between baseline and follow-up scores to estimate the degree of change. RESULTS Although overall longitudinal cognitive performance of CHR individuals improved, the magnitude of improvement was not statistically different from that of normal controls at the group level. However, the individual data yielded two groups of CHR subjects showing opposite trajectories of cognitive change in semantic fluency (i.e., improvement or decline), which was significantly associated with changes in negative symptoms and functioning. Moreover, the relationships between negative symptoms and functioning were more strengthened over time than baseline. CONCLUSIONS Our findings show that semantic fluency seems to be a neurocognitive indicator reflecting clinical courses in CHR individuals. The longitudinal relationship of negative symptoms and functioning with semantic fluency may represent ongoing pathological processes in neural systems involving aberrant fronto-temporal interaction in the early phase of schizophrenia.
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191
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Lim J, Lee SA, Lam M, Rapisarda A, Kraus M, Keefe RSE, Lee J. The relationship between negative symptom subdomains and cognition. Psychol Med 2016; 46:2169-2177. [PMID: 27087476 DOI: 10.1017/s0033291716000726] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Negative symptoms and cognitive deficits in schizophrenia are partially overlapping. However, the nature of the relationship between negative symptoms and cognition remains equivocal. Recent reviews have demonstrated the presence of two negative symptom subdomains, diminished emotional expression (DEE) and avolition. In view of this, we sought to clarify the relationship between negative symptoms and cognitive domains. METHOD A total of 687 participants with schizophrenia were assessed on measures of psychopathology and cognition. Three cognitive factors, namely executive function, fluency/memory and speed/vigilance were computed from the cognitive tests. Confirmatory factor analysis was utilized to examine if a one-factor or two-factor negative model was applicable to our sample. Subsequently, the relationships between negative symptoms and cognition were examined using structural equation modeling. RESULTS Results demonstrated that the two-factor model fitted the data well. While negative symptoms were mildly to moderately associated with cognition, we found that DEE had unique associations with cognition compared to social avolition, contributing to the validity of the constructs and suggesting the possibility of common underlying substrates in negative symptoms and cognition. CONCLUSIONS Our study highlighted the need to classify DEE and social avolition separately as both are necessary in refining the complex relationship between negative symptoms and cognition as well as potentially guiding treatment and management of schizophrenia.
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Affiliation(s)
- J Lim
- Research Division,Institute of Mental Health,Singapore
| | - S-A Lee
- Research Division,Institute of Mental Health,Singapore
| | - M Lam
- Research Division,Institute of Mental Health,Singapore
| | - A Rapisarda
- Research Division,Institute of Mental Health,Singapore
| | - M Kraus
- Department of Psychiatry & Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - R S E Keefe
- Department of Psychiatry & Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - J Lee
- Research Division,Institute of Mental Health,Singapore
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192
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Hasan A, Strube W, Palm U, Wobrock T. Repetitive Noninvasive Brain Stimulation to Modulate Cognitive Functions in Schizophrenia: A Systematic Review of Primary and Secondary Outcomes. Schizophr Bull 2016; 42 Suppl 1:S95-S109. [PMID: 27460623 PMCID: PMC4960427 DOI: 10.1093/schbul/sbv158] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite many years of research, there is still an urgent need for new therapeutic options for the treatment of cognitive deficits in schizophrenia. Noninvasive brain stimulation (NIBS) has been proposed to be such a novel add-on treatment option. The main objective of this review was to systematically evaluate the cognitive effects of repetitive NIBS in schizophrenia. As most studies have not been specifically designed to investigate cognition as primary outcome, we have focused on both, primary and secondary outcomes. The PubMed/MEDLINE database (1985-2015) was systematically searched for interventional studies investigating the effects of repetitive NIBS on schizophrenia symptoms. All interventional clinical trials using repetitive transcranial stimulation, transcranial theta burst stimulation, and transcranial direct current stimulation for the treatment of schizophrenia were extracted and analyzed with regard to cognitive measures as primary or secondary outcomes. Seventy-six full-text articles were assessed for eligibility of which 33 studies were included in the qualitative synthesis. Of these 33 studies, only 4 studies included cognition as primary outcome, whereas 29 studies included cognitive measures as secondary outcomes. A beneficial effect of frontal NIBS could not be clearly established. No evidence for a cognitive disruptive effect of NIBS (temporal lobe) in schizophrenia could be detected. Finally, a large heterogeneity between studies in terms of inclusion criteria, stimulation parameters, applied cognitive measures, and follow-up intervals was observed. This review provides the first systematic overview regarding cognitive effects of repetitive NIBS in schizophrenia.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany;
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Wobrock
- County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany; Department of Psychiatry and Psychotherapy, Georg-August-University, Göttingen, Germany
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193
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Jang SK, Choi HI, Park S, Jaekal E, Lee GY, Cho YI, Choi KH. A Two-Factor Model Better Explains Heterogeneity in Negative Symptoms: Evidence from the Positive and Negative Syndrome Scale. Front Psychol 2016; 7:707. [PMID: 27242619 PMCID: PMC4863882 DOI: 10.3389/fpsyg.2016.00707] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
Acknowledging separable factors underlying negative symptoms may lead to better understanding and treatment of negative symptoms in individuals with schizophrenia. The current study aimed to test whether the negative symptoms factor (NSF) of the Positive and Negative Syndrome Scale (PANSS) would be better represented by expressive and experiential deficit factors, rather than by a single factor model, using confirmatory factor analysis (CFA). Two hundred and twenty individuals with schizophrenia spectrum disorders completed the PANSS; subsamples additionally completed the Brief Negative Symptom Scale (BNSS) and the Motivation and Pleasure Scale—Self-Report (MAP-SR). CFA results indicated that the two-factor model fit the data better than the one-factor model; however, latent variables were closely correlated. The two-factor model’s fit was significantly improved by accounting for correlated residuals between N2 (emotional withdrawal) and N6 (lack of spontaneity and flow of conversation), and between N4 (passive social withdrawal) and G16 (active social avoidance), possibly reflecting common method variance. The two NSF factors exhibited differential patterns of correlation with subdomains of the BNSS and MAP-SR. These results suggest that the PANSS NSF would be better represented by a two-factor model than by a single-factor one, and support the two-factor model’s adequate criterion-related validity. Common method variance among several items may be a potential source of measurement error under a two-factor model of the PANSS NSF.
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Affiliation(s)
| | - Hye-Im Choi
- Department of Psychology, Korea University Seoul, South Korea
| | - Soohyun Park
- Department of Psychology, Korea University Seoul, South Korea
| | - Eunju Jaekal
- Department of Psychology, Korea University Seoul, South Korea
| | - Ga-Young Lee
- Department of Psychology, Korea University Seoul, South Korea
| | - Young Il Cho
- Department of Psychology, Sungshin Women's University Seoul, South Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University Seoul, South Korea
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194
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Kim JS, Jang SK, Park SC, Yi JS, Park JK, Lee JS, Choi KH, Lee SH. Measuring negative symptoms in patients with schizophrenia: reliability and validity of the Korean version of the Motivation and Pleasure Scale-Self-Report. Neuropsychiatr Dis Treat 2016; 12:1167-72. [PMID: 27274251 PMCID: PMC4869782 DOI: 10.2147/ndt.s107775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Clinical Assessment Interview for Negative Symptoms (CAINS) is one of the validated interview measures of negative symptoms in psychotic disorders. The Motivation and Pleasure Scale-Self-Report (MPSR) is a self-report measure that assesses the motivation and pleasure domains of negative symptoms based on the CAINS. This study evaluated the reliability and validity of a Korean version of the MPSR. METHODS A total of 139 patients with schizophrenia completed the MPSR, CAINS, Scale for the Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scales, Calgary Depression Scale for Schizophrenia, and other measures of trait and cognitive function. RESULTS The 15-item MPSR showed good internal consistency. In addition, it also had a good convergent validity with the Motivation and Pleasure subscale of the CAINS and the anhedonia/avolition subscale of the SANS. The scale was not associated with psychotic symptoms, agitation/mania, and depression/anxiety, and it showed good discriminant validity. MPSR scores were significantly correlated with Behavioral Activation System total score for trait measure. CONCLUSION The Korean version of the MPSR is a notable self-report method for examining the severity of negative symptoms in schizophrenia.
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Affiliation(s)
- Ji-Sun Kim
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea
| | - Seon-Kyeong Jang
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jung-Seo Yi
- Department of Psychiatry, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Joong-Kyu Park
- Department of Rehabilitation Psychology, Daegu University, Daegu, Republic of Korea
| | - Jung Suk Lee
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
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195
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Hasan A, Guse B, Cordes J, Wölwer W, Winterer G, Gaebel W, Langguth B, Landgrebe M, Eichhammer P, Frank E, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Malchow B, Karch S, Schneider-Axmann T, Falkai P, Wobrock T. Cognitive Effects of High-Frequency rTMS in Schizophrenia Patients With Predominant Negative Symptoms: Results From a Multicenter Randomized Sham-Controlled Trial. Schizophr Bull 2016; 42:608-18. [PMID: 26433217 PMCID: PMC4838079 DOI: 10.1093/schbul/sbv142] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cognitive impairments are one of the main contributors to disability and poor long-term outcome in schizophrenia. Proof-of-concept trials indicate that repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (DLPFC) has the potential to improve cognitive functioning. We analyzed the effects of 10-Hz rTMS to the left DLPFC on cognitive deficits in schizophrenia in a large-scale and multicenter, sham-controlled study. A total of 156 schizophrenia patients with predominant negative symptoms were randomly assigned to a 3-week intervention (10-Hz rTMS, 15 sessions, 1000 stimuli per session) with either active or sham rTMS. The Rey Auditory Verbal Learning Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Digit Span Test, and the Regensburg Word Fluency Test were administered before intervention and at day 21, 45, and 105 follow-up. From the test results, a neuropsychological composite score was computed. Both groups showed no differences in any of the outcome variables before and after intervention. Both groups improved markedly over time, but effect sizes indicate a numeric, but nonsignificant superiority of active rTMS in certain cognitive tests. Active 10-Hz rTMS applied to the left DLPFC for 3 weeks was not superior to sham rTMS in the improvement of various cognitive domains in schizophrenia patients with predominant negative symptoms. This is in contrast to previous preliminary proof-of-concept trials, but highlights the need for more multicenter randomized controlled trials in the field of noninvasive brain stimulation.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany; These authors contributed equally to the article.
| | - Birgit Guse
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; These authors contributed equally to the article
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Winterer
- The Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University, Düsseldorf, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik, Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christian Ohmann
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Raees Ahmed
- Institut für anwendungsorientierte Forschung und klinische Studien GmbH, Göttingen, Germany
| | - William G Honer
- Institute of Mental Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany; County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
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Stiekema APM, Liemburg EJ, van der Meer L, Castelein S, Stewart R, van Weeghel J, Aleman A, Bruggeman R. Confirmatory Factor Analysis and Differential Relationships of the Two Subdomains of Negative Symptoms in Chronically Ill Psychotic Patients. PLoS One 2016; 11:e0149785. [PMID: 26895203 PMCID: PMC4760738 DOI: 10.1371/journal.pone.0149785] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/04/2016] [Indexed: 01/30/2023] Open
Abstract
Research suggests a two factor structure for negative symptoms in patients with psychotic disorders: social amotivation (SA) and expressive deficits (ED). Applying this two-factor structure in clinical settings may provide valuable information with regard to outcomes and to target treatments. We aimed to investigate 1) whether the factor structure is also supported in chronically ill patients with a psychotic disorder and 2) what the relationship is between these factors and functioning (overall functioning and living situation), depressive symptoms and quality of life. 1157 Patients with a psychotic disorder and a duration of illness of 5 years or more were included in the analysis (data selected from the Pharmacotherapy Monitoring Outcome Survey; PHAMOUS). A confirmatory factor analysis was performed using items of the Positive and Negative Syndrome Scale that were previously identified to reflect negative symptoms (N1-4, N6, G5, G7, G13, G16). Subsequently, regression analysis was performed on outcomes. The results confirmed the distinction between SA (N2, N4, G16) and ED (N1, N3, N6, G5, G7, G13) in chronically ill patients. Both factors were related to worse overall functioning as measured with the Health of the Nation Outcome Scales, ED was uniquely associated with residential living status. Higher scores for SA were associated with more depressive symptoms and worse quality of life. Thus, SA is most strongly related to level of social-emotional functioning, while ED are more related to living situation and thereby are indicative of level of everyday functioning. This subdivision may be useful for research purposes and be a valuable additional tool in clinical practice and treatment development.
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Affiliation(s)
- Annemarie P. M. Stiekema
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, the Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
| | - Edith J. Liemburg
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Department, Lentis Center for Mental Health Care, Groningen, the Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, the Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stynke Castelein
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Department, Lentis Center for Mental Health Care, Groningen, the Netherlands
| | - Roy Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap van Weeghel
- Parnassia Group, Dijk en Duin Mental Health Center, Castricum, the Netherlands
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific center for Care and Welfare, Tilburg, the Netherlands
- Phrenos, Center of Expertise on severe mental illness, Utrecht, the Netherlands
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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197
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Engel M, Lincoln TM. Motivation and Pleasure Scale-Self-Report (MAP-SR): Validation of the German version of a self-report measure for screening negative symptoms in schizophrenia. Compr Psychiatry 2016; 65:110-5. [PMID: 26773998 DOI: 10.1016/j.comppsych.2015.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/28/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Validated self-report instruments could provide a time efficient screening method for negative symptoms in people with schizophrenia. The aim of this study was to examine the psychometric properties of a German version of the Motivation and Pleasure Scale-Self-Report (MAP-SR) which is based on the Clinical Assessment Interview for Negative Symptoms (CAINS). METHODS In- and outpatients (N=50) with schizophrenia or schizoaffective disorder were assessed with standardized interviews and questionnaires on negative and positive symptoms and general psychopathology in schizophrenia, depression, and global functioning. RESULTS The German version of the MAP-SR showed high internal consistency. Convergent validity was supported by significant correlations between the MAP-SR with the experience sub-scale of the CAINS and the negative symptom sub-scale of the Positive and Negative Syndrome Scale. The MAP-SR also exhibited discriminant validity indicated by its non-significant correlations with positive symptoms and general psychopathology, which is in line with the findings for the original version of the MAP-SR. However, the MAP-SR correlated moderately with depression. CONCLUSION The German MAP-SR appears to be a valid and suitable diagnostic tool for the identification of negative symptoms in schizophrenia.
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Affiliation(s)
- Maike Engel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania Marie Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
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198
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Gur RC, Gur RE. Social cognition as an RDoC domain. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:132-41. [PMID: 26607670 PMCID: PMC4843508 DOI: 10.1002/ajmg.b.32394] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/07/2015] [Indexed: 01/09/2023]
Abstract
While the bulk of research into neural substrates of behavior and psychopathology has focused on cognitive, memory and executive functions, there has been a recent surge of interest in emotion processing and social cognition, manifested in designating Social Cognition as a major RDoC domain. We describe the origins of this field's influence on cognitive neuroscience and highlight the most salient findings leading to the characterization of the "social brain" and the establishments of parameters that quantify normative and aberrant behaviors. Such parameters of behavior and neurobiology are required for a potentially successful RDoC construct, especially if heritability is established, because of the need to link with genomic systems. We proceed to illustrate how a social cognition measure can be used within the RDoC framework by presenting a task of facial emotion identification. We show that performance is sensitive to normative individual differences related to age and sex and to deficits associated with schizophrenia and other psychotic disorders. Neuroimaging studies with this task demonstrate that it recruits limbic and frontal regulatory activation in healthy samples as well as abnormalities in psychiatric populations. Evidence for its heritability was documented in genomic family studies and in patients with the 22q11.2 deletion syndrome. Measures that meet such criteria can help build translational bridges between cellular molecular mechanisms and behavior that elucidate aberrations related to psychopathology. Such links will transcend current diagnostic classifications and ultimately lead to a mechanistically based diagnostic nomenclature. Establishing such bridges will provide the elements necessary for early detection and scientifically grounded intervention.
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Affiliation(s)
- Ruben C. Gur
- Brain Behavior Laboratory, Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Brain Behavior Laboratory, Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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199
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Guimond S, Chakravarty MM, Bergeron-Gagnon L, Patel R, Lepage M. Verbal memory impairments in schizophrenia associated with cortical thinning. Neuroimage Clin 2015; 11:20-29. [PMID: 26909322 PMCID: PMC4732190 DOI: 10.1016/j.nicl.2015.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/11/2015] [Accepted: 12/20/2015] [Indexed: 01/22/2023]
Abstract
Verbal memory (VM) represents one of the most affected cognitive domains in schizophrenia. Multiple studies have shown that schizophrenia is associated with cortical abnormalities, but it remains unclear whether these are related to VM impairments. Considering the vast literature demonstrating the role of the frontal cortex, the parahippocampal cortex, and the hippocampus in VM, we examined the cortical thickness/volume of these regions. We used a categorical approach whereby 27 schizophrenia patients with 'moderate to severe' VM impairments were compared to 23 patients with 'low to mild' VM impairments and 23 healthy controls. A series of between-group vertex-wise GLM on cortical thickness were performed for specific regions of interest defining the parahippocampal gyrus and the frontal cortex. When compared to healthy controls, patients with 'moderate to severe' VM impairments revealed significantly thinner cortex in the left frontal lobe, and the parahippocampal gyri. When compared to patients with 'low to mild' VM impairments, patients with 'moderate to severe' VM impairments showed a trend of thinner cortex in similar regions. Virtually no differences were observed in the frontal area of patients with 'low to mild' VM impairments relative to controls. No significant group differences were observed in the hippocampus. Our results indicate that patients with greater VM impairments demonstrate significant cortical thinning in regions known to be important in VM performance. Treating VM deficits in schizophrenia could have a positive effect on the brain; thus, subgroups of patients with more severe VM deficits should be a prioritized target in the development of new cognitive treatments.
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Affiliation(s)
- S Guimond
- Department of Psychology, McGill University, Canada; Douglas Mental Health University Institute, Canada
| | - M M Chakravarty
- Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada
| | - L Bergeron-Gagnon
- Douglas Mental Health University Institute, Canada; Department of Psychology, University of Montreal, Canada
| | - R Patel
- Douglas Mental Health University Institute, Canada
| | - M Lepage
- Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada.
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200
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Altamura AC, Caletti E, Paoli RA, Cigliobianco M, Zugno E, Grillo P, Prunas C, Caldiroli A, Zago S. Correlation between neuropsychological and social cognition measures and symptom dimensions in schizophrenic patients. Psychiatry Res 2015; 230:172-80. [PMID: 26350702 DOI: 10.1016/j.psychres.2015.08.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/23/2015] [Accepted: 08/17/2015] [Indexed: 12/22/2022]
Abstract
Neurocognitive and social cognition deficits have been largely reported in Schizophrenia (SKZ) but their association with psychopathology remains uncertain. Our purpose was to explore the relationship between symptom dimensions and neuropsychological performances. We enrolled 35 stabilized schizophrenic outpatients of the Department of Psychiatry of Policlinico Hospital, University of Milan, who completed psychiatric Rating Scales, the Brief Assessment of Cognition in Schizophrenia (BACS) and the Executive and Social Cognition Battery (ESCB). Disorganized dimension seems to have the most significant impact on cognition, being associated with performance in several BACS subtests (verbal memory, working memory, motor speed, symbol coding, Tower of London) and ESCB tasks (MET and Hotel task number of tasks attempted, number of broken MET rules, sum of deviations in Hotel Task). Positive dimension correlated with performance in verbal fluency, negative dimension with IOWA Test results, cognitive dimension with MET number of inefficiencies and Eyes test score. Impulsive-aggressive and depressive dimensions weakly correlated only with Faux Pas test. Our study supports the existence of a specific disorganized dimension in SKZ, separated from cognitive dimension evaluated through clinical instruments (e.g. PANSS), but capable of influencing cognitive abilities. Furthermore, it strengthens the validity of ecological tasks in evaluating cognition in SKZ.
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Affiliation(s)
- A Carlo Altamura
- Psychiatric Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Caletti
- Psychiatric Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Augusto Paoli
- Psychiatric Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Michela Cigliobianco
- Psychiatric Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Elisa Zugno
- Psychiatric Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Grillo
- Epidemiology Unit, Department of Preventive Medicine, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cecilia Prunas
- Psychiatric Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- Psychiatric Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Zago
- Neurologic Clinic, Department of Neuroscience and Mental Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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