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Bielecki M, Tyburski E, Plichta P, Samochowiec J, Kucharska-Mazur J, Podwalski P, Rek-Owodziń K, Waszczuk K, Sagan L, Michalczyk A, Rudkowski K, Karabanowicz E, Świątkowska K, Misiak B, Bąba-Kubiś A, Mak M. Impulsivity and inhibitory control in deficit and non-deficit schizophrenia. BMC Psychiatry 2024; 24:473. [PMID: 38937731 PMCID: PMC11209995 DOI: 10.1186/s12888-024-05918-6] [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: 11/02/2023] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND There is conflicting evidence on impulsivity and its potential relationship with inhibitory control in schizophrenia. This study therefore aimed to identify differences in impulsivity and cognitive and motor inhibition between patients with deficit (DS) and non-deficit (NDS) schizophrenia and healthy controls (HC). We also explored the relationships between impulsivity and different dimensions of inhibitory control in all studied groups. METHODS The sample comprised 28 DS patients, 45 NDS patients, and 39 age-matched HC. A neuropsychological battery was used. RESULTS DS patients scored lower in venturesomeness, while those with NDS scored higher in impulsiveness compared to HC. In addition, both groups of patients scored higher on measures of cognitive and motor inhibition, including those relatively independent of information processing speed (although the results were slightly different after adjusting for IQ and/or years of education). Correlations between impulsivity and cognitive inhibition emerged in DS patients, while links between impulsivity and motor inhibition were observed in HC. CONCLUSIONS Our results suggest the presence of deficits in experimentally assessed inhibitory control in schizophrenia patients, with predominant impulsivity in the NDS population. In addition, impulsivity may affect the cognitive control of inhibition in deficit schizophrenia. Nevertheless, due to the preliminary nature of these findings, they require further empirical verification in future research.
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Affiliation(s)
- Maksymilian Bielecki
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Ernest Tyburski
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland.
| | - Piotr Plichta
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Piotr Podwalski
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Katarzyna Rek-Owodziń
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Katarzyna Waszczuk
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Anna Michalczyk
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Krzysztof Rudkowski
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ewa Karabanowicz
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Katarzyna Świątkowska
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
| | - Błażej Misiak
- Department of Consultation Psychiatry and Neuroscience, Wrocław Medical University, Wrocław, Poland
| | - Agata Bąba-Kubiś
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Monika Mak
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Broniewskiego 26 str, Szczecin, 71-457, Poland
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2
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Raugh IM, Strauss GP. Trait Mindfulness in Psychotic Disorders: Dimensions Predicting Symptoms, Cognition, and Functional Outcome. Behav Ther 2024; 55:55-67. [PMID: 38216237 PMCID: PMC10787159 DOI: 10.1016/j.beth.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Mindfulness-based treatments are efficacious for psychotic disorders (PD). However, which components of mindfulness (i.e., attentive monitoring and nonjudgmental acceptance) are most relevant treatment targets is unclear. Further, there is a dearth of literature examining clinical correlates of mindfulness in people with PD. The present study aimed to examine group differences and clinical correlates of mindfulness in people with PD. We hypothesized that PD would report lower monitoring and acceptance than CN and that mindfulness components would be associated with symptoms including dysfunctional beliefs, alexithymia, neurocognitive ability, positive symptoms, and mood symptoms. Groups included individuals with PD (n = 54) and nonpsychiatric controls (n = 55). Participants completed self-report measures of mindfulness and related constructs and clinical interviews of symptoms. Results of ANOVA models indicated that global mindfulness was lower in PD relative to CN, with greatest differences evident for acceptance in the affective psychosis group. Regression models found that greater monitoring was associated with improved neurocognitive performance, while acceptance was associated with lower defeatist beliefs, alexithymia, and depression/anxiety symptoms. Results highlight the importance of targeting acceptance in the psychosocial treatment of PDs, especially for those with mood symptoms.
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3
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Santos HC, Rodrigues A, Ferreira S, Martins JM, Baptista T, Gama Marques J, Kirkpatrick B, Prata D. The European Portuguese Version of the Brief Negative Symptom Scale. Psychopathology 2023; 57:76-80. [PMID: 37276842 DOI: 10.1159/000530705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/12/2023] [Indexed: 06/07/2023]
Abstract
Negative symptoms reflect a currently much-untreated loss of normal functioning and are frequently found in psychotic disorders. We present the first translation of the Brief Negative Symptom Scale (BNSS) to European Portuguese and evaluate its validity in a sample of Portuguese male patients with a psychotic spectrum disorder. The Portuguese BNSS showed excellent internal consistency, high convergent validity (i.e., strong correlation with the PANSS negative factor), and high discriminant validity (i.e., a lack of association with the PANSS positive factor). In sum, the present European Portuguese BNSS has shown to be reliable, thus extending this instrument's clinical availability worldwide.
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Affiliation(s)
- Henrique Castro Santos
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - Alexandra Rodrigues
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- Unidade de Neurorradiologia, Hospital Central Do Funchal, Funchal, Portugal
| | - Sara Ferreira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - João Malhadas Martins
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Baptista
- Departamento de Imagiologia, Hospital CUF Tejo, Lisboa, Portugal
| | - João Gama Marques
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Brian Kirkpatrick
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Diana Prata
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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4
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Cognitive Dysfunctions Measured with the MCCB in Deficit and Non-Deficit Schizophrenia. J Clin Med 2023; 12:jcm12062257. [PMID: 36983258 PMCID: PMC10053076 DOI: 10.3390/jcm12062257] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
This study compared cognitive domains between deficit schizophrenia (DS) and non-deficit schizophrenia (NDS) patients and healthy controls (HC), analyzing relationships between psychopathological dimensions and cognitive domains. A total of 29 DS patients, 45 NDS patients, and 39 HC subjects participated. Cognitive domains were measured using the Measurement and Treatment Research to Improve Cognition in Schizophrenia Battery. Psychopathological symptoms were evaluated with the Positive and Negative Syndrome Scale. Clinical groups performed poorer than HC groups in regards to speed of processing, attention/vigilance, working memory, verbal and visual learning and memory, reasoning and problem solving, and social cognition. DS patients scored poorer than NDS patients in terms of all cognitive domains and the overall score, except for reasoning and problem solving. Positive, negative, disorganization, and resistance symptoms were related to cognitive functions only in NDS patients. Our findings suggest that the MCCB battery is sensitive to detecting cognitive dysfunctions in both deficit and non-deficit schizophrenia.
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Executive Functions and Psychopathology Dimensions in Deficit and Non-Deficit Schizophrenia. J Clin Med 2023; 12:jcm12051998. [PMID: 36902784 PMCID: PMC10003976 DOI: 10.3390/jcm12051998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
This study: (a) compared executive functions between deficit (DS) and non-deficit schizophrenia (NDS) patients and healthy controls (HC), controlling premorbid IQ and level of education; (b) compared executive functions in DS and NDS patients, controlling premorbid IQ and psychopathological symptoms; and (c) estimated relationships between clinical factors, psychopathological symptoms, and executive functions using structural equation modelling. Participants were 29 DS patients, 44 NDS patients, and 39 HC. Executive functions were measured with the Mazes Subtest, Spatial Span Subtest, Letter Number Span Test, Color Trail Test, and Berg Card Sorting Test. Psychopathological symptoms were evaluated with the Positive and Negative Syndrome Scale, Brief Negative Symptom Scale, and Self-evaluation of Negative Symptoms. Compared to HC, both clinical groups performed poorer on cognitive flexibility, DS patients on verbal working memory, and NDS patients on planning. DS and NDS patients did not differ in executive functions, except planning, after controlling premorbid IQ and negative psychopathological symptoms. In DS patients, exacerbation had an effect on verbal working memory and cognitive planning; in NDS patients, positive symptoms had an effect on cognitive flexibility. Both DS and NDS patients presented deficits, affecting the former to a greater extent. Nonetheless, clinical variables appeared to significantly affect these deficits.
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Giordano GM, Caporusso E, Pezzella P, Galderisi S. Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia. Expert Rev Neurother 2022; 22:541-555. [PMID: 35758871 DOI: 10.1080/14737175.2022.2092402] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Negative symptoms in schizophrenia are associated with poor response to available treatments, poor quality of life, and functional outcome. Therefore, they represent a substantial burden for people with schizophrenia, their families, and health-care systems. AREAS COVERED In this manuscript, we will provide an update on the conceptualization, assessment, and treatment of this complex psychopathological dimension of schizophrenia. EXPERT OPINION Despite the progress in the conceptualization of negative symptoms and in the development of state-of-the-art assessment instruments made in the last decades, these symptoms are still poorly recognized, and not always assessed in line with current conceptualization. Every effort should be made to disseminate the current knowledge on negative symptoms, on their assessment instruments and available treatments whose efficacy is supported by research evidence. Longitudinal studies should be promoted to evaluate the natural course of negative symptoms, improve our ability to identify the different sources of secondary negative symptoms, provide effective interventions, and target primary and persistent negative symptoms with innovative treatment strategies. Further research is needed to identify pathophysiological mechanisms of primary negative symptoms and foster the development of new treatments.
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7
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Podwalski P, Tyburski E, Szczygieł K, Rudkowski K, Waszczuk K, Andrusewicz W, Kucharska-Mazur J, Michalczyk A, Mak M, Cyranka K, Misiak B, Sagan L, Samochowiec J. Psychopathology and Integrity of the Superior Longitudinal Fasciculus in Deficit and Nondeficit Schizophrenia. Brain Sci 2022; 12:brainsci12020267. [PMID: 35204030 PMCID: PMC8870217 DOI: 10.3390/brainsci12020267] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 01/27/2023] Open
Abstract
The superior longitudinal fasciculus (SLF) is a white matter bundle that connects the frontal areas with the parietal areas. As part of the visuospatial attentional network, it may be involved in the development of schizophrenia. Deficit syndrome (DS) is characterized by primary and enduring negative symptoms. The present study assessed SLF integrity in DS and nondeficit schizophrenia (NDS) patients and examined possible relationships between it and psychopathology. Twenty-six DS patients, 42 NDS patients, and 36 healthy controls (HC) underwent psychiatric evaluation and diffusion tensor imaging (DTI). After post-processing, fractional anisotropy (FA) values within the SLF were analyzed. Psychopathology was assessed with the Positive and Negative Syndrome Scale, Brief Negative Symptom Scale, and Self-evaluation of Negative Symptoms. The PANSS proxy for the deficit syndrome was used to diagnose DS. NDS patients had lower FA values than HC. DS patients had greater negative symptoms than NDS patients. After differentiating clinical groups and HC, we found no significant correlations between DTI measures and psychopathological dimensions. These results suggest that changes in SLF integrity are related to schizophrenia, and frontoparietal dysconnection plays a role in its etiopathogenesis. We confirmed that DS patients have greater negative psychopathology than NDS patients. These results are preliminary; further studies are needed.
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Affiliation(s)
- Piotr Podwalski
- Department of Psychiatry, Pomeranian Medical University, 71-460 Szczecin, Poland; (K.S.); (K.R.); (K.W.); (J.K.-M.); (A.M.); (J.S.)
- Correspondence:
| | - Ernest Tyburski
- Department of Health Psychology, Pomeranian Medical University, 71-460 Szczecin, Poland; (E.T.); (M.M.)
| | - Krzysztof Szczygieł
- Department of Psychiatry, Pomeranian Medical University, 71-460 Szczecin, Poland; (K.S.); (K.R.); (K.W.); (J.K.-M.); (A.M.); (J.S.)
| | - Krzysztof Rudkowski
- Department of Psychiatry, Pomeranian Medical University, 71-460 Szczecin, Poland; (K.S.); (K.R.); (K.W.); (J.K.-M.); (A.M.); (J.S.)
| | - Katarzyna Waszczuk
- Department of Psychiatry, Pomeranian Medical University, 71-460 Szczecin, Poland; (K.S.); (K.R.); (K.W.); (J.K.-M.); (A.M.); (J.S.)
| | - Wojciech Andrusewicz
- Department of Neurosurgery, Pomeranian Medical University, 71-252 Szczecin, Poland; (W.A.); (L.S.)
| | - Jolanta Kucharska-Mazur
- Department of Psychiatry, Pomeranian Medical University, 71-460 Szczecin, Poland; (K.S.); (K.R.); (K.W.); (J.K.-M.); (A.M.); (J.S.)
| | - Anna Michalczyk
- Department of Psychiatry, Pomeranian Medical University, 71-460 Szczecin, Poland; (K.S.); (K.R.); (K.W.); (J.K.-M.); (A.M.); (J.S.)
| | - Monika Mak
- Department of Health Psychology, Pomeranian Medical University, 71-460 Szczecin, Poland; (E.T.); (M.M.)
| | - Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, 31-501 Krakow, Poland;
- Department of Metabolic Diseases, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University, 71-252 Szczecin, Poland; (W.A.); (L.S.)
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, 71-460 Szczecin, Poland; (K.S.); (K.R.); (K.W.); (J.K.-M.); (A.M.); (J.S.)
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8
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Ahmed AO, Kirkpatrick B, Granholm E, Rowland LM, Barker PB, Gold JM, Buchanan RW, Outram T, Bernardo M, Paz García-Portilla M, Mane A, Fernandez-Egea E, Strauss GP. Two Factors, Five Factors, or Both? External Validation Studies of Negative Symptom Dimensions in Schizophrenia. Schizophr Bull 2022; 48:620-630. [PMID: 35020936 PMCID: PMC9077418 DOI: 10.1093/schbul/sbab148] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Negative symptom studies frequently use single composite scores as indicators of symptom severity and as primary endpoints in clinical trials. Factor analytic and external validation studies do not support this practice but rather suggest a multidimensional construct. The current study used structural equation modeling (SEM) to compare competing dimensional models of negative symptoms to determine the number of latent dimensions that best capture variance in biological, psychological, and clinical variables known to have associations with negative symptoms. METHODS Three independent studies (total n = 632) compared unidimensional, two-factor, five-factor, and hierarchical conceptualizations of negative symptoms in relation to cognition, psychopathology, and community functioning (Study 1); trait emotional experience and defeatist performance beliefs (Study 2); and glutamate and gamma-aminobutyric acid levels in the anterior cingulate cortex quantified using proton magnetic resonance spectroscopy (Study 3). RESULTS SEM favored the five-factor and hierarchical models over the unidimensional and two-factor models regardless of the negative symptom measure or external validator. The five dimensions-anhedonia, asociality, avolition, blunted affect, and alogia-proved vital either as stand-alone domains or as first-order domains influenced by second-order dimensions-motivation and pleasure and emotional expression. The two broader dimensions sometimes masked important associations unique to the five narrower domains. Avolition, anhedonia, and blunted affect showed the most domain-specific associations with external variables across study samples. CONCLUSIONS Five domains and a hierarchical model reflect the optimal conceptualization of negative symptoms in relation to external variables. Clinical trials should consider using the two dimensions as primary endpoints and the five domains as secondary endpoints.
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Affiliation(s)
- Anthony O Ahmed
- To whom correspondence should be addressed; Department of Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY 10605, USA; tel: 914-997-5251, e-mail:
| | - Brian Kirkpatrick
- Department of Psychiatry, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Laura M Rowland
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peter B Barker
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA,FM Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - James M Gold
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert W Buchanan
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tacina Outram
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain,Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - María Paz García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain,Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Anna Mane
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain,Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, USA
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9
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Dollfus S, Mucci A, Giordano GM, Bitter I, Austin SF, Delouche C, Erfurth A, Fleischhacker WW, Movina L, Glenthøj B, Gütter K, Hofer A, Hubenak J, Kaiser S, Libiger J, Melle I, Nielsen MØ, Papsuev O, Rybakowski JK, Sachs G, Üçok A, Brando F, Wojciak P, Galderisi S. European Validation of the Self-Evaluation of Negative Symptoms (SNS): A Large Multinational and Multicenter Study. Front Psychiatry 2022; 13:826465. [PMID: 35173641 PMCID: PMC8841841 DOI: 10.3389/fpsyt.2022.826465] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/04/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Negative symptoms are usually evaluated with scales based on observer ratings and up to now self-assessments have been overlooked. The aim of this paper was to validate the Self-evaluation of Negative Symptoms (SNS) in a large European sample coming from 12 countries. We wanted to demonstrate: (1) good convergent and divergent validities; (2) relationships between SNS scores and patients' functional outcome; (3) the capacity of the SNS compared to the Brief Negative Symptom Scale (BNSS) to detect negative symptoms; and (4) a five-domain construct in relation to the 5 consensus domains (social withdrawal, anhedonia, alogia, avolition, blunted affect) as the best latent structure of SNS. METHODS Two hundred forty-five subjects with a DSM-IV diagnosis of schizophrenia completed the SNS, the Positive and Negative Syndrome Scale (PANSS), the BNSS, the Calgary Depression Scale for Schizophrenia (CDSS), and the Personal and Social Performance (PSP) scale. Spearman's Rho correlations, confirmatory factor analysis investigating 4 models of the latent structure of SNS and stepwise multiple regression were performed. RESULTS Significant positive correlations were observed between the total score of the SNS and the total scores of the PANSS negative subscale (r = 0.37; P < 0.0001) and the BNSS (r = 0.43; p < 0.0001). SNS scores did not correlate with the level of insight, parkinsonism, or the total score of the PANSS positive subscale. A positive correlation was found between SNS and CDSS (r = 0.35; p < 0.0001). Among the 5 SNS subscores, only avolition subscores entered the regression equation explaining a lower functional outcome. The 1-factor and 2-factor models provided poor fit, while the 5-factor model and the hierarchical model provided the best fit, with a small advantage of the 5-factor model. The frequency of each negative dimension was systematically higher using the BNSS and the SNS vs. the PANSS and was higher for alogia and avolition using SNS vs. BNSS. CONCLUSION In a large European multicentric sample, this study demonstrated that the SNS has: (1) good psychometric properties with good convergent and divergent validities; (2) a five-factor latent structure; (3) an association with patients' functional outcome; and (4) the capacity to identify subjects with negative symptoms that is close to the BNSS and superior to the PANSS negative subscale.
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Affiliation(s)
- Sonia Dollfus
- Service de Psychiatrie, CHU de Caen, Caen, France.,UFR de Médecine, UNICAEN, Normandie Université, Caen, France.,ISTS, UNICAEN, Normandie Université, Caen, France
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giulia M Giordano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Stephen F Austin
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Camille Delouche
- Service de Psychiatrie, CHU de Caen, Caen, France.,UFR de Médecine, UNICAEN, Normandie Université, Caen, France.,ISTS, UNICAEN, Normandie Université, Caen, France
| | - Andreas Erfurth
- 1st Department of Psychiatry and Psychotherapeutic Medicine, Klinik Hietzing, Vienna, Austria
| | - W Wolfgang Fleischhacker
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Larisa Movina
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Gütter
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Jan Hubenak
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Jan Libiger
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Ingrid Melle
- NORMENT Centre, Institute of Clinical Psychiatry, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Mette Ø Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oleg Papsuev
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alp Üçok
- Psychotic Disorders Research Program, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Francesco Brando
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pawel Wojciak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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Laraki Y, Lebrun C, Merenciano M, Eisenblaetter M, Attal J, Macgregor A, Decombe A, Capdevielle D, Raffard S. Validation of the French Clinical Assessment Interview for Negative Symptoms in a Sample of Stable French Individuals With Schizophrenia. Front Psychiatry 2022; 13:836600. [PMID: 35432043 PMCID: PMC9010618 DOI: 10.3389/fpsyt.2022.836600] [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: 12/15/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Clinical Assessment Interview for Negative Symptoms (CAINS) is an interview-based instrument evaluating the existence and severity of negative symptoms in people diagnosed with schizophrenia or schizoaffective disorder. The aim of this study is to translate and validate a French version of the CAINS in a French sample of outpatients diagnosed with schizophrenia or schizoaffective disorder. METHODS In this study, we included 84 outpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier, France. All participants were assessed for the severity of negative symptoms as well as level of depression. Psychometric properties of the French CAINS were investigated including its factor structure, internal consistency, and interrater and test-retest reliabilities. We also determined the discriminant and convergent validity. RESULTS Exploratory factor analysis and parallel analysis reproduced the two-factor model, and explained 43.55% of the total score variation with good internal consistency (Cronbach α of 0.87). Both interrater and test-retest reliabilities were high for the CAINS and its subscales (intraclass correlation coefficient range, 0.89-0.99). The standard errors of measurement and minimal detectable change were also investigated. Convergent validity of the CAINS was underpinned by correlations obtained with various measures of negative symptoms. Adequate discriminant validity was established by showing that the CAINS did not correlate with positive symptoms. CONCLUSION Overall, our results obtained were similar to those found in the original study of the CAINS. Structural analyses also replicated the two-factor model of the CAINS. Our results indicate that the French CAINS has robust psychometric properties and is a valid tool for evaluating negative symptoms in French-speaking individuals diagnosed with schizophrenia.
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Affiliation(s)
- Yasmine Laraki
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
| | - Cindy Lebrun
- Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
| | - Marine Merenciano
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | | | - Jerôme Attal
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Alexandra Macgregor
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Amandine Decombe
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Raffard
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
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11
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Hajj A, Hallit S, Chamoun K, Sacre H, Obeid S, Haddad C, Dollfus S, Khabbaz LR. Negative symptoms in schizophrenia: correlation with clinical and genetic factors. Pharmacogenomics 2021; 22:389-399. [PMID: 33858192 DOI: 10.2217/pgs-2020-0171] [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: 11/21/2022] Open
Abstract
Aim: Explore the possible association between clinical factors and genetic variants of the dopamine pathways and negative symptoms. Materials & methods: Negative symptoms were assessed in 206 patients with schizophrenia using the Arabic version of the self-evaluation of negative symptoms scale and the Positive and Negative Syndrome Scale. Genotyping for COMT, DRD2, MTHFR and OPRM1 genes was performed. Results: Multivariable analysis showed that higher self-evaluation of negative symptoms scale scores were significantly associated with higher age, higher chlorpromazine-equivalent daily dose for typical antipsychotics and in married patients. Higher negative Positive and Negative Syndrome Scale scores were significantly associated with women and having the CT genotype for MTHFR c.677C>T (β = 4.25; p = 0.008) compared with CC patients. Conclusion: Understanding both clinical/genetic factors could help improve the treatment of patients.
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Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine & Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
| | - Karam Chamoun
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, PO Box 60096, Jal Eddib, Lebanon.,Faculty of Art and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, PO Box 60096, Jal Eddib, Lebanon.,INSERM, Univ. Limoges, CH Esquirol Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Sonia Dollfus
- CHU de Caen, Service de Psychiatrie, 14000, Caen, France.,Normandie University, UNICAEN, ISTS, GIP Cyceron, 14000, Caen, France
| | - Lydia Rabbaa Khabbaz
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
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12
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Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, Giordano GM, Vandevelde A, Nielsen MØ, Glenthøj LB, Sabé M, Pezzella P, Bitter I, Gaebel W. EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e23. [PMID: 33597064 PMCID: PMC8080207 DOI: 10.1192/j.eurpsy.2021.11] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
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Affiliation(s)
- S Galderisi
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - S Dollfus
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - P Pezzella
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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13
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Hajj A, Hallit S, Chamoun K, Sacre H, Obeid S, Haddad C, Dollfus S, Rabbaa Khabbaz L. Validation of the Arabic version of the "self-evaluation of negative symptoms" scale (SNS). BMC Psychiatry 2020; 20:240. [PMID: 32408876 PMCID: PMC7227103 DOI: 10.1186/s12888-020-02647-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The self-evaluation of negative symptoms scale (SNS) is a new easy-to-use self-administered questionnaire allowing clinicians to understand the clinical and genetic factors affecting the negative symptoms in patients with schizophrenia. There was a need to translate and validate this scale in Arabic so that Arab-speaking patients benefit from it. Therefore, the aim of our study was to validate the Arabic version of the SNS in a sample of Lebanese patients with schizophrenia. METHODS The Arabic SNS was used to quantify the disability associated with negative symptoms in patients with schizophrenia (n = 206). Six weeks after completing the SNS, the participants were interviewed again to assess test-retest reproducibility. The validity was confirmed by factor analyses using the principal component analysis technique with a varimax rotation. The Positive and Negative Syndrome Scale (PANSS) was also assessed. RESULTS None of the items of the SNS scale were removed; all items converged over a solution of five factors that had an eigenvalue > 1, explaining a total of 66.01% of the variance (Cronbach's alpha = 0.879; test part). The mean total SNS score was 17.33 ± 8.43 for the "test", and 16.35 ± 7.50 for the "retest". The correlation coefficients between the SNS total score and the PANSS scale and subscales were as follows: total PANSS (r = 0.044; p = 0.530), positive PANSS score (r = - 0.106; p = 0.131), negative PANSS score (r = 0.204; p = 0.003), and general psychopathological PANSS score (r = 0.03; p = 0.530). CONCLUSION This study is the first to validate the Arabic version of the SNS in patients with schizophrenia. Using this scale would help improve treatment by correctly assessing negative symptoms, thus optimizing treatment options.
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Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon. .,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon.
| | - Souheil Hallit
- grid.444434.70000 0001 2106 3658Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon ,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Karam Chamoun
- grid.42271.320000 0001 2149 479XFaculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon ,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon ,Research Department, Psychiatric Hospital of the Cross, P.O Box 60096, Jal Eddib, Lebanon ,grid.444434.70000 0001 2106 3658Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, P.O Box 60096, Jal Eddib, Lebanon
| | - Sonia Dollfus
- grid.411149.80000 0004 0472 0160CHU de Caen, Service de Psychiatrie, 14000 Caen, France ,grid.412043.00000 0001 2186 4076Normandie Univ, UNICAEN, ISTS, GIP Cyceron, 14000 Caen, France
| | - Lydia Rabbaa Khabbaz
- grid.42271.320000 0001 2149 479XFaculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon ,grid.42271.320000 0001 2149 479XLaboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
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