151
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López-Díaz Á, Lara I, Lahera G. Is the Prevalence of the Deficit Syndrome in Schizophrenia Higher than Estimated? Results of a Meta-Analysis. Psychiatry Investig 2018; 15:94-98. [PMID: 29422932 PMCID: PMC5795038 DOI: 10.4306/pi.2018.15.1.94] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/23/2017] [Accepted: 04/27/2017] [Indexed: 01/14/2023] Open
Abstract
The primary and enduring presence of negative symptoms observed in a relatively homogeneous subgroup of patients with schizophrenia led to the concept of deficit syndrome (DS). Until date, it is considered that 20-25% of schizophrenia cohorts have DS. The aim of this meta-analysis was to determine the current prevalence of DS, including international and most recent studies. Thirteen observational studies met the inclusion criteria, comprising 2092 patients from eight countries. Pooled proportion of the DS subgroup was 32.64%, higher than previously reported. Based on our outcomes, up to one-third of patients with schizophrenia might have idiopathic and stable negative symptoms. This significant proportion of patients should be well represented in clinical trial's samples.
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Affiliation(s)
- Álvaro López-Díaz
- Mental Health Clinical Management Unit Virgen Macarena University Hospital, Seville, Spain
| | - Ignacio Lara
- Mental Health Clinical Management Unit Virgen Macarena University Hospital, Seville, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialties University of Alcalá, IryCIS, CIBERSAM, Madrid, Spain
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152
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Kirschner M, Hager OM, Muff L, Bischof M, Hartmann-Riemer MN, Kluge A, Habermeyer B, Seifritz E, Tobler PN, Kaiser S. Ventral Striatal Dysfunction and Symptom Expression in Individuals With Schizotypal Personality Traits and Early Psychosis. Schizophr Bull 2018; 44:147-157. [PMID: 27798223 PMCID: PMC5767950 DOI: 10.1093/schbul/sbw142] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Striatal abnormalities play a crucial role in the pathophysiology of schizophrenia. Growing evidence suggests an association between aberrant striatal activity during reward anticipation and symptom dimensions in schizophrenia. However, it is not clear whether this holds across the psychosis continuum. The aim of the present study was to investigate alterations of ventral striatal activation during reward anticipation and its relationship to symptom expression in persons with schizotypal personality traits (SPT) and first-episode psychosis. Twenty-six individuals with high SPT, 26 patients with non-affective first-episode psychosis (including 13 with brief psychotic disorder (FEP-BPD) and 13 with first-episode schizophrenia [FEP-SZ]) and 25 healthy controls underwent event-related functional magnetic resonance imaging while performing a variant of the Monetary Incentive Delay task. Ventral striatal activation was positively correlated with total symptom severity, in particular with levels of positive symptoms. This association was observed across the psychosis continuum and within each subgroup. Patients with FEP-SZ showed the strongest elevation of striatal activation during reward anticipation, although symptom levels did not differ between groups in the psychosis continuum. While our results provide evidence that variance in striatal activation is mainly explained by dimensional symptom expression, patients with schizophrenia show an additional dysregulation of striatal activation. Trans-diagnostic approaches are promising in order to disentangle dimensional and categorical neural mechanisms in the psychosis continuum.
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Affiliation(s)
- Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland,To whom correspondence should be addressed; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; tel: +41-44-384-36-14, fax: +41-44-383-44-56, e-mail:
| | - Oliver M Hager
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Larissa Muff
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Bischof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Matthias N Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Agne Kluge
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Benedikt Habermeyer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Philippe N Tobler
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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153
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Mørch-Johnsen L, Agartz I, Jensen J. The Neural Correlates of Negative Symptoms in Schizophrenia: Examples From MRI Literature. Clin EEG Neurosci 2018; 49:12-17. [PMID: 29243527 DOI: 10.1177/1550059417746214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Negative symptoms of schizophrenia have a negative impact on psychosocial functioning and disease outcome. It is therefore important to investigate the pathophysiology underlying negative symptoms as this may aid the development of better treatment. In the current article, examples from studies investigating neural correlates of negative symptoms in schizophrenia are given. Investigations using both structural and functional magnetic resonance imaging are presented at different levels of symptomatology descriptions, from the more heterogenous construct of negative symptoms to more single discrete symptoms. Some methods to improve imaging studies of negative symptoms in schizophrenia are also suggested.
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Affiliation(s)
- Lynn Mørch-Johnsen
- 1 Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,2 NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- 1 Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,2 NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,3 Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jimmy Jensen
- 4 Centre for Psychology, Kristianstad University, Kristianstad, Sweden
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154
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Treatment following myocardial infarction in patients with schizophrenia. PLoS One 2017; 12:e0189289. [PMID: 29236730 PMCID: PMC5728533 DOI: 10.1371/journal.pone.0189289] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 11/23/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A correlation between excess mortality from myocardial infarctions (MI) and schizophrenia has already been established. What remains unclear is whether the initial communication between the treating doctor and the corresponding patient contributes to this excess mortality. AIM The aim of this study is to investigate whether a patient with schizophrenia receives the same offers for examination and treatment following a MI compared to a psychiatric healthy control (PHC). METHODS This cohort study includes patients diagnosed with schizophrenia at the time of their first MI (n = 47) in the years between 1995-2015 matched 1:2 to psychiatric healthy MI patients on gender, age and year of first MI. All existing hospital files for the 141 patients were thoroughly reviewed and the number of offered and accepted examinations and treatments were extracted for comparisons between the two groups. RESULTS In general patients with schizophrenia were less likely to be offered and accept examination and at the same time be offered and accept treatment as compared to PHCs (p<0.01). In addition, there was a statistical trend towards patients with schizophrenia being more likely to decline examination (p = 0.10) and decline treatment (p = 0.09) compared to PHCs, while being offered examination and being offered treatment both contributed statistically insignificantly to the overall discrepancy between the two patient groups. CONCLUSIONS Being diagnosed with schizophrenia limits the treatment received following a first MI compared to PHCs. However, we are unable to pinpoint, whether Physician bias, patient's unwillingness to receive health care or both contribute to the excess mortality seen in these comorbid patients.
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155
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The effect of SMS (text message) reminders on attendance at a community adult mental health service clinic: do SMS reminders really increase attendance? Ir J Med Sci 2017; 187:561-564. [DOI: 10.1007/s11845-017-1710-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
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156
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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: 41] [Impact Index Per Article: 5.9] [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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157
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Depp CA, Moore RC, Perivoliotis D, Granholm E. Technology to assess and support self-management in serious mental illness. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489457 PMCID: PMC4969704 DOI: 10.31887/dcns.2016.18.2/cdepp] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The functional impairment associated with serious mental illness (SMI) places an immense burden on individuals and society, and disability often persists even after efficacious treatment of psychopathologic symptoms. Traditional methods of measuring functioning have limitations, and numerous obstacles reduce the reach and impact of evidence-based interventions developed to improve functioning in SMI. This review describes the potential of technological innovations for overcoming the challenges involved in both functional assessment and intervention in people with SMI. Ecological momentary assessment (EMA), which involves the repeated sampling of naturalistic behaviors and experiences while individuals carry out their daily lives, has provided a new window through which the determinants of day-to-day function in SMI can be observed. EMA has several advantages over traditional assessment methods and has in recent years evolved to use mobile-based platforms, such as text messaging and smartphone applications, for both assessment and promotion of self-management in people with SMI. We will review promising data regarding the acceptability, adherence, and efficacy of EMA-based mobile technologies; explore ways in which these technologies can extend the reach and impact of evidence-based psychosocial rehabilitative interventions in SMI; and outline future directions for research in this important area.
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Affiliation(s)
- Colin A Depp
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Dimitri Perivoliotis
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
| | - Eric Granholm
- UC San Diego Department of Psychiatry, La Jolla, California, USA; VA San Diego, La Jolla, California, USA
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158
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Mueller DR, Khalesi Z, Benzing V, Castiglione CI, Roder V. Does Integrated Neurocognitive Therapy (INT) reduce severe negative symptoms in schizophrenia outpatients? Schizophr Res 2017; 188:92-97. [PMID: 28185784 DOI: 10.1016/j.schres.2017.01.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 12/16/2022]
Abstract
Negative symptoms often inhibit the social integration of people suffering from schizophrenia. Reducing severe negative symptoms (SNS) in a clinically relevant way is a major unmet need. The aim of this study was to investigate whether Integrated Neurocognitive Therapy (INT), a group cognitive remediation therapy (CRT), reduces SNS in schizophrenia outpatients. INT was compared with Treatment As Usual (TAU) in a randomized-controlled trial (RCT). A total of 61 SNS outpatients participated in the study, 28 were allocated to the INT group and 33 to the TAU group. A test-battery was used at baseline, post-treatment at 15weeks, and 1-year-follow-up. Remission rates of SNS after therapy were significantly higher for INT compared to TAU. A trend favoring INT was obtained at follow-up. Furthermore, INT showed significantly higher functional outcome during follow-up compared to TAU. Regarding cognition, the strongest significant effect was found in attention post-treatment. No effects between groups on more complex neurocognition and social cognition were evident. SNS outpatients seem to accept INT group intervention as suggested by the high attendance rate.
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Affiliation(s)
- Daniel R Mueller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Zahra Khalesi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Valentin Benzing
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Institute of Sport Science, University of Bern, Switzerland
| | - Clelia I Castiglione
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Volker Roder
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
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159
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160
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Linking persistent negative symptoms to amygdala-hippocampus structure in first-episode psychosis. Transl Psychiatry 2017; 7:e1195. [PMID: 28786981 PMCID: PMC5611735 DOI: 10.1038/tp.2017.168] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/12/2017] [Accepted: 05/15/2017] [Indexed: 01/07/2023] Open
Abstract
Early persistent negative symptoms (PNS) following a first episode of psychosis (FEP) are linked to poor functional outcome. Reports of reduced amygdalar and hippocampal volumes in early psychosis have not accounted for heterogeneity of symptoms. Age is also seldom considered in this population, a factor that has the potential to uncover symptom-specific maturational biomarkers pertaining to volume and shape changes within the hippocampus and amygdala. T1-weighted volumes were acquired for early (N=21), secondary (N=30), non-(N=44) PNS patients with a FEP, and controls (N=44). Amygdalar-hippocampal volumes and surface area (SA) metrics were extracted with the Multiple Automatically Generated Templates (MAGeT)-Brain algorithm. Linear mixed models were applied to test for a main effect of group and age × group interactions. Early PNS patients had significantly reduced left amygdalar and right hippocampal volumes, as well as similarly lateralized negative age × group interactions compared to secondary PNS patients (P<0.017, corrected). Morphometry revealed decreased SA in early PNS compared with other patient groups in left central amygdala, and in a posterior region when compared with controls. Early and secondary PNS patients had significantly decreased SA as a function of age compared with patients without such symptoms within the right hippocampal tail (P<0.05, corrected). Significant amygdalar-hippocampal changes with age are linked to PNS after a FEP, with converging results from volumetric and morphometric analyses. Differential age trajectories suggest an aberrant maturational process within FEP patients presenting with PNS, which could represent dynamic endophenotypes setting these patients apart from their non-symptomatic peers. Studies are encouraged to parse apart such symptom constructs when examining neuroanatomical changes emerging after a FEP.
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161
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Dollfus S, Lyne J. Negative symptoms: History of the concept and their position in diagnosis of schizophrenia. Schizophr Res 2017; 186:3-7. [PMID: 27401529 DOI: 10.1016/j.schres.2016.06.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 06/19/2016] [Indexed: 11/18/2022]
Abstract
Current conceptualizations of schizophrenia have been introduced over centuries and continue to progress in recent decades. Symptoms have been divided into several domains, contrasting negative and positive symptoms which are different in their nature, onset, progression and response to treatment. An account of the different historical changes of the concept – essentially nosographic – has led to models attempting to integrate findings for each dimension of the disorder. This paper reviews the history of negative symptoms in diagnosis and how different approaches have been utilised to consider negative symptoms in the concept of schizophrenia. The paper also bridges various international classifications which have evolved and modified the role of negative symptoms in their diagnostic criteria for schizophrenia, which highlights the challenge of defining this disease.
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Affiliation(s)
- Sonia Dollfus
- CHU de Caen, Service de psychiatrie, Centre Esquirol, Caen F-14000, France; Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS), Normandie Univ, Faculté de médecine, Caen F-14000, France; ISTCT, Normandie Univ, UNICAEN, CEA, CNRS,14000 Caen, France.
| | - John Lyne
- Royal College of Surgeons in Ireland and North Dublin Mental Health Service, 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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162
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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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163
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Dissecting negative symptoms of schizophrenia: History, assessment, pathophysiological mechanisms and treatment. Schizophr Res 2017; 186:1-2. [PMID: 27185482 DOI: 10.1016/j.schres.2016.04.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 11/22/2022]
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164
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Kirschner M, Aleman A, Kaiser S. Secondary negative symptoms - A review of mechanisms, assessment and treatment. Schizophr Res 2017; 186:29-38. [PMID: 27230288 DOI: 10.1016/j.schres.2016.05.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022]
Abstract
Negative symptoms in schizophrenia may be classified as primary or secondary. Primary negative symptoms are thought to be intrinsic to schizophrenia, while secondary negative symptoms are caused by positive symptoms, depression, medication side-effects, social deprivation or substance abuse. Most of the research on secondary negative symptoms has aimed at ruling them out in order to isolate primary negative symptoms. However, secondary negative symptoms are common and can have a major impact on patient-relevant outcomes. Therefore, the assessment and treatment of secondary negative symptoms are clinically relevant. Furthermore, understanding the mechanisms underlying secondary negative symptoms can contribute to an integrated model of negative symptoms. In this review we provide an overview of concepts, evidence, assessment and treatment for the major causes of secondary negative symptoms. We also summarize neuroimaging research relevant to secondary negative symptoms. We emphasize the relevance of recent developments in psychopathological assessment of negative symptoms, such as the distinction between amotivation and diminished expression, which have only rarely been applied in research on secondary negative symptoms.
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Affiliation(s)
- Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
| | - André Aleman
- Neuro-imaging Center, University of Groningen, University Medical Center Groningen, the Netherlands; Department of Psychology, University of Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, Zurich, Switzerland
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165
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A Randomized Clinical Trial of Oxytocin or Galantamine for the Treatment of Negative Symptoms and Cognitive Impairments in People With Schizophrenia. J Clin Psychopharmacol 2017; 37:394-400. [PMID: 28590362 PMCID: PMC5484721 DOI: 10.1097/jcp.0000000000000720] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE/BACKGROUND Negative symptoms and cognitive impairments tend to co-occur in people with schizophrenia. If their association with each other is due, in part, to shared pathophysiology, then this suggests that a single drug could potentially be effective for both domains. The current study was designed to examine this hypothesis. METHODS/PROCEDURES Fifty-eight participants with either Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision schizophrenia or schizoaffective disorder entered into a 6-week double-blind, placebo-controlled, double-dummy, randomized clinical trial of intranasal oxytocin and galantamine. Seventeen participants were randomized to intranasal oxytocin, 20 were randomized to galantamine, and 21 were randomized to placebo. The Scale for the Assessment of Negative Symptoms total score was used to assess change in negative symptoms (the primary outcome measure for oxytocin). The MATRICS Consensus Cognitive Battery composite score was used to assess cognition (the primary outcome measure for galantamine). FINDINGS/RESULTS There were no significant group differences for negative symptoms (oxytocin vs placebo: F2,47.4 = 0.19, P = 0.83; galantamine vs placebo: F2,52.5 = 0.41, P = 0.67). There were no significant group differences for cognitive impairments (galantamine vs placebo: t40 = 0.71, P = 0.48; oxytocin vs placebo: t40 = 0.50, P = 0.62). There were also no significant group differences for the functional capacity or ancillary symptom measures. IMPLICATIONS/CONCLUSIONS The lack of an efficacy signal for either compound precluded our ability to test whether pharmacological treatment pathways for negative symptoms and cognitive impairments overlap or are independent.
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166
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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: 92] [Impact Index Per Article: 13.1] [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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167
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Chaix J, Golay P, Fankhauser C, Nguyen A, Gooding DC, Favrod J. Confirmatory Factor Analysis of the French Version of the Anticipatory and Consummatory Interpersonal Pleasure Scale. Front Psychol 2017; 8:1296. [PMID: 28804473 PMCID: PMC5532448 DOI: 10.3389/fpsyg.2017.01296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/17/2017] [Indexed: 11/13/2022] Open
Abstract
The Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS), a measure specifically designed to assess hedonic capacity for social and interpersonal pleasure, was used to evaluate the presence of social anhedonia in patients as well as the general population. The first goal of this study was to validate the structure of the French version of the ACIPS. The second objective was to verify whether a one, two or three factor solution is most appropriate for the ACIPS scale. The French version of the ACIPS was tested on 263 French-speaking pre-graduate students or professional volunteers. For the confirmatory factor analysis, data were treated as categorical ordinal and all the models were estimated using a robust weighted least squares estimator with adjustments for the mean and variance. Three models were estimated. A one-factor model representing a general undifferentiated "pleasure" latent construct was first tested on the 17 ACIPS items. A two-factor model distinguishing anticipatory-pleasure and consummatory-pleasure was tested next. Finally, a three-factor model including subdomains of intimate social interactions, group social interactions, and social bonding was tested. The one and two-factor models showed a somewhat poor fit to the data. However, the goodness of fit of the three factor model was adequate. These results suggest that individuals who enjoyed interaction in one of these three subdomains were more likely to enjoy doing so in the two other domains. However, on the basis of the comparison between the one and three factor models, these three types of interactions may not be considered as indistinguishable. Rather, they represent distinct and theoretically meaningful dimensions. These results show the French version of the ACIPS is a useful and valid scale to measure the capacity of savoring different kinds of social relationships.
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Affiliation(s)
- Joséphine Chaix
- School of Nursing Sciences La Source, University of Applied Sciences and Arts of Western SwitzerlandLausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, University Hospital CenterLausanne, Switzerland
| | - Caroline Fankhauser
- School of Nursing Sciences La Source, University of Applied Sciences and Arts of Western SwitzerlandLausanne, Switzerland
| | - Alexandra Nguyen
- School of Nursing Sciences La Source, University of Applied Sciences and Arts of Western SwitzerlandLausanne, Switzerland
| | - Diane C Gooding
- Department of Psychology, University of Wisconsin-Madison, MadisonWI, United States
| | - Jérôme Favrod
- School of Nursing Sciences La Source, University of Applied Sciences and Arts of Western SwitzerlandLausanne, Switzerland.,Community Psychiatry Service, Department of Psychiatry, University Hospital CenterLausanne, Switzerland
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168
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Rezaei F, Mesgarpour B, Jeddian A, Zeionoddini A, Mohammadinejad P, Salardini E, Shahriari M, Zeinoddini A, Akhondzadeh S. Cilostazol adjunctive therapy in treatment of negative symptoms in chronic schizophrenia: Randomized, double-blind, placebo-controlled study. Hum Psychopharmacol 2017; 32. [PMID: 28421639 DOI: 10.1002/hup.2583] [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: 10/29/2016] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase III, as an adjunctive to risperidone in alleviating the negative symptoms of schizophrenia. METHODS Eighty-four in-patients with diagnosis of chronic schizophrenia participated in a randomized, placebo-controlled trial and underwent 8 weeks of treatment with either cilostazol (50 mg twice a day) or placebo as an adjuvant to risperidone. Participants were assessed using the positive and negative syndrome scale (PANSS) at baseline and at weeks 2, 4, 6, and 8. The primary outcome measure of the trial was to evaluate the efficacy of cilostazol compared to placebo in improving the PANSS negative subscale score. RESULT General linear model repeated measures demonstrated significant effect for time × treatment interaction on negative subscale scores (p < .001) and PANSS total (p = .006) but did not demonstrate significant effect on the PANSS positive (p = .37) and general (p = .06) subscales. Frequency of adverse events was not significantly different between the 2 treatment groups. No serious adverse event was observed. CONCLUSION An 8-week course of treatment with cilostazol as an adjunct to risperidone showed a favorable safety and efficacy profile in patients with schizophrenia.
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Affiliation(s)
- Farzin Rezaei
- Qods Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bita Mesgarpour
- National Institute for Medical Research Development, Tehran, Iran
| | - Alireza Jeddian
- Digestive Disease Research Institute, Tehran University of medical science, Tehran, Iran
| | - Atefeh Zeionoddini
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Mohammadinejad
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Salardini
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Shahriari
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arefeh Zeinoddini
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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169
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Affiliation(s)
- William T. Carpenter
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert W. Buchanan
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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170
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Abstract
In the DSM5, negative symptoms are 1 of the 5 core dimensions of psychopathology evaluated for schizophrenia. However, negative symptoms are not pathognomonic-they are also part of the diagnostic criteria for other schizophrenia-spectrum disorders, disorders that sometimes have comorbid psychosis, diagnoses not in the schizophrenia-spectrum, and the general "nonclinical" population. Although etiological models of negative symptoms have been developed for chronic schizophrenia, there has been little attention given to whether these models have transdiagnostic applicability. In the current review, we examine areas of commonality and divergence in the clinical presentation and etiology of negative symptoms across diagnostic categories. It was concluded that negative symptoms are relatively frequent across diagnostic categories, but individual disorders may differ in whether their negative symptoms are persistent/transient or primary/secondary. Evidence for separate dimensions of volitional and expressive symptoms exists, and there may be multiple mechanistic pathways to the same symptom phenomenon among DSM-5 disorders within and outside the schizophrenia-spectrum (ie, equifinality). Evidence for a novel transdiagnostic etiological model is presented based on the Research Domain Criteria (RDoC) constructs, which proposes the existence of 2 such pathways-a hedonic pathway and a cognitive pathway-that can both lead to expressive or volitional symptoms. To facilitate treatment breakthroughs, future transdiagnostic studies on negative symptoms are warranted that explore mechanisms underlying volitional and expressive pathology.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
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171
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Lutgens D, Gariepy G, Malla A. Psychological and psychosocial interventions for negative symptoms in psychosis: systematic review and meta-analysis. Br J Psychiatry 2017; 210:324-332. [PMID: 28302699 DOI: 10.1192/bjp.bp.116.197103] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/10/2016] [Accepted: 01/27/2017] [Indexed: 01/15/2023]
Abstract
BackgroundNegative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.AimsTo conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.MethodWe searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.ResultsA total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive-behavioural therapy (pooled SMD -0.34, 95% CI -0.55 to -0.12), skills-based training (pooled SMD -0.44, 95% CI -0.77 to -0.10), exercise (pooled SMD -0.36, 95% CI -0.71 to -0.01), and music treatments (pooled SMD -0.58, 95% CI -0.82 to -0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD -0.38, 95% CI -0.53 to -0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.ConclusionsSpecific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.
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Affiliation(s)
- Danyael Lutgens
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Genevieve Gariepy
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ashok Malla
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
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172
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Abstract
The specific efficacy of antipsychotics on negative symptoms is questionable, suggesting an urgent need for specific treatments for negative symptoms. This review includes studies published since 2014 with a primary or secondary focus on treating negative symptoms in schizophrenia. Special emphasis is given to recently published meta-analyses. Topics include novel pharmacological approaches, including glutamatergic-based and nicotinic-acetylcholinergic treatments, treatments approved for other indications by the US FDA (or other regulatory bodies) (antipsychotics, antidepressants, and mood stabilizers), brain stimulation, and behavioral- and activity-based approaches, including physical exercise. Potential complications regarding the design of current negative symptom trials are discussed and include inconsistent placebo effects, lack of reliable biomarkers, negative symptom scale and inclusion criteria variability, attempts to distinguish between primary and secondary negative symptoms, lack of focus on early psychosis, and the potential iatrogenic bias of clinical trials.
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA. .,Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, NY, 10032, USA. .,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10023, USA.
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173
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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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174
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Németh G, Laszlovszky I, Czobor P, Szalai E, Szatmári B, Harsányi J, Barabássy Á, Debelle M, Durgam S, Bitter I, Marder S, Fleischhacker WW. Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia: a randomised, double-blind, controlled trial. Lancet 2017; 389:1103-1113. [PMID: 28185672 DOI: 10.1016/s0140-6736(17)30060-0] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although predominant negative symptoms of schizophrenia can be severe enough to cause persistent impairment, effective treatment options are lacking. We aimed to assess the new generation antipsychotic cariprazine in adult patients with predominant negative symptoms. METHODS In this randomised, double-blind, phase 3b trial, we enrolled adults aged 18-65 years with long-term (>2 year), stable schizophrenia and predominant negative symptoms (>6 months) at 66 study centres (mainly hospitals and university clinics, with a small number of private practices) in 11 European countries. Patients were randomly assigned (1:1) by an interactive web response system to 26 weeks of monotherapy with fixed-dose oral cariprazine (3 mg, 4·5 mg [target dose], or 6 mg per day) or risperidone (3 mg, 4 mg [target dose], or 6 mg per day); previous medication was discontinued over 2 weeks. The primary outcome was change from baseline to week 26 or end of treatment on the Positive and Negative Syndrome Scale factor score for negative symptoms (PANSS-FSNS) analysed in a modified intention-to-treat population of patients who had follow-up assessments within 5 days after last receipt of study drugs with a mixed-effects model for repeated measures. Safety was assessed in all patients who received at least one dose of study drug. This study is registered with EudraCT, number 2012-005485-36. FINDINGS Between May 27, 2013, and Nov 17, 2014, 533 patients were screened and 461 (86%) patients were randomised to treatment (230 for cariprazine and 231 for risperidone); 460 were included in the safety population (one patient discontinued before study drug intake). 227 (99%) of 230 patients in the cariprazine group and 229 (99%) of 230 patients in the risperidone group were included in the modified intention-to-treat population (178 [77%] in each group completed 26 weeks of treatment). Mean daily doses were 4·2 mg (SD 0·6) for cariprazine and 3·8 mg (0·4) for risperidone. Treatment-emergent adverse events (eg, insomnia, akathisia, worsening of schizophrenia, headache, anxiety) were reported in 123 (54%) patients treated with cariprazine and 131 (57%) patients treated with risperidone. Use of cariprazine led to a greater least squares mean change in PANSS-FSNS from baseline to week 26 than did risperidone (-8·90 points for cariprazine vs -7·44 points for risperidone; least squares mean difference -1·46, 95% CI -2·39 to -0·53; p=0·0022; effect size 0·31). One patient in the risperidone group died of a cause regarded as unrelated to treatment. INTERPRETATION Our results support the efficacy of cariprazine in the treatment of predominant negative symptoms of schizophrenia. FUNDING Gedeon Richter Plc.
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Affiliation(s)
- György Németh
- Medical Division, Gedeon Richter Plc, Budapest, Hungary.
| | | | - Pál Czobor
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | | | | | | | - Marc Debelle
- Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Suresh Durgam
- Clinical Development, Forest Research Institute, an Allergan affiliate, Jersey City, NJ, USA
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Stephen Marder
- Section on Psychosis, Semel Institute for Neuroscience at University of California Los Angeles, Los Angeles, CA, USA
| | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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175
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Lyne J, Joober R, Schmitz N, Lepage M, Malla A. Duration of active psychosis and first-episode psychosis negative symptoms. Early Interv Psychiatry 2017; 11:63-71. [PMID: 25582878 DOI: 10.1111/eip.12217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/02/2014] [Indexed: 01/22/2023]
Abstract
AIM Duration of untreated psychosis (DUP) has been associated with negative symptoms in several studies; however, longitudinal findings have been inconsistent. No previous study has accounted for active psychosis after presentation, although this could impact on outcomes in a manner similar to DUP. METHODS We measured Scale for the Assessment of Positive Symptoms at frequent intervals during the 12 months after initial presentation to determine the active psychosis duration for 230 individuals with first-episode psychosis. This duration was added to DUP prior to presentation to create a new variable, duration of active psychosis (DAP). Negative symptoms were divided into expressivity and motivation/pleasure domains as measured by Scale for the Assessment of Negative Symptoms (SANS). The relationship of DUP and DAP with negative symptoms at 24-month follow up was determined and confounders controlled for using regression analysis. RESULTS When DUP and DAP were compared as binary variables with long and short groups, 25.2% of individuals had differing category membership. DAP had a significant uncorrected association with both expressivity domain and motivation/pleasure domains at 24 months; however, relationship with DUP was not significant. DAP remained a significant predictor of 24-month expressivity domain after controlling for potential confounders. CONCLUSIONS Active psychosis after presentation is substantial, which is a limitation of DUP studies if active psychosis is considered as the key factor within DUP. DAP is a better predictor of negative symptoms than DUP at 2-year follow up, which suggests this concept requires further research.
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Affiliation(s)
- John Lyne
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University Institute, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University Institute, Montreal, Quebec, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University Institute, Montreal, Quebec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University Institute, Montreal, Quebec, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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176
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Akhondzadeh S, Moazen-Zadeh E. More ACTIONS needed to reach a consensus on adjunctive antidepressant therapy for negative symptoms of schizophrenia. EVIDENCE-BASED MENTAL HEALTH 2017; 20:e3. [PMID: 28011708 PMCID: PMC10688420 DOI: 10.1136/eb-2016-102500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/28/2016] [Accepted: 12/08/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Moazen-Zadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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177
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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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178
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Smulevich AB, Romanov DV, Voronova EI, Mukhorina AK, Chitlova VV, Sorokina OY. Evolution of the schizophrenic deficit concept. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:4-14. [DOI: 10.17116/jnevro2017117914-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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179
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Choi KH, Jaekal E, Lee GY. Motivational and Behavioral Activation as an Adjunct to Psychiatric Rehabilitation for Mild to Moderate Negative Symptoms in Individuals with Schizophrenia: A Proof-of-Concept Pilot Study. Front Psychol 2016; 7:1759. [PMID: 27895602 PMCID: PMC5107574 DOI: 10.3389/fpsyg.2016.01759] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/26/2016] [Indexed: 12/31/2022] Open
Abstract
Few psychosocial approaches address the negative symptoms of schizophrenia, which shares common features with depression and anxiety. Behavioral activation (BA) is effective for addressing depression and anxiety in adults with various mental disorders. Motivational interviewing (MI) has been successfully applied to address ambivalence or lack of motivation toward treatment. Motivational and behavioral activation (mBA) has been developed by incorporating the core principles from BA and MI with recent findings on the negative symptoms of schizophrenia. In this study, we aimed to examine the feasibility and preliminary efficacy of mBA in a non-randomized controlled pilot study that included individuals with schizophrenia with mild to moderate negative symptoms receiving psychiatric rehabilitation. A total of 73 individuals with schizophrenia were recruited. Forty-seven of the participants who met the study inclusion and exclusion criteria were assigned to either an mBA + usual psychiatric rehabilitation group (mBA) or a usual psychiatric rehabilitation only group (treatment as usual, TAU). Administering mBA to individuals with schizophrenia with mild to moderate negative symptoms was feasible in a community mental health setting. Relative to TAU, mBA was associated with large effects in reducing negative symptoms measured using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). However, after considering PANSS cognitive deficits and marital status as covariates due to significant differences in their baseline levels, the treatment effects on the BNSS were partially observed. In addition, participants in the mBA group showed improved verbal learning and memory compared with those in the TAU group. In individuals with schizophrenia receiving the usual forms of psychiatric rehabilitation in a community mental health setting, mBA appears to offer a promising adjunctive approach for addressing mild to moderate negative symptoms. Further investigations are needed to replicate the current findings in a randomized controlled trial.
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Affiliation(s)
- Kee-Hong Choi
- Department of Psychology, Korea University Seoul, Republic of Korea
| | - Eunju Jaekal
- Department of Psychology, Korea University Seoul, Republic of Korea
| | - Ga-Young Lee
- Department of Psychology, Korea University Seoul, Republic of Korea
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180
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Ricarte JJ, Ros L, Latorre JM, Watkins E. Mapping autobiographical memory in schizophrenia: Clinical implications. Clin Psychol Rev 2016; 51:96-108. [PMID: 27846438 DOI: 10.1016/j.cpr.2016.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 10/11/2016] [Accepted: 11/07/2016] [Indexed: 01/08/2023]
Abstract
Increasing evidence suggests that impaired autobiographical memory (AM) mechanisms may be associated with the onset and maintenance of psychopathology. However, there is not yet a comprehensive review of the components of autobiographical memory in schizophrenic patients. The first aim of this review is a synthesis of evidence about the functioning of AM in schizophrenic patients. The main autobiographical elements reviewed in schizophrenic patients include the study of overgeneral memory (form); self-defining memories (contents); consciousness during the process of retrieval (awareness), and the abnormal early reminiscence bump (distribution). AM impairments have been involved in the clinical diagnosis and prognosis of other psychopathologies, especially depression. The second aim is to examine potential parallels between the mechanisms responsible for the onset and maintenance of disturbed AM in other clinical diagnosis and the mechanisms of disturbed autobiographical memory functioning in schizophrenic patients. Cognitive therapies for schizophrenic patients are increasingly demanded. The third aim is the suggestion of key elements for the adaptation of components of autobiographical recall in cognitive therapies for the treatment of symptoms and consequences of schizophrenia.
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Affiliation(s)
- J J Ricarte
- Department of Psychology, Faculty of Medicine, University of Castilla La Mancha, Albacete 02006, Spain
| | - L Ros
- Department of Psychology, Faculty of Medicine, University of Castilla La Mancha, Albacete 02006, Spain.
| | - J M Latorre
- Department of Psychology, Faculty of Medicine, University of Castilla La Mancha, Albacete 02006, Spain
| | - E Watkins
- School of Psychology, University of Exeter and Sir Henry Welcome Building for Mood Disorders Research, Exeter, EX4 4QG, UK
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181
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Maurel M, Belzeaux R, Adida M, Azorin JM. [Negative symptoms: which antipsychotics?]. Encephale 2016; 41:6S32-5. [PMID: 26776390 DOI: 10.1016/s0013-7006(16)30008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Treating negative symptoms of schizophrenia is a major issue and a challenge for the functional and social prognosis of the disease, to which they are closely linked. First- and second-generation antipsychotics allow a reduction of all negative symptoms. The hope of acting directly on primary negative symptoms with any antipsychotic is not supported by the literature. However, the effectiveness of first- and second-generation antipsychotics is demonstrated on secondary negative symptoms.
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Affiliation(s)
- M Maurel
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France.
| | - R Belzeaux
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- 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
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182
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Santos CM, Peres FF, Diana MC, Justi V, Suiama MA, Santana MG, Abílio VC. Peripubertal exposure to environmental enrichment prevents schizophrenia-like behaviors in the SHR strain animal model. Schizophr Res 2016; 176:552-559. [PMID: 27338757 DOI: 10.1016/j.schres.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 11/28/2022]
Abstract
Schizophrenia is a highly disabling mental disorder, in which genetics and environmental factors interact culminating in the disease. The treatment of negative symptoms and cognitive deficits with antipsychotics is currently inefficient and is an important field of research. Environmental enrichment (EE) has been suggested to improve some cognitive deficits in animal models of various psychiatric disorders. In this study, we aimed to evaluate a possible beneficial effect of early and long-term exposure to EE on an animal model of schizophrenia, the SHR strain. Young male Wistar rats (control strain) and SHRs (21 post-natal days) were housed for 6weeks in two different conditions: in large cages (10 animals per cage) containing objects of different textures, forms, colors and materials that were changed 3 times/week (EE condition) or in standard cages (5 animals per cage - Control condition). Behavioral evaluations - social interaction (SI), locomotion, prepulse inhibition of startle (PPI) and spontaneous alternation (SA) - were performed 6weeks after the end of EE. SHRs presented deficits in PPI (a sensorimotor impairment), SI (mimicking the negative symptoms) and SA (a working memory deficit), and also hyperlocomotion (modeling the positive symptoms). EE was able to reduce locomotion and increase PPI in both strains, and to prevent the working memory deficit in SHRs. EE also increased the number of neurons in the CA1 and CA3 of the hippocampus. In conclusion, EE can be a potential nonpharmacological strategy to prevent some behavioral deficits associated with schizophrenia.
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Affiliation(s)
- Camila Mauricio Santos
- LiNC - Interdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil
| | - Fernanda Fiel Peres
- LiNC - Interdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil; Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 5° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil
| | - Mariana Cepollaro Diana
- LiNC - Interdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil
| | - Veronica Justi
- LiNC - Interdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil
| | - Mayra Akimi Suiama
- LiNC - Interdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil; Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 5° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil
| | - Marcela Gonçalves Santana
- LiNC - Interdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil; Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 5° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil
| | - Vanessa Costhek Abílio
- LiNC - Interdisciplinary Laboratory of Clinical Neurosciences, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 3° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil; Department of Pharmacology, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 5° andar, Ed. de Pesquisas II, CEP 04039-032 São Paulo, SP, Brazil
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183
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Carrión RE, Demmin D, Auther AM, McLaughlin D, Olsen R, Lencz T, Correll CU, Cornblatt BA. Duration of attenuated positive and negative symptoms in individuals at clinical high risk: Associations with risk of conversion to psychosis and functional outcome. J Psychiatr Res 2016; 81:95-101. [PMID: 27424062 PMCID: PMC5021595 DOI: 10.1016/j.jpsychires.2016.06.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/25/2016] [Accepted: 06/24/2016] [Indexed: 11/17/2022]
Abstract
Research in individuals at clinical high-risk (CHR) for psychosis has focused on subjects with no more than 12 months of present or worsened attenuated positive symptoms. However, the impact of long duration attenuated positive and/or negative prodromal symptoms on outcomes is unclear. Seventy-six CHR subjects with attenuated positive symptoms and at least moderate severity level negative symptoms rated on the Scale of Prodromal Symptoms (SOPS) were prospectively followed for a mean of 3.0 ± 1.6 years. Social and Role functioning was assessed with the Global Functioning: Social and Role scales. Correlations between attenuated positive and negative symptom duration and severity and conversion to psychosis and functional outcomes were analyzed. The average onset of SOPS rated negative symptoms (M = 53.24 months, SD = 48.90, median = 37.27) was approximately twelve months prior to the emergence of attenuated positive symptom (M = 40.15 months, SD = 40.33, median = 24.77, P < 0.05). More severe positive symptoms (P = 0.004), but not longer duration of positive (P = 0.412) or negative (P = 0.754) symptoms, predicted conversion to psychosis. Neither positive symptom duration (P = 0.181) nor severity (P = 0.469) predicted role or social functioning at study endpoint. Conversely, longer negative symptom duration predicted poor social functioning (P = 0.004). Overall, our findings suggest that the severity of attenuated positive symptoms at baseline may be more important than symptom duration for determining individuals at increased risk of developing psychosis. In contrast, long-standing negative symptoms may be associated with persistent social difficulties and therefore have an important position in the treatment of disability.
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Affiliation(s)
- Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, 11030, USA; Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA.
| | - Docia Demmin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Andrea M Auther
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA
| | - Danielle McLaughlin
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Ruth Olsen
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Todd Lencz
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, 11030, USA; Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA; Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, 11030, USA; Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA; Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, 11030, USA; Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA; Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, 11549, USA
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184
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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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185
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Rakitzi S, Georgila P, Efthimiou K, Mueller DR. Efficacy and feasibility of the Integrated Psychological Therapy for outpatients with schizophrenia in Greece: Final results of a RCT. Psychiatry Res 2016; 242:137-143. [PMID: 27280523 DOI: 10.1016/j.psychres.2016.05.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/03/2016] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
Abstract
The goal of this study was to evaluate the efficacy and the feasibility of cognitive remediation group therapy in patients with schizophrenia in Greece. For this purpose, the cognitive part of the Integrated Psychological Therapy (IPT), focusing on neuro- and social cognition, was compared in a randomized controlled trial (RCT) with treatment as usual (TAU). 48 outpatients took part in the study. IPT groups received 20 biweekly 1-h-therapy sessions. A test-battery was assessed at baseline, after therapy, and at a 3-month follow-up. Regarding cognitive functioning, significant effects favouring IPT were found in working memory and social perception during therapy and at follow-up. No effects could be found in verbal memory and vigilance. Significant effects favoring IPT were found in negative symptoms, in insight and in general symptoms during therapy and at follow-up using the Positive and Negative Syndrome Scale (PANSS). No effects were evident in positive symptoms and in psychosocial functioning. Significant effects favoring TAU were found in the quality of life assessment at follow-up. The study supports evidence for the feasibility and efficacy of IPT in psychiatric care in Greece and it hopefully will initiate the broader use of evidenced-based treatments like IPT in Greek Psychiatry.
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Affiliation(s)
| | - Polyxeni Georgila
- Psychiatric Department for Adults at the General Hospital "G. Gennimatas", Mesogion 154, 11527 Athens, Greece.
| | | | - Daniel R Mueller
- University Hospital of Psychiatry and Psychotherapy Bern, Bolligenstrasse 111, CH 3000 Bern 60, Switzerland.
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186
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Age-related cortical thickness trajectories in first episode psychosis patients presenting with early persistent negative symptoms. NPJ SCHIZOPHRENIA 2016; 2:16029. [PMID: 27602388 PMCID: PMC5007985 DOI: 10.1038/npjschz.2016.29] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/15/2016] [Accepted: 07/07/2016] [Indexed: 12/23/2022]
Abstract
Recent work has clearly established that early persistent negative symptoms (ePNS) can be observed following a first episode of psychosis (FEP), and can negatively affect functional outcome. There is also evidence for cortical changes associated with ePNS. Given that a FEP often occurs during a period of ongoing complex brain development and maturation, neuroanatomical changes may have a specific age-related component. The current study examines cortical thickness (CT) and trajectories with age using longitudinal structural imaging. Structural T1 volumes were acquired at three time points for ePNS (N=21), PNS due to secondary factors (N=31), non-PNS (N=45) patients, and controls (N=48). Images were processed using the CIVET pipeline. Linear mixed models were applied to test for the main effects of (a) group, (b) time, and interactions between (c) time and group membership, and (d) age and group membership. Compared with the non-PNS and secondary PNS patient groups, the ePNS group showed cortical thinning over time in temporal regions and a thickening with age primarily in prefrontal areas. Early PNS patients also had significantly different linear and quadratic age relationships with CT compared with other groups within cingulate, prefrontal, and temporal cortices. The current study demonstrates that FEP patients with ePNS show significantly different CT trajectories with age. Increased CT may be indicative of disruptions in cortical maturation processes within higher-order brain regions. Individuals with ePNS underline a unique subgroup of FEP patients that are differentiated at the clinical level and who exhibit distinct neurobiological patterns compared with their non-PNS peers.
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187
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Abstract
Although treatment-resistant schizophrenia (TRS) was described 50 years ago and has a gold standard treatment with clozapine based on well-defined criteria, there is still a matter of great interest and controversy. In terms of the underlying mechanisms of the development of TRS, progress has been made for the elucidation of the neurochemical mechanisms. Structural neuroimaging studies have shown that patients with TRS have significant reduction of the prefrontal cortex volume when compared with non- TRS. This article updates and enhances our previous review with new evidence mainly derived from new studies, clinical trials, systematic reviews, and meta-analyses.
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Affiliation(s)
- Helio Elkis
- Instituto de Psiquiatria HC- FMUSP, Rua Ovidio Pires de Campos 785-São Paulo, SP-05403-010, Brazil.
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188
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van Donkersgoed RJM, de Jong S, Pijnenborg GHM. Metacognitive Reflection and Insight Therapy (MERIT) with a Patient with Persistent Negative Symptoms. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016; 46:245-253. [PMID: 27795575 PMCID: PMC5061837 DOI: 10.1007/s10879-016-9333-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metacognition comprises a spectrum of mental activities involving thinking about thinking. Metacognitive impairments may sustain and trigger negative symptoms in people with schizophrenia. Without complex ideas of the self and others, there may be less reason to pursue goal-directed activities and less ability to construct meaning in daily activities, leading to the experience of negative symptoms. As these symptoms tend to be nonresponsive to pharmacotherapy and other kinds of treatment metacognition might be a novel treatment target; improvement of metacognition might lead to improvements in negative symptoms. One therapy that seeks to promote metacognition is the Metacognitive Reflection and Insight Therapy (MERIT). In this study, a case is presented in which a first episode patient with severe negative symptoms is treated with MERIT. A case illustration and the eight core principles of MERIT are presented. Independent assessments of metacognition and negative symptoms before and after therapy show a significant increase of metacognition and decrease of negative symptoms over the course of 40 weeks.
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Affiliation(s)
- R. J. M. van Donkersgoed
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, The Netherlands
| | - S. de Jong
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychotic Disorders GGZ-Drenthe, Assen, The Netherlands
| | - G. H. M. Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Psychotic Disorders GGZ-Drenthe, Assen, The Netherlands
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189
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Kallel L, Mondino M, Brunelin J. Effects of theta-rhythm transcranial alternating current stimulation (4.5 Hz-tACS) in patients with clozapine-resistant negative symptoms of schizophrenia: a case series. J Neural Transm (Vienna) 2016; 123:1213-7. [PMID: 27194229 DOI: 10.1007/s00702-016-1574-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
Our aim was to assess the efficacy and safety of theta-rhythm transcranial Alternating Current Stimulation (4.5 Hz-tACS) in patients with clozapine-resistant symptoms of schizophrenia. In an open case series, 3 patients received 20 sessions of 4.5 Hz-tACS (20 min, 2 mA) applied over the dorsolateral prefrontal cortex. The patients exhibited a decrease of negative symptoms (-10 %), general symptoms (-18 %) and an improvement of insight into the illness (-25 %). 4.5 Hz-tACS might be a suitable alternative treatment for clozapine-resistant symptoms of schizophrenia.
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Affiliation(s)
| | - Marine Mondino
- Centre Interdisciplinaire de Recherche en Réadaptation et en Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale, Medical School, Université Laval, Québec, QC, Canada
| | - Jerome Brunelin
- Centre Interdisciplinaire de Recherche en Réadaptation et en Intégration Sociale, Centre de Recherche de l'Institut Universitaire en Santé Mentale, Medical School, Université Laval, Québec, QC, Canada. .,INSERM U1028, CNRS UMR5292, Lyon University, University Lyon 1, Lyon Neuroscience Research Center, PSYR2 team: Psychiatric Disorders: from Resistance to Response Team, Centre Hospitalier Le Vinatier, 69678, Bron, France.
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190
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Kalisz A, Cechnicki A. The stability of negative syndrome, persistent negative syndrome and deficit syndrome in a twenty-year follow-up study of schizophrenia patients. Psychiatry Res 2016; 238:236-241. [PMID: 27086239 DOI: 10.1016/j.psychres.2016.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/20/2022]
Abstract
AIMS To assess the prevalence and stability of negative symptoms in schizophrenia according to the BPRS-withdrawal/retardation, persistent negative symptoms and deficit syndrome over twenty years. METHOD Fifty people diagnosed with schizophrenia were evaluated during their first psychiatric hospitalisation and after three, seven, twelve and twenty years. the presence of negative symptoms was assumed when at least one of the BPRS-withdrawal/retardation symptoms (blunted affect, emotional withdrawal, motor retardation), equalled three or more points at the discharge from the index hospitalisation. The groups with persistent negative symptoms and deficit syndrome were identified based on two measurements taken at the index discharge and one year later. The Proxy for the Deficit Syndrome (PDS) was employed to identify deficit syndrome. RESULTS The prevalence of BPRS-withdrawal/retardation, persistent negative symptoms and deficit syndrome after one year was 20%, 4% and 6% respectively. Four of the ten people with BPRS-withdrawal/retardation symptoms maintained them at all follow-ups. No symptoms, however, were found in any of the members of the persistent negative symptoms and deficit syndrome group after twelve and twenty years. CONCLUSIONS The prevalence of primary, persistent negative symptoms after the first episode of psychosis was minimal. A long-term observation does not confirm their stability.
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Affiliation(s)
- Aneta Kalisz
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University, Pl. Sikorskiego 2/8, 31-115, Kraków, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University, Pl. Sikorskiego 2/8, 31-115, Kraków, Poland.
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191
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Farhat SL, Hochard C, Orens S, Gautier C, Lambert T, Geret L, Bralet MC. [MODen: Psychoeducationnal therapeutic group program for schizophrenic patients, based on nutritional balance and pleasure, using cognitive functions: A pilot study]. Encephale 2016; 42:410-414. [PMID: 26995151 DOI: 10.1016/j.encep.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/08/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Schizophrenia causes psychological difficulties (with positive and/or negative symptoms) as well as cognitive disabilities (attention, memory, executive functions and social cognition). Moreover, 40 to 60% of patients suffer from an excess of weight or obesity (due to bad eating habits, eating disorders or medication). All these difficulties impair their autonomy and their insertion into the society. In this context, setting-up a therapeutic tool, which may have cognitive benefits seems relevant. Thus, MODen is a therapeutic educational tool whose aim is to improve cognitive functions and the symptoms by using "nutritional balance" as an aid. METHOD In this treatment program, two therapists lead a group of 5 to 8 patients which group meets once a week during two to four hours for 16 weeks, divided in 4 cycles. The first three weeks of each cycle consists of theoretical instruction: patients talk about their eating habits, information is given about nutritional balance and preparation of meals. In the different cycles, flexibility, planning, memory and attention are trained. For instance, the work on categorisation of foods and nutritional balance allow enhancing flexibility abilities. Writing down the lists of different ingredients needed for one week's meals and preparation of meals train planning abilities. MODen also takes into account ecological issues such as the limited budget of patients to do their shopping (this budget is around 4 euros per meal in France). The budget is also linked to planning abilities and reasoning. Finally, during the last session of each cycle the group prepares a meal (from the shopping to cooking). This last session is all about sharing and social cognition abilities. By the end of the program, patients will have prepared four meals together. Also "homework" has to be done each week in order to facilitate memorisation of what has been learned during the last session and to prepare the beginning of the next session. RESULTS In a pilot study with 8 patients with schizophrenia (DSM-IV), improvements in PANSS negative symptoms and disorganization (respectively P<0.02; P<0.02) were observed. An underlying improvement at BECS scores was also observed (P<0.08). Regarding those preliminary results as well as the ecological qualities of this program, this therapeutic tool could be relevant in the treatment of patients with schizophrenia.
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Affiliation(s)
- S L Farhat
- Unité Crisalid, pôle FJ5, CHI Clermont-de-l'Oise, 2, rue des Finets, 60600 Clermont, France; GDR 3557, groupe de recherche en psychiatrie, 7, rue Cabanis, 75014 Paris, France.
| | - C Hochard
- Unité Crisalid, pôle FJ5, CHI Clermont-de-l'Oise, 2, rue des Finets, 60600 Clermont, France
| | - S Orens
- Unité Crisalid, pôle FJ5, CHI Clermont-de-l'Oise, 2, rue des Finets, 60600 Clermont, France
| | - C Gautier
- Unité Crisalid, pôle FJ5, CHI Clermont-de-l'Oise, 2, rue des Finets, 60600 Clermont, France
| | - T Lambert
- Unité Crisalid, pôle FJ5, CHI Clermont-de-l'Oise, 2, rue des Finets, 60600 Clermont, France
| | - L Geret
- Unité Crisalid, pôle FJ5, CHI Clermont-de-l'Oise, 2, rue des Finets, 60600 Clermont, France
| | - M C Bralet
- Unité Crisalid, pôle FJ5, CHI Clermont-de-l'Oise, 2, rue des Finets, 60600 Clermont, France; GDR 3557, groupe de recherche en psychiatrie, 7, rue Cabanis, 75014 Paris, France; Unité Inserm U669, Psigiam, universités Paris 5-11, 9, boulevard de Port-Royal, 75014 Paris, France
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192
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[Concept and results of the German Research Network on Schizophrenia]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:412-9. [PMID: 26955980 DOI: 10.1007/s00103-016-2311-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The German Research Network on Schizophrenia (GRNS) was funded by the Federal Ministry of Education and Research (BMBF) from 1999 to 2011. The aim was to obtain a better horizontal and vertical networking of German research and care facilities on schizophrenia, in order to investigate open research questions, to transfer the results into clinical practice and improve care and quality of life in patients with schizophrenia. OBJECTIVES/METHODS This paper describes the concept and operations of the GRNS as well as its results on the basis of selected research projects. RESULTS The GRNS comprised about 25 clinical trials of high practical relevance, which were closely interrelated regarding content, methodology and organization. The trials primarily served the development and evaluation of new and established diagnostic and therapeutic approaches, the assessment of the status quo of clinical care, as well as its improvements, together with the investigation of basic scientific questions. Many substantial results to highly relevant issues were obtained, which led or will lead to an improvement in mental health care. CONCLUSIONS Quantitative and qualitative evaluation parameters, such as scientific publications and obtaining additional grants, as well as promotion of young scientists, public relations activities, congress activities and the foundation of a European Schizophrenia Association, document the successful work of the network. Successful funding requests will allow us to continue cooperative schizophrenia research in Germany as initiated by the GRNS, without necessarily always binding these activities formally to the GRNS.
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Iranpour N, Zandifar A, Farokhnia M, Goguol A, Yekehtaz H, Khodaie-Ardakani MR, Salehi B, Esalatmanesh S, Zeionoddini A, Mohammadinejad P, Zeinoddini A, Akhondzadeh S. The effects of pioglitazone adjuvant therapy on negative symptoms of patients with chronic schizophrenia: a double-blind and placebo-controlled trial. Hum Psychopharmacol 2016; 31:103-12. [PMID: 26856695 DOI: 10.1002/hup.2517] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 11/23/2015] [Accepted: 12/09/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The evident central role of inflammation, oxidative stress, and metabolic derangement in pathophysiology of negative symptoms of schizophrenia has opened new insights into probable pharmacological options for these symptoms. Pioglitazone is an antidiabetic agent with anti-inflammatory and antioxidant properties. In this study, we evaluated the efficacy of pioglitazone as an adjunct to risperidone for reduction of negative symptoms in schizophrenia. METHODS In this randomized, double-blind, placebo-controlled trial, 40 patients with chronic schizophrenia and a minimum score of 20 on the negative subscale of Positive and Negative Syndrome Scale (PANSS) were randomly allocated to receive risperidone plus either pioglitazone (30 mg/day) or placebo for 8 weeks. Patients' symptoms and adverse events were rated at baseline and weeks 2, 4, 6, and 8. The difference between the two groups in decline of PANSS negative subscale scores was considered as the primary outcome of this study. RESULTS At the study endpoint, patients in the pioglitazone group showed significantly more improvement in PANSS negative subscale scores (p < 0.001) as well as PANSS total scores (p = 0.01) compared with the placebo group. CONCLUSION These findings suggest the probable efficacy of pioglitazone as an augmentation therapy in reducing the negative symptoms of schizophrenia.
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Affiliation(s)
- Negar Iranpour
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zandifar
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Farokhnia
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Goguol
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibeh Yekehtaz
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bahman Salehi
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran
| | - Sophia Esalatmanesh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zeionoddini
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Mohammadinejad
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arefeh Zeinoddini
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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194
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Nelson BD, Bjorkquist OA, Olsen EK, Herbener ES. Schizophrenia symptom and functional correlates of anterior cingulate cortex activation to emotion stimuli: An fMRI investigation. Psychiatry Res 2015; 234:285-91. [PMID: 26596521 PMCID: PMC4679428 DOI: 10.1016/j.pscychresns.2015.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022]
Abstract
Schizophrenia is a chronic mental illness characterized by distinct positive and negative symptoms and functional impairment. The anterior cingulate cortex (ACC) is a region of the brain's limbic system that is hypoactive during emotion processing in schizophrenia. Recent evidence suggests the hypoactive ACC in schizophrenia is due to negative (and not positive) symptoms. However, this finding has not been replicated and the functional significance of this relationship remains unclear. The present study examined the association between positive and negative symptoms, ACC activation to emotional images, and functional outcome in schizophrenia. Specifically, 16 schizophrenia/schizoaffective disorder (SZ/SZAF) and 15 control (CON) participants underwent an fMRI scan while completing an emotional picture-rating task. SZ/SZAF participants also completed clinician-rated measures of positive and negative symptoms and functional abilities. SZ/SZAF participants with high negative symptoms had reduced ACC activation to pleasant images relative to those with low negative symptoms and CON, who did not differ. Furthermore, amongst all SZ/SZAF participants poorer social functioning was associated with decreased ACC activation to pleasant images. Finally, ACC activation partially mediated the relationship between negative symptoms and social dysfunction. These results provide evidence of the functional significance of the relationship between negative symptoms and ACC dysfunction in schizophrenia.
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Affiliation(s)
- Brady D. Nelson
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA,Correspondence concerning this article should be addressed to Brady D. Nelson, Department of Psychology, Stony Brook University, Stony Brook, NY, 11794. Phone: 631-632-7697; Fax: 631-632-7876;
| | | | - Emily K. Olsen
- Department of Psychology, University of Illinois-Chicago, Chicago, IL, USA
| | - Ellen S. Herbener
- Department of Psychology, University of Illinois-Chicago, Chicago, IL, USA,Department of Psychiatry, University of Illinois-Chicago, Chicago, IL, USA
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195
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Siegrist K, Millier A, Amri I, Aballéa S, Toumi M. Association between social contact frequency and negative symptoms, psychosocial functioning and quality of life in patients with schizophrenia. Psychiatry Res 2015; 230:860-6. [PMID: 26626950 DOI: 10.1016/j.psychres.2015.11.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 11/16/2022]
Abstract
The lack of social contacts may be an important element in the presumed vicious circle aggravating, or at least stabilising negative symptoms in patients with schizophrenia. A European 2-year cohort study collected negative symptom scores, psychosocial functioning scores, objective social contact frequency scores and quality of life scores every 6 months. Bivariate analyses, correlation analyses, multivariate regressions and random effects regressions were conducted to describe relations between social contact and outcomes of interest and to gain a better understanding of this relation over time. Using data from 1208 patients with schizophrenia, a link between social contact frequency and negative symptom scores, functioning and quality of life at baseline was established. Regression models confirmed the significant association between social contact and negative symptoms as well as psychosocial functioning. This study aimed at demonstrating the importance of social contact for deficient behavioural aspects of schizophrenia.
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Affiliation(s)
- Karin Siegrist
- Graduate School Public Health, Heinrich-Heine-Universität Düsseldorf, Dusseldorf, Germany.
| | - Aurelie Millier
- Creativ-Ceutical, 215 rue du Faubourg Saint Honoré, 75008 Paris, France.
| | | | - Samuel Aballéa
- Creativ-Ceutical, 215 rue du Faubourg Saint Honoré, 75008 Paris, France.
| | - Mondher Toumi
- Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France.
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196
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Sarkar S, Hillner K, Velligan DI. Conceptualization and treatment of negative symptoms in schizophrenia. World J Psychiatry 2015; 5:352-361. [PMID: 26740926 PMCID: PMC4694548 DOI: 10.5498/wjp.v5.i4.352] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/07/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
Negative symptoms of schizophrenia including social withdrawal, diminished affective response, lack of interest, poor social drive, and decreased sense of purpose or goal directed activity predict poor functional outcomes for patients with schizophrenia. They may develop and be maintained as a result of structural and functional brain abnormalities, particularly associated with dopamine reward pathways and by environmental and psychosocial factors such as self-defeating cognitions and the relief from overstimulation that accompanies withdrawal from social and role functioning. Negative symptoms are more difficult to treat than the positive symptoms of schizophrenia and represent an unmet therapeutic need for large numbers of patients with schizophrenia. While antipsychotic medications to treat the symptoms of schizophrenia have been around for decades, they have done little to address the significant functional impairments in the disorder that are associated with negative symptoms. Negative symptoms and the resulting loss in productivity are responsible for much of the world-wide personal and economic burden of schizophrenia. Pharmacologic treatments may be somewhat successful in treating secondary causes of negative symptoms, such as antipsychotic side effects and depression. However, in the United States there are no currently approved treatments for severe and persistent negative symptoms (PNS) that are not responsive to treatments for secondary causes. Pharmacotherapy and psychosocial treatments are currently being developed and tested with severe and PNS as their primary targets. Academia, clinicians, the pharmaceutical industry, research funders, payers and regulators will need to work together to pursue novel treatments to address this major public health issue.
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197
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Haro JM, Altamura C, Corral R, Elkis H, Evans J, Malla A, Krebs MO, Zink M, Bernasconi C, Lalonde J, Nordstroem AL. Understanding the impact of persistent symptoms in schizophrenia: Cross-sectional findings from the Pattern study. Schizophr Res 2015; 169:234-240. [PMID: 26431792 DOI: 10.1016/j.schres.2015.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/30/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The high societal burden of schizophrenia is largely caused by the persistence of symptoms and accompanying functional impairment. To date, no studies have specifically assessed the course of persistent symptoms or the individual contributions of positive and negative symptoms to patient functioning. The cross-sectional analysis of the Pattern study provides an international perspective of the burden of schizophrenia. METHODS Clinically stable outpatients from 140 study centers across eight countries (Argentina, Brazil, Canada, France, Germany, Italy, Spain and the United Kingdom) were assessed using clinical rating scales: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia (CGI-SCH) Scale and the Personal and Social Performance (PSP) Scale. Additional measures included patient-reported outcomes, patient socio-demographic variables, living situation, employment and resource use. RESULTS Overall, 1379 patients were assessed and analyzed and had similar sociodemographic characteristics across countries, with 61.6% having persistent positive and/or negative symptoms. Positive and negative symptoms had been persistent for a mean of 9.6 and 8.9 years (SD: 8.8 and 9.6), respectively. Approximately 86% of patients had a functional disability classified as greater than mild. Patients with a higher PANSS Negative Symptom Factor Score were more likely to have a poorer level of functioning. CONCLUSIONS This analysis examines individual contributions of persistent positive and negative symptoms on patient functioning in different countries. A high prevalence of patients with persistent symptoms and functional impairment was a consistent finding across countries. Longitudinal observations are necessary to assess how to improve persistent symptoms of schizophrenia and overall patient functioning.
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Affiliation(s)
- Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
| | - Carlo Altamura
- University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
| | - Ricardo Corral
- Fundación para el Estudio y Tratamiento de las Enfermedades Mentales (FETEM), Cerviño 4634 5th floor Apt. B, Buenos Aires C1425AHQ, Argentina
| | - Helio Elkis
- Departamento e Instituto de Psiquiatria-FMUSP, Sao Paulo, Brazil
| | - Jonathan Evans
- Centre for Academic Mental Health, University of Bristol, Bristol BS8 2BN, UK
| | - Ashok Malla
- Douglas Mental Health University Institute, McGill University, Montréal, Qc H4H 1R3, Canada
| | - Marie-Odile Krebs
- Service Hospitalo Universitaire, Laboratoire de Physiopathologie des Maladies Psychiatriques, Inserm, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Mathias Zink
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Lodovighi MA, Palomba A, Belzeaux R, Adida M, Azorin JM. Symptômes négatifs de la schizophrénie : nouvelles approches pharmacologiques. Encephale 2015; 41:6S41-9. [DOI: 10.1016/s0013-7006(16)30010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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199
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Bicks LK, Koike H, Akbarian S, Morishita H. Prefrontal Cortex and Social Cognition in Mouse and Man. Front Psychol 2015; 6:1805. [PMID: 26635701 PMCID: PMC4659895 DOI: 10.3389/fpsyg.2015.01805] [Citation(s) in RCA: 327] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/09/2015] [Indexed: 12/15/2022] Open
Abstract
Social cognition is a complex process that requires the integration of a wide variety of behaviors, including salience, reward-seeking, motivation, knowledge of self and others, and flexibly adjusting behavior in social groups. Not surprisingly, social cognition represents a sensitive domain commonly disrupted in the pathology of a variety of psychiatric disorders including Autism Spectrum Disorder (ASD) and Schizophrenia (SCZ). Here, we discuss convergent research from animal models to human disease that implicates the prefrontal cortex (PFC) as a key regulator in social cognition, suggesting that disruptions in prefrontal microcircuitry play an essential role in the pathophysiology of psychiatric disorders with shared social deficits. We take a translational perspective of social cognition, and review three key behaviors that are essential to normal social processing in rodents and humans, including social motivation, social recognition, and dominance hierarchy. A shared prefrontal circuitry may underlie these behaviors. Social cognition deficits in animal models of neurodevelopmental disorders like ASD and SCZ have been linked to an altered balance of excitation and inhibition (E/I ratio) within the cortex generally, and PFC specifically. A clear picture of the mechanisms by which altered E/I ratio in the PFC might lead to disruptions of social cognition across a variety of behaviors is not well understood. Future studies should explore how disrupted developmental trajectory of prefrontal microcircuitry could lead to altered E/I balance and subsequent deficits in the social domain.
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Affiliation(s)
- Lucy K Bicks
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Hiroyuki Koike
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Schahram Akbarian
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Hirofumi Morishita
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA ; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA
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200
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Goodby E, MacLeod AK. Future-directed thinking in first-episode psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2015; 55:93-106. [PMID: 26514944 DOI: 10.1111/bjc.12096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 09/15/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study employed the Future Thinking Task (MacLeod et al., 2005, Br. J. Clin. Psychol., 44, 495) to investigate whether future-directed thinking in first-episode psychosis is significantly different from that of matched controls, and to identify its correlates in this patient group. DESIGN Cross-sectional, mixed-model, case-control design. METHOD Participants were 30 patients with first-episode psychosis and 27 matched controls. The Future Thinking Task was used to assess future-directed thinking in both groups. Anxiety and depression were also measured as well as self-report measures of hopelessness, suicide ideation and a measure of negative symptoms. RESULTS Individuals with psychosis were impaired in future-directed thinking in both positive and negative domains, particularly with respect to the coming year. Increased self-reported hopelessness was associated with reduced positive future thinking and increased negative future thinking. Increased positive future thinking was also associated with reduced severity of negative symptoms, whilst negative future thinking was associated with suicide ideation. CONCLUSIONS Individuals with first-episode psychosis show a reduction in positive future thinking in line with that seen in other clinical groups, but this is accompanied by an unexpected reduction in negative future thinking. The findings suggest a general disengagement with the future in this group that may affect recovery and functioning. PRACTITIONER POINTS Individuals with first-episode psychosis may benefit from interventions to help them engage with their future, in particular in the mid-range, up to 1 year. The Future Thinking Task may be a helpful addition to the assessment of suicide risk in those with first-episode psychosis. Decreased positive future thinking was associated with increased severity of negative symptoms, indicating a potential new treatment angle for this resistant aspect of psychosis. The cross-sectional design of this study does not allow for conclusions about the causal relationship between psychosis and future-directed thinking. This study investigated future-directed thinking in individuals with a range of psychotic illnesses employing a trans-diagnostic approach; therefore, conclusions cannot be drawn about the nature of future-directed thinking in individual psychotic disorders.
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Affiliation(s)
- Emmeline Goodby
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Andrew K MacLeod
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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