1
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Luther L, Jarvis SA, Spilka MJ, Strauss GP. Global reward processing deficits predict negative symptoms transdiagnostically and transphasically in a severe mental illness-spectrum sample. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01714-7. [PMID: 38051397 DOI: 10.1007/s00406-023-01714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023]
Abstract
Reward processing impairments are a key factor associated with negative symptoms in those with severe mental illnesses. However, past findings are inconsistent regarding which reward processing components are impaired and most strongly linked to negative symptoms. The current study examined the hypothesis that these mixed findings may be the result of multiple reward processing pathways (i.e., equifinality) to negative symptoms that cut across diagnostic boundaries and phases of illness. Participants included healthy controls (n = 100) who served as a reference sample and a severe mental illness-spectrum sample (n = 92) that included psychotic-like experiences, clinical high-risk for psychosis, bipolar disorder, and schizophrenia participants. All participants completed tasks measuring four RDoC Positive Valence System constructs: value representation, reinforcement learning, effort-cost computation, and hedonic reactivity. A k-means cluster analysis of the severe mental illness-spectrum samples identified three clusters with differential reward processing profiles that were characterized by: (1) global reward processing deficits (22.8%), (2) selective impairments in hedonic reactivity alone (40.2%), and (3) preserved reward processing (37%). Elevated negative symptoms were only observed in the global reward processing cluster. All clusters contained participants from each clinical group, and the distribution of these groups did not significantly differ among the clusters. Findings identified one pathway contributing to negative symptoms that was transdiagnostic and transphasic. Future work further characterizing divergent pathways to negative symptoms may help to improve symptom trajectories and personalized treatments.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
| | - Sierra A Jarvis
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Michael J Spilka
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
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2
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Luther L, Westbrook A, Ayawvi G, Ruiz I, Raugh IM, Chu AOK, Chang WC, Strauss GP. The role of defeatist performance beliefs on cognitive effort-cost decision-making in schizophrenia. Schizophr Res 2023; 261:216-224. [PMID: 37801740 DOI: 10.1016/j.schres.2023.09.035] [Citation(s) in RCA: 1] [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: 01/10/2023] [Revised: 07/01/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
Impairments in effort-cost decision-making have been consistently observed in people with schizophrenia (SZ) and may be an important mechanism of negative symptoms. However, the processes that give rise to impairments in effort-cost decision-making are unclear, leading to limited progress in identifying the most relevant treatment targets. Drawing from cognitive models of negative symptoms and goal-directed behavior, this study aimed to examine how and under what type of task conditions defeatist performance beliefs contribute to these decision-making processes. Outpatients with SZ (n = 30) and healthy controls (CN; n = 28) completed a cognitive effort allocation task, the Cognitive Effort-Discounting (COGED) task, which assesses participants' willingness to exert cognitive effort for monetary rewards based on parametrically varied working memory demands (completing N-back levels). Results showed that although participants with SZ demonstrated reduced willingness to work for rewards across N-back levels compared to CN participants, they showed less choice modulation across different N-back conditions. However, among SZ participants with greater defeatist performance beliefs, there was a reduced willingness to choose the high effort option at higher N-back levels (N-back levels 3, 4, and 5 versus 2-back). Results suggest that compared to CN, the SZ group's subjective willingness to expend effort largely did not dynamically adjust as cognitive load increased. However, defeatist beliefs may undermine willingness to expend cognitive effort, especially when cognitive task demands are high. These beliefs may be a viable treatment target to improve effort-cost decision-making impairments in people with SZ.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | | | - Gifty Ayawvi
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ivan Ruiz
- Department of Psychology, University of Georgia, Athens, GA, USA; Department of Psychiatry, University of California, Los Angeles, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Angel On Ki Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong; Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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3
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Wang LL, Tam MHW, Ho KKY, Hung KSY, Wong JOY, Lui SSY, Chan RCK. Bridge centrality network structure of negative symptoms in people with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2023; 273:589-600. [PMID: 35972557 DOI: 10.1007/s00406-022-01474-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
Negative symptoms are complex psychopathology. Although evidence generally supported the NIMH five consensus domains, research seldom examined measurement invariance of this model, and domain-specific correspondence across multiple scales. This study aimed to examine the interrelationship between negative symptom domains captured by different rating scales, and to examine the domain-specific correspondence across multiple scales. We administered the Brief Negative Symptom Scale (BNSS), the Self-evaluation of Negative Symptoms (SNS), and the Scale for Assessment of Negative Symptoms (SANS) to 204 individuals with schizophrenia. We used network analysis to examine the interrelationship between negative symptom domains. Besides regularized partial correlation network, we estimated bridge centrality indices to investigate domain-specific correspondence, while taking each scale as an independent community. The regularized partial correlation network showed that the SNS nodes clustered together, whereas the SANS and the BNSS nodes intermingled together. The SANS attention domain lied at the periphery of the network according to the Fruchterman-Reingold algorithm. The SANS anhedonia-asociality (strength = 1.48; EI = 1.48) and the SANS affective flattening (strength = 1.06; EI = 1.06) had the highest node strength and EI. Moreover, the five nodes of the BNSS bridged the nodes of the SANS and the SNS. BNSS blunted affect (strength = 0.76; EI = 0.76) and SANS anhedonia-asociality (strength = 0.76; EI = 0.74) showed the highest bridge strength and bridge EI. The BNSS captures negative symptoms and bridges the symptom domains measured by the SANS and the SNS. The three scales showed domain-specific correspondence.
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Affiliation(s)
- Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Michelle H W Tam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Karen K Y Ho
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Jessica O Y Wong
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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4
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Chen G, Chen J, Tian H, Lin C, Zhu J, Ping J, Chen L, Zhuo C, Jiang D. Validity and reliability of a Chinese version of the self-evaluation of negative symptoms. Brain Behav 2023; 13:e2924. [PMID: 36908244 PMCID: PMC10097046 DOI: 10.1002/brb3.2924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/19/2023] [Accepted: 02/04/2023] [Indexed: 03/14/2023] Open
Abstract
The negative symptoms of schizophrenia can be present at any clinical stage, but evaluating the negative symptoms always remains challenging. To screen the negative symptoms effectively, self-evaluation should be introduced. To date, professional psychiatrists used almost all of the scales available to screen the negative symptoms but could not obtain an accurate outcome. At the same time, an advanced self-assessment scale is needed to accompany the patients' self-feeling-based treatment strategies to understand their feelings about their symptoms. Hence, Chinese self-evaluation of negative symptoms (SNS) should be introduced in China. This study aims to examine the validity and reliability of the Chinese version of SNS. Two hundred patients with schizophrenia were included in this study and were evaluated entirely with the self-assessed negative symptoms by the Chinese version. The correlation analysis was performed between SNS and the Scale for Assessment of Negative Symptoms (SANS) to assess the criterion validity of SNS for screening negative symptoms. Exploratory factor analysis was used to determine the constructive validity of the SNS. Two senior professional psychiatrists were involved in this assessment based on their clinical experience and capability to define the severity of the negative symptoms. Receiver operating characteristic curve (ROC) analysis was performed to assess the cutoff point of SNS. Cronbach's alpha coefficient and intraclass correlation (ICC) coefficient were used to determine the reliability of SNS. We have the following findings: The Chinese version of SNS demonstrated a significant correlation with the SANS (r = .774, p < .05). Exploratory factor analysis demonstrated that the factor loading varies from .442 to .788. ROC analysis demonstrated that at SNS ≥ 8, the patients demonstrated a mild severity of negative symptoms, and at SNS ≥ 15, the patients demonstrated a severe severity of negative symptoms. Subsequently, 9 < SNS < 14 was defined as a moderate severity of negative symptoms. The Cronbach's alpha and ICC coefficients of the Chinese version SNS were .877 and .774, respectively. Our results showed that the acceptable validity and reliability of the Chinese version of SNS confirmed that SNS is an ideal tool for self-assessment of the negative symptoms in patients with schizophrenia.
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Affiliation(s)
- Guangdong Chen
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Jiayue Chen
- Department of PsychiatryTianjin Medical University Affiliated of Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin Fourth Center HospitalTianjinChina
| | - Hongjun Tian
- Department of PsychiatryTianjin Medical University Affiliated of Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin Fourth Center HospitalTianjinChina
| | - Chongguang Lin
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Jingjing Zhu
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Jing Ping
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Langlang Chen
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
| | - Chuanjun Zhuo
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
- Department of PsychiatryTianjin Medical University Affiliated of Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin Fourth Center HospitalTianjinChina
- Department of Psychiatry, Tianjin Anding HospitalTianjin Mental Health Center of Tianjin Medical UniversityTianjinChina
| | - Deguo Jiang
- Department of PsychiatryWenzhou Seventh Peoples HospitalWenzhouChina
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Renz KE, Schlier B, Lincoln TM. Are effort-based decision-making tasks worth the effort?-A study on the associations between effort-based decision-making tasks and self-report measures. Int J Methods Psychiatr Res 2023; 32:e1943. [PMID: 36088538 PMCID: PMC9976602 DOI: 10.1002/mpr.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Amotivation is a common symptom in various mental disorders, including psychotic or depressive disorders. Effort-based decision-making (EBDM)-tasks quantifying amotivation at a behavioral level have been on the rise. Task performance has been shown to differentiate patient groups from healthy controls. However, findings on indicators of construct validity, such as the correlations between different tasks and between tasks and self-reported/observer-rated amotivation in clinical and healthy samples have been inconclusive. METHODS In a representative community sample (N = 90), we tested the construct validity of the Deck Choice Task, the Expenditure for Rewards Task and the Balloon Task. We calculated correlations between the EBDM-tasks and between the EBDM-tasks and self-reported amotivation, apathy, anticipatory pleasure, and BIS/BAS. RESULTS Correlations between tasks were low to moderate (0.198 ≤ r ≤ 0.358), with the Balloon Task showing the largest correlations with the other tasks, but no significant correlations between any EBDM-task and the self-report measures. CONCLUSION Although different EBDM-tasks are conceptualized to measure the same construct, a large part of what each task measures could not be accounted for by the other tasks. Moreover, the tasks did not appear to substantially capture what was measured in established self-report instruments for amotivation in our sample, which could be interpreted as questioning the construct validity of EBDM-tasks.
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Affiliation(s)
- Katharina E Renz
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
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6
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Strauss GP, Bartolomeo LA, Luther L. Reduced willingness to expend effort for rewards is associated with risk for conversion and negative symptom severity in youth at clinical high-risk for psychosis. Psychol Med 2023; 53:714-721. [PMID: 34120660 DOI: 10.1017/s003329172100204x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Schizophrenia (SZ) is typically preceded by a prodromal (i.e. pre-illness) period characterized by attenuated positive symptoms and declining functional outcome. Negative symptoms are prominent among individuals at clinical high-risk (CHR) for psychosis (i.e. those with prodromal syndromes) and predictive of conversion to illness. Mechanisms underlying negative symptoms are unclear in the CHR population. METHODS The current study evaluated whether CHR participants demonstrated deficits in the willingness to expend effort for rewards and whether these impairments are associated with negative symptoms and greater risk for conversion. Participants included 44 CHR participants and 32 healthy controls (CN) who completed the Effort Expenditure for Reward Task (EEfRT). RESULTS Compared to CN, CHR participants displayed reduced likelihood of exerting high effort for high probability and magnitude rewards. Among CHR participants, reduced effort expenditure was associated with greater negative symptom severity and greater probability of conversion to a psychotic disorder on a cross-sectional risk calculator. CONCLUSIONS Findings suggest that effort-cost computation is a marker of illness liability and a transphasic mechanism underlying negative symptoms in the SZ spectrum.
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Affiliation(s)
| | | | - Lauren Luther
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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7
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Renz KE, Lincoln TM. The effect of salience of rewards on effort-based decision making in psychotic disorders. BMC Psychiatry 2022; 22:643. [PMID: 36229803 PMCID: PMC9559256 DOI: 10.1186/s12888-022-04274-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although motivational negative symptoms account for reduced functioning and quality of life in individuals with psychotic disorders, the underlying mechanisms are yet not fully understood. Neuroimaging studies suggest that an impaired perception of reward cues could result in a lack of incentive value that then leads to a decrease in goal-directed behavior. Therefore, the aim of this study was to test the effect of increasing the salience of reward cues on goal-directed behavior. METHODS We recruited a sample of n = 30 participants with a psychotic disorder and at least mild negative symptoms and n = 30 healthy controls. We used the Balloon Effort Task, an effort-based decision-making paradigm, to assess amotivation on a behavioral level. We manipulated the salience of rewards in the paradigm by highlighting the monetary rewards in half of the trials. RESULTS Total effort expenditure did not differ between participants with and without psychotic disorders, but participants with psychotic disorders showed a significantly reduced effort allocation to the level of rewards. The salience of rewards manipulation significantly increased effort expenditure both in participants with psychotic disorders and in the healthy controls, but had no impact on effort allocation. CONCLUSIONS Increasing the salience of reward cues promotes goal-directed behavior. This opens up new possibilities for interventions addressing amotivation in individuals with negative symptoms by facilitating the perception of reward cues.
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Affiliation(s)
- Katharina E. Renz
- grid.9026.d0000 0001 2287 2617Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Tania M. Lincoln
- grid.9026.d0000 0001 2287 2617Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
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8
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Ince Guliyev E, Guloksuz S, Ucok A. Impaired Effort Allocation in Patients with Recent-Onset Schizophrenia and Its Relevance to Negative Symptoms Assessments and Persistent Negative Symptoms. J Clin Med 2022; 11:jcm11175060. [PMID: 36078990 PMCID: PMC9457458 DOI: 10.3390/jcm11175060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Our aims in this study were (i) to compare effort allocation capacity measured between patients with recent-onset schizophrenia (SCZ) and healthy controls (HCs), (ii) within the SCZ, to investigate the association of effort allocation capacity with negative symptoms (NS), and (iii) to compare this association with the type of NS scale used. (2) Methods: Thirty-one patients with SCZ and 30 HCs participated in the study. The NS was examined using an older-generation (Scale for the Assessment of Negative Symptoms, SANS), a newer-generation (Brief Negative Symptoms Scale, BNSS), and a self-rated (Self-evaluation of Negative Symptoms Scale, SNS) negative symptom scale, as well as longitudinally by using persistent NS (PNS) distinction. (3) Results: The SCZ group was less willing to expend effort in high/moderate-probability and -magnitude conditions but more in low-probability and -magnitude conditions. A general reduction in effort allocation capacity was also present. Patients with PNS were less likely to choose hard tasks than non-PNS patients. Clinician-rated scales correlated with 50% probability and moderate-reward-magnitude conditions. Correlations with the SNS were minimal. (4) Conclusions: Our findings suggest that patients with SCZ may show a general reduction in effort allocation capacity and make inefficient choices, although they are not totally reward-insensitive. The effects of NS on effort expenditure can be more pronounced when the rewarding stimulus is vague.
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Affiliation(s)
- Ezgi Ince Guliyev
- Department of Psychiatry, Erenkoy Training and Research Hospital for Mental and Neurological Diseases, University of Health Sciences, Istanbul 34736, Turkey
- Correspondence:
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, 6202 Maastricht, The Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Alp Ucok
- Department of Psychiatry, Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey
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9
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DeTore NR, Balogun-Mwangi O, Tepper M, Cather C, Russinova Z, Lanca M, Mueser KT. The interrelationships of motivation, positive symptoms, stigma, and role functioning in early psychosis. Early Interv Psychiatry 2022; 16:736-743. [PMID: 34431230 DOI: 10.1111/eip.13213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
AIM Avolition, or the lack of motivation, has consistently been shown to be a significant predictor of poor psychosocial outcome, with decreased overall motivation as the single strongest predictor of poor work or school outcome in first episode psychosis. This study aimed to better understand the ways in which motivation impacts work and school functioning. This study first examined the factors related to motivation in people recovering from a recent onset of psychosis, then explored the unique interrelationships between positive symptoms, stigma, and motivation and how they influence role functioning. METHODS A total of 40 participants with early psychosis were recruited for this cross-sectional design study; with a mean of 14.5 months of treatment prior to study assessment. RESULTS Neither experienced nor internalized stigma were related to motivation in this sample, but internalized stigma was related to work and school functioning. Positive symptoms were significantly inversely related to both work and school functioning and motivation, with mediation analyses showing that motivation significantly mediates the relationship between positive symptoms and role functioning. CONCLUSION This relationship may shed light on the link between motivational deficits and work and school outcomes early in the course of psychosis, an area of critical importance for early intervention.
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Affiliation(s)
- Nicole R DeTore
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA
| | | | - Miriam Tepper
- Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Corinne Cather
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zlatka Russinova
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA
| | - Margaret Lanca
- Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA.,Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
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10
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Renz KE, Pillny M, Lincoln TM. Increasing motivation in effort-based decision-making tasks: effects of salience and reward expectancy manipulations. Cogn Neuropsychiatry 2022; 27:20-34. [PMID: 34812121 DOI: 10.1080/13546805.2021.2007068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A significant proportion of patients with affective and psychotic disorders show a marked reduction in goal-directed behaviour, which is also reflected in the behavioural outcomes of effort-based decision-making paradigms. The factors underlying this reduction are not yet fully understood. Reward salience and reward expectancy have been discussed as factors that potentially influence approach behaviour. The aim of this study was thus to test their effects on behaviour in an effort-based decision-making paradigm. METHODS In two studies with community samples we applied a modified version of the Balloon Task. In study 1, we manipulated reward salience in a within-subject design (N = 32) by highlighting the monetary rewards. In study 2, we manipulated reward expectancy in a between-subject design (N = 72) by adding five practice trials with either positive or negative feedback prior to the task. RESULTS The salience of rewards manipulation significantly increased effort expenditure and the allocation of effort to the level of rewards whereas the reward expectancy manipulation did not. CONCLUSIONS The finding that increasing the salience of rewards increases motivated behaviour in an effort-based decision-making paradigm offers promising possibilities for intervention in disorders characterised by motivational deficits, such asaffective and psychotic disorders.
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Affiliation(s)
- Katharina E Renz
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
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11
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Silvia PJ, Eddington KM, Maloney KH, Lunsford JM, Harper KL, Kwapil TR. Self-Report Measures of Anhedonia and Approach Motivation Weakly Correspond to Anhedonia and Depression Assessed via Clinical Interviews. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021; 179. [PMID: 33994609 DOI: 10.1016/j.paid.2021.110963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Self-report scales are popular tools for measuring anhedonic experiences and motivational deficits, but how well do they reflect clinically significant anhedonia? Seventy-eight adults participated in face-to-face structured diagnostic interviews: 22 showed clinically significant anhedonia, and 18 met criteria for depression. Analyses of effect sizes comparing the anhedonia and depression groups to their respective controls found large effects, as expected, for measures of depressive symptoms, but surprisingly weak effect sizes (all less than d=.50) for measures of general, social, or physical anhedonia, behavioral activation, and anticipatory and consummatory pleasure. Measures of Neuroticism and Extraversion distinguished the anhedonic and depressed groups from the controls at least as well as measures of anhedonia and motivation. Taken together, the findings suggest that caution is necessary when extending self-report findings to populations with clinically significant symptoms.
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Affiliation(s)
- Paul J Silvia
- Department of Psychology, University of North Carolina at Greensboro
| | - Kari M Eddington
- Department of Psychology, University of North Carolina at Greensboro
| | | | - Jaimie M Lunsford
- Department of Psychology, University of North Carolina at Greensboro
| | - Kelly L Harper
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System
| | - Thomas R Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign
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12
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Strauss GP, Bartolomeo LA, Harvey PD. Avolition as the core negative symptom in schizophrenia: relevance to pharmacological treatment development. NPJ SCHIZOPHRENIA 2021; 7:16. [PMID: 33637748 PMCID: PMC7910596 DOI: 10.1038/s41537-021-00145-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
Negative symptoms have long been considered a core component of schizophrenia. Modern conceptualizations of the structure of negative symptoms posit that there are at least two broad dimensions (motivation and pleasure and diminished expression) or perhaps five separable domains (avolition, anhedonia, asociality, blunted affect, alogia). The current review synthesizes a body of emerging research indicating that avolition may have a special place among these dimensions, as it is generally associated with poorer outcomes and may have distinct neurobiological mechanisms. Network analytic findings also indicate that avolition is highly central and interconnected with the other negative symptom domains in schizophrenia, and successfully remediating avolition results in global improvement in the entire constellation of negative symptoms. Avolition may therefore reflect the most critical treatment target within the negative symptom construct. Implications for targeted treatment development and clinical trial design are discussed.
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Affiliation(s)
| | | | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Breitborde NJK, Pine JG, Moe AM. Uncontrolled trial of specialized, multi-component care for individuals with first-episode psychosis: Effects on motivation orientations. Early Interv Psychiatry 2021; 15:41-46. [PMID: 31889415 PMCID: PMC9292764 DOI: 10.1111/eip.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/20/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022]
Abstract
AIM Deficits in motivation are present early in the course of psychotic disorders. However, growing data have highlighted important heterogeneity in motivation among individuals with psychosis, suggesting that this variable may not be a unitary concept. Outside of the psychosis literature, research on self-determination theory has identified three motivational orientations that guide the initiation and regulation of behaviour: autonomous, controlled and impersonal. Thus, our study goal is to investigate the longitudinal course of motivational orientations among individuals participating in a specialized clinical service for individuals with first-episode psychosis (ie, coordinated specialty care: CSC). METHODS Forty-one individuals with first-episode psychosis participating in CSC completed assessments of motivation orientations at enrolment and after 6 months of care. RESULTS Whereas there were no changes in controlled or impersonal orientations over the first 6-months of care, individuals with first-episode psychosis reported an increase in autonomous orientations. Moreover, while individuals with first-episode psychosis reported lower autonomous orientations at enrolment as compared to individuals without psychosis, after 6 months of care, ratings of autonomous orientations among individuals with first-episode psychosis were equivalent to those of individuals without psychosis. CONCLUSIONS Although the results should be interpreted cautiously given the uncontrolled study design, the results suggest that the benefits of participation in early intervention services for psychosis may extend to improvements in motivation.
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Affiliation(s)
- Nicholas J K Breitborde
- Department of Psychiatry & Behavioral Health, Early Psychosis Intervention Center (EPICENTER), Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Jacob G Pine
- Department of Psychiatry & Behavioral Health, Early Psychosis Intervention Center (EPICENTER), Columbus, Ohio
| | - Aubrey M Moe
- Department of Psychiatry & Behavioral Health, Early Psychosis Intervention Center (EPICENTER), Columbus, Ohio
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14
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Luther L, Fischer MW, Johnson-Kwochka AV, Minor KS, Holden R, Lapish CL, McCormick B, Salyers MP. Mobile enhancement of motivation in schizophrenia: A pilot randomized controlled trial of a personalized text message intervention for motivation deficits. J Consult Clin Psychol 2020; 88:923-936. [PMID: 32790451 PMCID: PMC9836765 DOI: 10.1037/ccp0000599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Motivation deficits remain an unmet treatment need in schizophrenia. Recent research has identified mechanisms underlying motivation deficits (i.e., impaired effort-cost computations, reduced future reward-value representation maintenance) that may be effective treatment targets to improve motivation. This study tested the feasibility and preliminary effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), an intervention that leverages mobile technology to target these mechanisms with text messages. METHOD Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over 8 weeks. Participants in the MEMS group additionally received personalized, interactive text messages on their personal cellphones each weekday. RESULTS Retention and engagement in MEMS were high: 92.6% completed 8 weeks of MEMS, with an 86.1% text message response rate, and 100% reported being satisfied with the text messages. Compared to participants in the control condition, the participants in the MEMS condition had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and attained significantly more recovery-oriented goals at 8 weeks. There were no significant group differences in purported mechanisms (performance-based effort-cost computations and future reward-value representations) or in self-reported motivation, quality of life, or functioning. CONCLUSION Results demonstrate that MEMS is feasible as a brief, low-intensity mobile intervention that could effectively improve some aspects of motivation (i.e., initiation and maintenance of goal-directed behaviors) and recovery goal attainment for those with schizophrenia-spectrum disorders. More work is needed with larger samples and to understand the mechanisms of change in MEMS. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Lauren Luther
- Massachusetts General Hospital, Department of Psychiatry, 149 13 Street, Room 2603, Charlestown, MA 02129; Phone: (617) 726-6043,Harvard Medical School, 25 Shattuck Street, Boston, MA,Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202
| | - Melanie W. Fischer
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202
| | - Annalee V. Johnson-Kwochka
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202
| | - Kyle S. Minor
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202
| | - Richard Holden
- Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200,Regenstrief Institute, Inc. 1101 West 10 Street, Indianapolis, IN 46202
| | - Chris L. Lapish
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202
| | - Bryan McCormick
- Temple University, Department of Health and Rehabilitation Sciences in the College of Public Health, 1700 N. Broad Street, Suite 301C, Philadelphia, PA 19122
| | - Michelle P. Salyers
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202
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15
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Luu S, Province H, Berry-Kravis E, Hagerman R, Hessl D, Vaidya D, Lozano R, Rosselot H, Erickson C, Kaufmann WE, Budimirovic DB. Response to Placebo in Fragile X Syndrome Clinical Trials: An Initial Analysis. Brain Sci 2020; 10:E629. [PMID: 32932789 PMCID: PMC7563217 DOI: 10.3390/brainsci10090629] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 12/16/2022] Open
Abstract
Fragile X syndrome (FXS) is the leading cause of inherited intellectual disability and autism spectrum disorder. Individuals with FXS often present with a wide range of cognitive deficits and problem behaviors. Educational, behavioral and pharmacological interventions are used to manage these and other complex issues affecting individuals with FXS. Despite the success of preclinical models and early-phase drug clinical studies in FXS, large-scale randomized-controlled trials have failed to meet primary endpoints. Currently, no targeted or disease-modifying treatments for FXS have received regulatory approval. Here, we examined the placebo response in FXS clinical trials conducted between 2006 and 2018. Specifically, we performed a meta-analysis of placebo-treated groups in eight double-blind, randomized controlled trials. Placebo groups demonstrated significant improvements on caregiver-rated efficacy endpoints, which were greater in adolescents and adults than in children. Among the latter measures, the Visual Analog Scale scores displayed the greatest improvements, whereas the positive effects on the Vineland-II Adaptive Behavior Composite and the Aberrant Behavior Checklist-Community/fragile X version were statistically significant in both children and adolescents/adults. Although the Clinical Global Impression scale Improvement appears to have exhibited a substantial placebo effect in multiple clinical trials in FXS, limited data availability for meta-analysis, prevented us from drawing conclusions. No placebo-related improvements were observed in performance-rated measures. These findings raise substantial concerns about placebo effects in outcome measures commonly used in the randomized-controlled trials in FXS and suggest several potential improvements in the study design and implementation of such trials. Considering the small number of trials available for this study, larger and more detailed follow up meta-analyses are needed. Meanwhile, efforts to improve the measurement properties of endpoints and rater training in drug trials in FXS should be prioritized.
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Affiliation(s)
- Skylar Luu
- Albany Medical Center, Albany Medical College, 43 New Scotland Ave, Albany, NY 12208, USA;
| | - Haley Province
- Feinberg School of Medicine, Northwestern University, 420 E. Superior St, Chicago, IL 60611, USA;
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, 1725 West Harrison, Suite 718, Chicago, IL 60612, USA;
| | - Randi Hagerman
- MIND Institute and the Department of Pediatrics, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817, USA;
| | - David Hessl
- MIND Institute and the Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817, USA;
| | - Dhananjay Vaidya
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA;
| | - Reymundo Lozano
- Departments of Genetics and Genomic Sciences, Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA;
| | | | - Craig Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229, USA;
| | - Walter E. Kaufmann
- Boston Children’s Hospital and Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Atlanta, GA 30322, USA
| | - Dejan B. Budimirovic
- Kennedy Krieger Institute/The Johns Hopkins Medical Institutions, Department of Psychiatry & Behavioral Sciences-Child Psychiatry, the Johns Hopkins University School of Medicine, 1741 Ashland Ave, Rm 241, Baltimore, MD 21205, USA
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16
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Le TP, Lucas HD, Schwartz EK, Mitchell KR, Cohen AS. Frontal alpha asymmetry in schizotypy: electrophysiological evidence for motivational dysfunction. Cogn Neuropsychiatry 2020; 25:371-386. [PMID: 32873177 DOI: 10.1080/13546805.2020.1813096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Schizotypy is defined as personality traits reflecting an underlying risk for schizophrenia-spectrum disorders. As yet, there is a dearth of suitable objective markers for measuring schizotypy. Frontal alpha asymmetry, characterised by reduced left versus right frontal region activity, reflects trait-like diminished approach-related systems and has been found in schizophrenia. Methods: The present study used electroencephalography (EEG) recorded on a consumer-grade mobile headset to examine asymmetric resting-state frontal alpha, beta, and gamma power within the multidimensional schizotypy (e.g. positive, negative, disorganised) during a three-minute "eyes closed" resting period in college undergraduates (n=49). Results: Findings suggest that schizotypy was exclusively related to reduced left versus right-lateralised power in the alpha frequency (8.1-12.9 Hz., R2= .16). Follow-up analysis suggested that positive schizotypy was uniquely associated with increased right alpha activity, indicating increased withdrawal motivation. Conclusions: Frontal asymmetry is a possible ecologically valid objective marker for schizotypy that may be detectable using easily accessible, consumer-grade technology.
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Affiliation(s)
- Thanh P Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Heather D Lucas
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Elana K Schwartz
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Kyle R Mitchell
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), La Jolla, CA, USA
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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17
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Zhou C, Li Z. Modelling of self‐management in schizophrenia: The role of neurocognition, self‐efficacy and motivation. J Clin Nurs 2020; 29:3966-3976. [DOI: 10.1111/jocn.15407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Chenxi Zhou
- School of Nursing Peking Union Medical College Beijing China
| | - Zheng Li
- School of Nursing Peking Union Medical College Beijing China
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18
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Cohen AS, Schwartz E, Le TP, Cowan T, Kirkpatrick B, Raugh IM, Strauss GP. Digital phenotyping of negative symptoms: the relationship to clinician ratings. Schizophr Bull 2020; 47:44-53. [PMID: 32467967 PMCID: PMC7825094 DOI: 10.1093/schbul/sbaa065] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Negative symptoms are a critical, but poorly understood, aspect of schizophrenia. Measurement of negative symptoms primarily relies on clinician ratings, an endeavor with established reliability and validity. There have been increasing attempts to digitally phenotype negative symptoms using objective biobehavioral technologies, eg, using computerized analysis of vocal, speech, facial, hand and other behaviors. Surprisingly, biobehavioral technologies and clinician ratings are only modestly inter-related, and findings from individual studies often do not replicate or are counterintuitive. In this article, we document and evaluate this lack of convergence in 4 case studies, in an archival dataset of 877 audio/video samples, and in the extant literature. We then explain this divergence in terms of "resolution"-a critical psychometric property in biomedical, engineering, and computational sciences defined as precision in distinguishing various aspects of a signal. We demonstrate how convergence between clinical ratings and biobehavioral data can be achieved by scaling data across various resolutions. Clinical ratings reflect an indispensable tool that integrates considerable information into actionable, yet "low resolution" ordinal ratings. This allows viewing of the "forest" of negative symptoms. Unfortunately, their resolution cannot be scaled or decomposed with sufficient precision to isolate the time, setting, and nature of negative symptoms for many purposes (ie, to see the "trees"). Biobehavioral measures afford precision for understanding when, where, and why negative symptoms emerge, though much work is needed to validate them. Digital phenotyping of negative symptoms can provide unprecedented opportunities for tracking, understanding, and treating them, but requires consideration of resolution.
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Affiliation(s)
- Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA,To whom correspondence should be addressed; Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803; tel: +1-225-578-7017, fax: +1-225-578-4125, e-mail:
| | - Elana Schwartz
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Thanh P Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Tovah Cowan
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
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19
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Luther L, Bonfils KA, Fischer MW, Johnson-Kwochka AV, Salyers MP. Metacognition moderates the relationship between self-reported and clinician-rated motivation in schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100140. [PMID: 31828017 PMCID: PMC6889663 DOI: 10.1016/j.scog.2019.100140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 12/18/2022]
Abstract
Introduction Prior work has found varied relationships between self-reported and clinician-rated motivation measures in schizophrenia, suggesting that moderators might impact the strength of this relationship. This current study sought to identify whether metacognition – the ability to form complex representations about oneself, others, and the world – moderates the relationship between self-reported and clinician-rated motivation measures. We also explored whether clinical insight and neurocognition moderated this relationship. Methods Fifty-six participants with a schizophrenia-spectrum disorder completed the Motivation and Pleasure Self-Report Scale and the clinician-rated motivation index from the Heinrichs-Carpenter Quality of Life Scale. Results Metacognition significantly moderated the relationship; self-reported and clinician-rated motivation were positively and significantly correlated only when metacognition was relatively high. Neither clinical insight nor neurocognition moderated the relationship. Discussion Metacognition appears to be a key variable impacting the strength of the relationship between self-reported and clinician-rated motivation measures and may help to partly explain the varied relationships observed in prior work. Using a metacognitive framework to guide assessment interviews and targeting metacognition in psychosocial treatments may help to improve the synchrony between self-perceptions and clinician ratings of motivation.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, United States of America
- University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, 279, Chicago, IL 60608, United States of America
- Corresponding author at: IUPUI School of Science, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, United States of America.
| | - Kelsey A. Bonfils
- VISN 4 Mental Illness Research, Education, & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, 4100 Allequippa St., Pittsburgh, PA 15219, United States of America
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA 15213, United States of America
| | - Melanie W. Fischer
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, United States of America
| | - Annalee V. Johnson-Kwochka
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, United States of America
| | - Michelle P. Salyers
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, United States of America
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20
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Luther L, Fischer MW, Firmin RL, Salyers MP. Clarifying the overlap between motivation and negative symptom measures in schizophrenia research: A meta-analysis. Schizophr Res 2019; 206:27-36. [PMID: 30577993 PMCID: PMC6525651 DOI: 10.1016/j.schres.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
Motivation and negative symptom research has recently been hampered by a series of inconsistent findings, leading to calls for a greater consensus on the type of measures used across studies. To inform this issue, we conducted a meta-analysis that quantified the association between motivation measures (self-report, performance-based) and clinician-rated negative symptom measures as well as a series of moderator analyses to develop a greater understanding of the measurement factors impacting this relationship. Forty-seven eligible studies with people with schizophrenia-spectrum disorders were included. Using a random-effects meta-analytic model, a small but significant overall effect size emerged between motivation and clinician-rated negative symptoms (r = -0.18). Several significant moderators were identified, including the generation of negative symptom measures such that there was a significantly stronger relationship between motivation and second-generation (r = -0.38) than first-generation negative symptom measures (r = -0.17). Further, the type of performance-based measure used moderated the relationship, with effort discounting tasks most strongly related to negative symptoms (r = -0.44). The domain of motivation assessed (intrinsic, extrinsic, amotivation) also moderated the relationship. These findings help to identify sources of inconsistencies observed in prior studies and point to both second-generation and effort discounting tasks as the most promising types of measures, particularly for those interested in validating motivation measures or assessing the effectiveness of motivation treatments. Although additional research is needed, our results suggest that using these measures may help to reduce inconsistencies across studies and move the field forward.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA; University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, 279, Chicago, IL 60608, USA.
| | - Melanie W Fischer
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA.
| | - Ruth L Firmin
- University of California Los Angeles, Semel Institute, 760 Westwood Plaza, Los Angeles, CA 90046, USA.
| | - Michelle P Salyers
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA.
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