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Abram SV, Weittenhiller LP, Bertrand CE, McQuaid JR, Mathalon DH, Ford JM, Fryer SL. Psychological Dimensions Relevant to Motivation and Pleasure in Schizophrenia. Front Behav Neurosci 2022; 16:827260. [PMID: 35401135 PMCID: PMC8985863 DOI: 10.3389/fnbeh.2022.827260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Motivation and pleasure deficits are common in schizophrenia, strongly linked with poorer functioning, and may reflect underlying alterations in brain functions governing reward processing and goal pursuit. While there is extensive research examining cognitive and reward mechanisms related to these deficits in schizophrenia, less attention has been paid to psychological characteristics that contribute to resilience against, or risk for, motivation and pleasure impairment. For example, psychological tendencies involving positive future expectancies (e.g., optimism) and effective affect management (e.g., reappraisal, mindfulness) are associated with aspects of reward anticipation and evaluation that optimally guide goal-directed behavior. Conversely, maladaptive thinking patterns (e.g., defeatist performance beliefs, asocial beliefs) and tendencies that amplify negative cognitions (e.g., rumination), may divert cognitive resources away from goal pursuit or reduce willingness to exert effort. Additionally, aspects of sociality, including the propensity to experience social connection as positive reinforcement may be particularly relevant for pursuing social goals. In the current review, we discuss the roles of several psychological characteristics with respect to motivation and pleasure in schizophrenia. We argue that individual variation in these psychological dimensions is relevant to the study of motivation and reward processing in schizophrenia, including interactions between these psychological dimensions and more well-characterized cognitive and reward processing contributors to motivation. We close by emphasizing the value of considering a broad set of modulating factors when studying motivation and pleasure functions in schizophrenia.
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Affiliation(s)
- Samantha V Abram
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren P Weittenhiller
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Claire E Bertrand
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
| | - John R McQuaid
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel H Mathalon
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Judith M Ford
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Susanna L Fryer
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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2
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Abplanalp SJ, Mote J, Uhlman AC, Weizenbaum E, Alvi T, Tabak BA, Fulford D. Parsing social motivation: development and validation of a self-report measure of social effort. J Ment Health 2021; 31:366-373. [PMID: 34304675 DOI: 10.1080/09638237.2021.1952948] [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: 10/20/2022]
Abstract
BACKGROUND Reduced efforts to form and maintain social bonds can exist in the context of a sufficient desire for social connection. Thus, social impairment common across many psychiatric conditions may often reflect failures in social effort exertion, despite normative levels of social liking and wanting. Although there are many questionnaires available that assess sociability, desire, or lack thereof for connection and perceived social support, there is no current self-report assessment of the behavioral outputs of social motivation. AIMS We aimed to develop and validate a measure of the social effort in college students and the general population. METHODS College students (n = 981) and a broader sample of adults via Amazon's Mechanical Turk (MTurk; n = 506) participated in the study. RESULTS We identified two factors that represented content related to general social effort and social effort in adherence with social norms; we named the measure the Social Effort and Conscientiousness Scale (SEACS). Results suggest the SEACS is a reliable and valid measure of social effort. CONCLUSIONS Lower scores on the SEACS were associated with symptoms of depression and anxiety, highlighting the scale's potential utility in clinical populations. We include a discussion of possible applications of the SEACS, including its further use and application in psychopathology research.
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Affiliation(s)
- Samuel J Abplanalp
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Jasmine Mote
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Anne C Uhlman
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Emma Weizenbaum
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - Talha Alvi
- Department of Psychology, Southern Methodist University, University Park, TX, USA
| | - Benjamin A Tabak
- Department of Psychology, Southern Methodist University, University Park, TX, USA
| | - Daniel Fulford
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA.,Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
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3
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Mow JL, Gandhi A, Fulford D. Imaging the "social brain" in schizophrenia: A systematic review of neuroimaging studies of social reward and punishment. Neurosci Biobehav Rev 2020; 118:704-722. [PMID: 32841653 DOI: 10.1016/j.neubiorev.2020.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/20/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
Decreased social functioning and high levels of loneliness and social isolation are common in schizophrenia spectrum disorders (SSD), contributing to reduced quality of life. One key contributor to social impairment is low social motivation, which may stem from aberrant neural processing of socially rewarding or punishing stimuli. To summarize research on the neurobiology of social motivation in SSD, we performed a systematic literature review of neuroimaging studies involving the presentation of social stimuli intended to elicit feelings of reward and/or punishment. Across 11 studies meeting criteria, people with SSD demonstrated weaker modulation of brain activity in regions within a proposed social interaction network, including prefrontal, cingulate, and striatal regions, as well as the amygdala and insula. Firm conclusions regarding neural differences in SSD in these regions, as well as connections within networks, are limited due to conceptual and methodological inconsistencies across the available studies. We conclude by making recommendations for the study of social reward and punishment processing in SSD in future research.
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Affiliation(s)
- Jessica L Mow
- Department of Psychological & Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, United States.
| | - Arti Gandhi
- Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, United States
| | - Daniel Fulford
- Department of Psychological & Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA, 02215, United States; Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, United States
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4
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Loijen A, Vrijsen JN, Egger JI, Becker ES, Rinck M. Biased approach-avoidance tendencies in psychopathology: A systematic review of their assessment and modification. Clin Psychol Rev 2020; 77:101825. [DOI: 10.1016/j.cpr.2020.101825] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 01/18/2023]
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5
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Papousek I, Wimmer S, Lackner HK, Schulter G, Perchtold CM, Paechter M. Trait positive affect and students’ prefrontal EEG alpha asymmetry responses during a simulated exam situation. Biol Psychol 2019; 148:107762. [DOI: 10.1016/j.biopsycho.2019.107762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/19/2019] [Accepted: 08/31/2019] [Indexed: 12/20/2022]
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6
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Social motivation in schizophrenia: How research on basic reward processes informs and limits our understanding. Clin Psychol Rev 2018; 63:12-24. [PMID: 29870953 DOI: 10.1016/j.cpr.2018.05.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/18/2018] [Accepted: 05/26/2018] [Indexed: 12/17/2022]
Abstract
Limited quantity and quality of interpersonal exchanges and relationships predict worse symptomatic and hospitalization outcomes and limit functional recovery in people with schizophrenia. While deficits in social skills and social cognition contribute to much of the impairment in social functioning in schizophrenia, our focus on the current review is social motivation-the drive to connect with others and form meaningful, lasting relationships. We pay particular attention to how recent research on reward informs, and limits, our understanding of the construct. Recent findings that parse out key components of human motivation, especially the temporal nature of reward and effort, are informative for understanding some aspects of social motivation. This approach, however, fails to fully integrate the critical influence of uncertainty and punishment (e.g., avoidance, threat) in social motivation. In the current review, we argue for the importance of experimental paradigms and real-time measurement to capture the interaction between social approach and avoidance in characterizing social affiliation in schizophrenia. We end with suggestions for how researchers might move the field forward by emphasizing the ecological validity of social motivation paradigms, including dynamic, momentary assessment of social reward and punishment using mobile technology and other innovative tools.
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Papousek I, Aydin N, Rominger C, Feyaerts K, Schmid-Zalaudek K, Lackner HK, Fink A, Schulter G, Weiss EM. DSM-5 personality trait domains and withdrawal versus approach motivational tendencies in response to the perception of other people’s desperation and angry aggression. Biol Psychol 2018; 132:106-115. [DOI: 10.1016/j.biopsycho.2017.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 02/06/2023]
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8
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Radke S, Kalt T, Wagels L, Derntl B. Implicit and Explicit Motivational Tendencies to Faces Varying in Trustworthiness and Dominance in Men. Front Behav Neurosci 2018; 12:8. [PMID: 29410619 PMCID: PMC5787135 DOI: 10.3389/fnbeh.2018.00008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/11/2018] [Indexed: 11/13/2022] Open
Abstract
Motivational tendencies to happy and angry faces are well-established, e.g., in the form of aggression. Approach-avoidance reactions are not only elicited by emotional expressions, but also linked to the evaluation of stable, social characteristics of faces. Grounded in the two fundamental dimensions of face-based evaluations proposed by Oosterhof and Todorov (2008), the current study tested whether emotionally neutral faces varying in trustworthiness and dominance potentiate approach-avoidance in 50 healthy male participants. Given that evaluations of social traits are influenced by testosterone, we further tested for associations of approach-avoidance tendencies with endogenous and prenatal indicators of testosterone. Computer-generated faces signaling high and low trustworthiness and dominance were used to elicit motivational reactions in three approach-avoidance tasks, i.e., one implicit and one explicit joystick-based paradigm, and an additional rating task. When participants rated their behavioral tendencies, highly trustworthy faces evoked approach, and highly dominant faces evoked avoidance. This pattern, however, did not translate to faster initiation times of corresponding approach-avoidance movements. Instead, the joystick tasks revealed general effects, such as faster reactions to faces signaling high trustworthiness or high dominance. These findings partially support the framework of Oosterhof and Todorov (2008) in guiding approach-avoidance decisions, but not behavioral tendencies. Contrary to our expectations, neither endogenous nor prenatal indicators of testosterone were associated with motivational tendencies. Future studies should investigate the contexts in which testosterone influences social motivation.
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Affiliation(s)
- Sina Radke
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,JARA - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at Systemic Levels, RWTH Aachen University, Aachen, Germany
| | - Theresa Kalt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Lisa Wagels
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.,JARA - BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at Systemic Levels, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-10), Research Center Jülich, Jülich, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Medical School, University of Tübingen, Tübingen, Germany.,Werner Reichardt Center for Integrative Neuroscience, University of Tübingen, Tübingen, Germany.,LEAD Graduate School, University of Tübingen, Tübingen, Germany
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9
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Angry but not neutral faces facilitate response inhibition in schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 2017; 267:621-627. [PMID: 27866272 DOI: 10.1007/s00406-016-0748-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
Schizophrenia is a very heterogeneous disorder with extensive impairments in cognitive as well as emotional abilities. One critical domain is response inhibition, and previous studies in schizophrenia patients have mostly observed impairments, i.e., slower inhibition. Moreover, response inhibition to socially salient stimuli has not been investigated in schizophrenia so far. Therefore, to elucidate emotion-cognition interactions by examining potential emotional effects on inhibition processes and further investigate the association of cognition with inhibition we used an emotional stop signal task in 27 schizophrenia patients and 27 gender- and age-matched controls. Task irrelevant emotional faces (angry and neutral) were used as stimuli in a stop signal reaction time task. Regarding accuracy, patients showed significantly worse performance in neutral trials, while their performance in anger trials (stop and go) was similar to controls. Angry faces elicited faster response inhibition in both groups, underlining an emotional facilitation effect. Neurocognitive functions significantly correlated with accuracy in the stop signal task in schizophrenia patients, thus further strengthening the notion of the strong link between cognitive abilities and inhibition processes. Inhibitory control impairments are of high clinical interest due to their association with substance abuse, impulsive behavior and suicide. Based on our data, neutral faces significantly affect response inhibition in schizophrenia while an emotional facilitation effect was apparent for angry faces even in schizophrenia patients. Thus, our data further support the notion that neutral face processing is critically impaired in schizophrenia.
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10
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Reddy LF, Green MF, Wynn JK, Rinck M, Horan WP. Approaching anger in schizophrenia: What an implicit task tells you that self-report does not. Schizophr Res 2016; 176:514-519. [PMID: 27242068 DOI: 10.1016/j.schres.2016.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/17/2016] [Accepted: 05/21/2016] [Indexed: 12/01/2022]
Abstract
Motivational deficits are important determinants of impaired social functioning in schizophrenia, yet we know very little about their precise nature. One influential model of motivation distinguishes between approach and avoidance neurobiological systems that impact the tendency to approach rewarding and avoid threatening stimuli. The current study evaluated approach and avoidance motivational tendencies using both implicit and explicit measures. One-hundred and sixteen individuals with schizophrenia and 73 healthy controls completed the implicit Approach Avoidance Task (AAT) which provides a reaction time-based measure of approach and avoidance tendencies for happy and angry faces, and the Behavioral Inhibition/Behavioral Activation System Scale (BIS/BAS), a self-report measure of approach and avoidance tendencies. The patient sample was re-administered the AAT four weeks later to evaluate re-test reliability. At baseline, patients showed a significant tendency to approach (rather than avoid) angry faces on the AAT. This same pattern was replicated at the follow-up assessment. In contrast, on the BIS/BAS, patients reported significantly elevated BIS scores, reflecting increased avoidance of aversive, anxiety-inducing stimuli. Results suggest a discrepancy between patients' implicit behavioral tendency to approach angry faces and their self-reported avoidance of aversive stimuli.
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Affiliation(s)
- L Felice Reddy
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States.
| | - Michael F Green
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States
| | - Jonathan K Wynn
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, Netherlands
| | - William P Horan
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States
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11
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Schilbach L, Derntl B, Aleman A, Caspers S, Clos M, Diederen KMJ, Gruber O, Kogler L, Liemburg EJ, Sommer IE, Müller VI, Cieslik EC, Eickhoff SB. Differential Patterns of Dysconnectivity in Mirror Neuron and Mentalizing Networks in Schizophrenia. Schizophr Bull 2016; 42:1135-48. [PMID: 26940699 PMCID: PMC4988733 DOI: 10.1093/schbul/sbw015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Impairments of social cognition are well documented in patients with schizophrenia (SCZ), but the neural basis remains poorly understood. In light of evidence that suggests that the "mirror neuron system" (MNS) and the "mentalizing network" (MENT) are key substrates of intersubjectivity and joint action, it has been suggested that dysfunction of these neural networks may underlie social difficulties in SCZ patients. Additionally, MNS and MENT might be associated differently with positive vs negative symptoms, given prior social cognitive and symptom associations. We assessed resting state functional connectivity (RSFC) in meta-analytically defined MNS and MENT networks in this patient group. Magnetic resonance imaging (MRI) scans were obtained from 116 patients and 133 age-, gender- and movement-matched healthy controls (HC) at 5 different MRI sites. Network connectivity was analyzed for group differences and correlations with clinical symptoms. Results demonstrated decreased connectivity within the MNS and also the MENT in patients compared to controls. Notably, dysconnectivity of the MNS was related to symptom severity, while no such relationship was observed for the MENT. In sum, these findings demonstrate that differential patterns of dysconnectivity exist in SCZ patients, which may contribute differently to the interpersonal difficulties commonly observed in the disorder.
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Affiliation(s)
- Leonhard Schilbach
- Max Planck Institute of Psychiatry, Munich, Germany;,Department of Psychiatry, University Hospital Cologne, Cologne, Germany;,These authors contributed equally
| | - Birgit Derntl
- Department of Psychiatry, Psychotherapy & Psychosomatics, RWTH University Aachen, Aachen, Germany; Jülich Aachen Research Alliance, JARA-BRAIN, Translational Brain Medicine, Jülich-Aachen, Germany; Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany; Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany;
| | - Andre Aleman
- BCN Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
| | - Mareike Clos
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
| | - Kelly M. J. Diederen
- Neuroscience Division, University Medical Center Utrecht & Rudolf Magnus Institute for Neuroscience, Utrecht, Netherlands
| | - Oliver Gruber
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany;,Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - Lydia Kogler
- Department of Psychiatry, Psychotherapy & Psychosomatics, RWTH University Aachen, Aachen, Germany;,Jülich Aachen Research Alliance, JARA-BRAIN, Translational Brain Medicine, Jülich-Aachen, Germany;,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Edith J. Liemburg
- BCN Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Iris E. Sommer
- Neuroscience Division, University Medical Center Utrecht & Rudolf Magnus Institute for Neuroscience, Utrecht, Netherlands
| | - Veronika I. Müller
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany;,Institute of Clinical Neuroscience and Medical Psychology, HHU Duesseldorf, Duesseldorf, Germany
| | - Edna C. Cieslik
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany;,Institute of Clinical Neuroscience and Medical Psychology, HHU Duesseldorf, Duesseldorf, Germany
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany;,Institute of Clinical Neuroscience and Medical Psychology, HHU Duesseldorf, Duesseldorf, Germany
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12
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Radke S, Seidel EM, Eickhoff SB, Gur RC, Schneider F, Habel U, Derntl B. When opportunity meets motivation: Neural engagement during social approach is linked to high approach motivation. Neuroimage 2016; 127:267-276. [DOI: 10.1016/j.neuroimage.2015.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/28/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022] Open
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13
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Schmitt A, Falkai P. Negative symptoms and therapy strategies in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2015; 265:541-2. [PMID: 26319528 DOI: 10.1007/s00406-015-0637-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstr. 7, 80336, Munich, Germany
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