Association between changes on the Negative Symptom Assessment scale (NSA-16) and measures of functional outcome in schizophrenia

Clinical symptoms and social functioning in schizophrenia

INTRODUCTION

The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms.

MATERIAL AND METHODS

A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S).

RESULTS

SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05-0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms.

CONCLUSIONS

Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

Negative symptom dimensions and social functioning in Chinese patients with schizophrenia

OBJECTIVE

Negative symptoms can seriously affect social functioning in patients with schizophrenia. However, the role of various components of negative symptoms in social functioning remains unclear. This study aimed to explore the associations among three different dimensions of negative symptoms (i.e., communication, emotion, and motivation) and social functioning to identify potential therapeutic targets.

METHODS

This cross-sectional study enrolled 202 Chinese participants with schizophrenia. Negative symptoms were evaluated using the Negative Symptom Assessment (NSA). Social functioning was represented by the Personal and Social Performance Scale (PSP) total score and employment status. Correlation analysis was conducted to clarify the relationship between negative symptoms and the PSP total score. Regression analysis was performed to explore the determinants of the PSP total score and employment status, considering negative symptoms and possible confounders, such as demographic features, positive symptoms, cognitive symptoms, depressive symptoms, and extrapyramidal side effects.

RESULTS

The PSP total score was correlated with all three dimensions of negative symptoms (i.e., emotion, motivation, and communication; rs = -0.509, -0.662, and -0.657, respectively). Motivation, instead of emotion or communication, predicted both low PSP total scores and unemployment.

CONCLUSION

Social functioning in patients with schizophrenia was significantly related to motivation. Further studies should focus on motivation and consider it as a therapeutic target to improve patients' social functioning.

EPA guidance on assessment of negative symptoms in schizophrenia

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.

Predicting Real-World Functioning in Schizophrenia: The Relative Contributions of Neurocognition, Functional Capacity, and Negative Symptoms

Neurocognition and functional capacity are commonly reported predictors of real-world functioning in schizophrenia. However, the additional impact of negative symptoms, specifically its subdomains, i.e., diminished expression (DE) and avolition-apathy (AA), on real-world functioning remains unclear. The current study assessed 58 individuals with schizophrenia. Neurocognition was assessed with the Brief Assessment of Cognition in Schizophrenia, functional capacity with the UCSD Performance-based Skills Assessment (UPSA-B), and negative symptoms with the Negative Symptom Assessment-16. Real-world functioning was assessed with the Multnomah Community Ability Scale (MCAS) with employment status as an additional objective outcome. Hierarchical regressions and sequential logistic regressions were used to examine the associations between the variables of interest. The results show that global negative symptoms contribute substantial additional variance in predicting MCAS and employment status above and beyond the variance accounted for by neurocognition and functional capacity. In addition, both AA and DE predict the MCAS after controlling for cognition and functional capacity. Only AA accounts for additional variance in employment status beyond that by UPSA-B. In summary, negative symptoms contribute substantial additional variance in predicting both real-world functioning and employment outcomes after accounting for neurocognition and functional capacity. Our findings emphasize both DE and AA as important treatment targets in functional recovery for people with schizophrenia.

Clinical symptoms and social functioning in schizophrenia

INTRODUCTION

The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms.

MATERIAL AND METHODS

A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S).

RESULTS

SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05-0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms.

CONCLUSIONS

Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

Efficacy of lurasidone across five symptom dimensions of schizophrenia: Pooled analysis of short-term, placebo-controlled studies

Objective:

To evaluate the efficacy of lurasidone for schizophrenia using an established five-factor model of the Positive and Negative Syndrome Scale (PANSS).

Methods:

Patient-level data were pooled from five randomized, double-blind, placebo-controlled, 6-week studies of lurasidone (fixed doses, 40–160 mg/d) for patients with an acute exacerbation of schizophrenia. Changes in five established PANSS factors were assessed using mixed-model repeated measures analysis.

Results:

Compared with placebo (n = 496), lurasidone (n = 1029, dose groups pooled) significantly improved the PANSS total score at Week 6 (−22.6 vs. −12.8; P < 0.001; effect size, 0.45), as well as all factor scores (P < 0.001 for each): positive symptoms (−8.4 vs. −6.0; effect size, 0.43), negative symptoms (−5.2 vs. −3.3; effect size, 0.33), disorganized thought (−4.9 vs. −2.8; effect size, 0.42), hostility/excitement (−2.7 vs. −1.6; effect size, 0.31), and depression/anxiety (−3.2 vs. −2.3; effect size, 0.31). Separation from placebo occurred at Week 1 for the positive symptoms, disorganized thought, and hostility/excitement factors and at Week 2 for the other factors.

Conclusions:

In this pooled analysis of short-term studies in patients with acute schizophrenia, lurasidone demonstrated significant improvement for each of the five PANSS factor scores, indicating effectiveness across the spectrum of schizophrenia symptoms.

Oxytocin Enhances an Amygdala Circuit Associated With Negative Symptoms in Schizophrenia: A Single-Dose, Placebo-Controlled, Crossover, Randomized Control Trial

Negative symptoms are core contributors to vocational and social deficits in schizophrenia (SZ). Available antipsychotic medications typically fail to reduce these symptoms. The neurohormone oxytocin (OT) is a promising treatment for negative symptoms, given its role in complex social behaviors mediated by the amygdala. In sample 1, we used a double-blind, placebo-controlled, crossover design to test the effects of a single dose of intranasal OT on amygdala resting-state functional connectivity (rsFC) in SZ (n = 22) and healthy controls (HC, n = 24) using a whole-brain corrected approach: we identified regions for which OT modulated SZ amygdala rsFC, assessed whether OT-modulated circuits were abnormal in SZ relative to HC on placebo, and evaluated whether connectivity on placebo and OT-induced connectivity changes correlated with baseline negative symptoms in SZ. Given our modest sample size, we used a second SZ (n = 183) and HC (n = 178) sample to replicate any symptom correlations. In sample 1, OT increased rsFC between the amygdala and left middle temporal gyrus, superior temporal sulcus, and angular gyrus (MTG/STS/AngG) in SZ compared to HC. Further, SZ had hypo-connectivity in this circuit compared to HC on placebo. More severe negative symptoms correlated with less amygdala-to-left-MTG/STS/AngG connectivity on placebo and with greater OT-induced connectivity increases. In sample 2, we replicated the correlation between amygdala-left-MTG/STS/AngG hypo-connectivity and negative symptoms, finding a specific association with expressive negative symptoms. These data suggest intranasal OT can normalize functional connectivity in an amygdala-to-left-MTG/STS/AngG circuit that contributes to negative symptoms in SZ.

[Effect of Lurasidone on symptoms of schizophrenia in five-factor dimensional model: pooled analysis of two short-term, randomized, double-blind, placebo-controlled studies in patients from Russia and Ukraine]

AIM

Evaluation of a new five-factor dimensional model of schizophrenia in recent revisions of classifications of mental disorders (DSM-5 and ICD-11) dictates the need to use this approach in conducting a comprehensive assessment of the effectiveness of new antipsychotic agents, including ethnically homogeneous populations of patients.

MATERIAL AND METHODS

Post-hoc analysis of pooled data from two randomized, double-blind, placebo-controlled, 6-week clinical studies (RCTs) of lurasidone (fixed doses, 40, 80, 120 or 160 mg/d) in patients experiencing an acute exacerbation of schizophrenia. Changes in PANSS total score, CGI-S score and five established PANSS factors were assessed using mixed-model repeated measures analysis.

RESULTS

Lurasidone (n=162, dose groups pooled) compared with placebo (n=68), significantly improved the PANSS total score at Week 6 (-23.0 vs. -10.5; p<0.001; effect size 0.82) as well as all PANSS factor scores: positive symptoms (-8.5 vs. -4.2; p<0.001; effect size 0.88), negative symptoms (-4.4 vs. -2.8; p=0.011, effect size 0.44), disorganized thoughts (-4.4 vs. -2.1; p<0.001; effect size 0.70), hostility/excitement (-2.7 vs. -0.7; p<0.001; effect size 0.66), and depression/anxiety (-3.5 vs. -2.2; p=0.002; effect size 0.53).

CONCLUSION

Lurasidone demonstrated significant improvement for both PANSS total score and each of the five PANSS factor scores, indicating effectiveness across the broad spectrum of schizophrenia symptoms. Effect size for both PANSS total score and each of the five PANSS factor scores for the local population was higher than for the wider population, which included patients from various countries.

Validation of the Chinese Version of the 16-Item Negative Symptom Assessment

PURPOSE

The Negative Symptom Assessment-16 (NSA-16) is an instrument with significant validity and utility for assessing negative symptoms associated with schizophrenia. This study aimed to validate the Chinese version of the NSA-16.

PATIENTS AND METHODS

A total of 172 participants with schizophrenia were assessed with the NSA-16, Scale for Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) and Rating Scale for Extrapyramidal Side Effects (RSESE). The factor structure of the NSA-16 was evaluated via exploratory and confirmatory factor analysis. Cronbach's α and intraclass correlation coefficients were computed. Correlations were evaluated via Spearman correlation coefficient.

RESULTS

The original five-factor model of the NSA-16 did not fit our sample. Exploratory factor analysis followed by confirmatory factor analysis suggested a three-factor structure, consisting of communication, emotion and motivation, with 15 items. The NSA with 15 items was termed as the NSA-15. The NSA-15 showed excellent convergent validity by high correlations with the SANS and PANSS total and negative factor scores and good divergent validity by independence from the PANSS positive factor, CDSS and RSESE. The NSA-15 showed good internal consistency, interrater reliability and test-retest reliability.

CONCLUSION

The NSA-15 is best characterized by a three-factor structure and is valid for assessing negative symptoms of schizophrenia in Chinese individuals.

Mapping cortical surface features in treatment resistant schizophrenia with in vivo structural MRI

Decreases in cortical volume (CV), thickness (CT) and surface area (SA) have been reported in individuals with schizophrenia by in vivo MRI studies. However, there are few studies that examine these cortical measures as potential biomarkers of treatment resistance (TR) and treatment response (NTR) in schizophrenia. This study used structural MRI to examine differences in CV, CT, and SA in 42 adults with schizophrenia (TR = 21, NTR = 21) and 23 healthy controls (HC) to test the hypothesis that individuals with TR schizophrenia have significantly greater reductions in these cortical measures compared to individuals with NTR schizophrenia. We found that individuals with TR schizophrenia showed significant reductions in CV and CT compared to individuals with NTR schizophrenia in right frontal and precentral regions, right parietal and occipital cortex, left temporal cortex and bilateral cingulate cortex. In line with previous literature, the temporal lobe and cingulate gyrus in both patient groups showed significant reductions of all three measures when compared to healthy controls. Taken together these results suggest that regional changes in CV and CT may index mechanisms specific to TR schizophrenia and potentially identify patients with TR schizophrenia for earlier treatment.

Health related quality of life in patients having schizophrenia negative symptoms - a systematic review

Background: Schizophrenia negative symptoms (SNS) contribute substantially to poor functional outcomes, loss in productivity and poor quality of life. It is unclear which instruments may be used for assessing quality of life in patients with SNS. Objective: The objective of this review was to identify instruments assessing health-related quality of life (HRQoL) validated in patients with SNS and to assess their level of validation. Data sources: We conducted a systematic literature review in Medline and the ISPOR database in March 2016 to identify studies on the quality of life in patients with SNS published by March 2016. Data extraction: Psychometric properties and validation steps. Data synthesis: After applying inclusion/exclusion criteria, 49 studies were selected for the analysis of HRQoL instruments; however, none of these instruments only addressed patients with SNS. Of these, 19 HRQoL instruments used in patients with schizophrenia or including patients with SNS among others, in the context of instrument validation, were identified (4 generic, 10 non-specific mental health, 5 schizophrenia-specific). Conclusion: No HRQoL instrument has been validated in patients with SNS only; for the remaining instruments identified, it remains unclear whether they were intended to capture HRQoL in patients with SNS.

The relationship between depression and cognitive function in adults with cardiovascular risk: Evidence from a randomised attention-controlled trial

Background and aim

This study assessed the association between depressive symptom severity and cognition in middle-to-older aged adults with mild-to-moderate depression and cardiovascular risk factors using an online test battery (CogState) and whether changes in depressive symptoms over 3 months were associated with changes in cognition.

Methods

Participants (mean age = 57.8) with cardiovascular risk and mild–to-moderate depressive symptoms completed measures of psychomotor speed, learning, and executive function prior to (n = 445)_and after (n = 334) online depression or attention control interventions. The symptom severity-cognition relationship was examined both cross-sectionally and prospectively.

Results

Participants exhibited significantly reduced psychomotor speed and variable impairments on measures of learning and executive functioning relative to normative data. However, there was no association of depression severity with cognition at baseline or of change in depressive symptoms with change in cognitive performance.

Limitations

Participants were well-educated, which may have protected against cognitive decline. Attrition may limit generalisability, though is unlikely to explain the lack of association between depression symptoms and cognition.

Conclusions

Adults with comorbid mild-to-moderate depressive symptoms and cardiovascular risks performed less well than age-matched normative data on three online cognitive tests; however, we were unable to show any symptom-cognition association cross-sectionally or longitudinally, despite significant improvements in depressive symptoms. This challenges the generalisability of such associations found in more severely unwell clinical samples to those with a broader depressive symptom profile, or suggests that underlying cardiovascular disease may account for the association seen in some clinical studies. This has implications for scaling up selective prevention of cognitive decline.

Identifying improvable employment-related factors in schizophrenia patients

Although many studies report various factors related to future employment of schizophrenia patients, few identify the treatable or improvable ones. The responses to the first year of treatment and daily antipsychotic drug doses may be the treatable and improvable factors. We surveyed 235 schizophrenia outpatients in three facilities, of whom 129 and 106 were employed and unemployed, respectively. Through face-to-face interviews and medical record reviews, we investigated symptomatic and social functioning responses to the first year of treatment using the Global Assessment of Psychopathology Scale (GAPS) and the Social and Occupational Functioning Assessment Scale (SOFAS). We investigated daily antipsychotic drug doses and other clinical assessments at the interview time. Finally, we used multivariable logistic regression analysis. SOFAS-measured improvements in the period 6 to 12 months after beginning treatment and daily antipsychotic drug doses equivalent to less than 600 mg of chlorpromazine were identified as an employment-related factor, but GAPS-measure improvements were not. Social functioning improvements in the period 6 to 12 months after beginning treatment and low-to-moderate daily antipsychotic drug doses were detected as employment-related factors, suggesting that early efforts to improve social functioning and optimize antipsychotic drug doses could lead to future employment for schizophrenia patients.

Mirtazapine adjunct for people with schizophrenia

BACKGROUND

Many individuals who have a diagnosis of schizophrenia experience a range of distressing and debilitating symptoms. These can include positive symptoms (such as delusions, hallucinations, disorganised speech), cognitive symptoms (such as trouble focusing or paying attention or using information to make decisions), and negative symptoms (such as diminished emotional expression, avolition, alogia, and anhedonia). Antipsychotic drugs are often only partially effective, particularly in treating negative symptoms, indicating the need for additional treatment. Mirtazapine is an antidepressant drug that when taken in addition to an antipsychotic may offer some benefit for negative symptoms.

OBJECTIVES

To systematically assess the effects of mirtazapine as adjunct treatment for people with schizophrenia.

SEARCH METHODS

The Information Specialist of Cochrane Schizophrenia searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (including registries of clinical trials) up to May 2018.

SELECTION CRITERIA

All randomised-controlled trials (RCTs) with useable data focusing on mirtazapine adjunct for people with schizophrenia.

DATA COLLECTION AND ANALYSIS

We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat (ITT) basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. For included studies we assessed risk of bias and created 'Summary of findings' table using GRADE.

MAIN RESULTS

We included nine RCTs with a total of 310 participants. All studies compared mirtazapine adjunct with placebo adjunct and were of short-term duration. We considered five studies to have a high risk of bias for either incomplete outcome data, selective reporting, or other bias.Our main outcomes of interest were clinically important change in mental state (negative and positive symptoms), leaving the study early for any reason, clinically important change in global state, clinically important change in quality of life, number of days in hospital and incidence of serious adverse events.One trial defined a reduction in the Scale for the Assessment of Negative Symptoms (SANS) overall score from baseline of at least 20% as no important response for negative symptoms. There was no evidence of a clear difference between the two treatments with similar numbers of participants from each group showing no important response to treatment (RR 0.81, 95% CI 0.57 to 1.14, 1 RCT, n = 20, very low-quality evidence).Clinically important change in positive symptoms was not reported, however, clinically important change in overall mental state was reported by two trials and data for this outcome showed a favourable effect for mirtazapine (RR 0.69, 95% CI 0.51 to 0.92; I² = 75%, 2 RCTs, n = 77, very low-quality evidence). There was no evidence of a clear difference for numbers of participants leaving the study early (RR 1.03, 95% CI 0.64 to 1.66, 9 RCTs, n = 310, moderate-quality evidence), and no evidence of a clear difference in global state Clinical Global Impressions Scale (CGI) severity scores (MD -0.10, 95% CI -0.68 to 0.48, 1 RCT, n = 39, very low-quality evidence). A favourable effect for mirtazapine adjunct was found for the outcome clinically important change in akathisia (RR 0.33, 95% CI 0.20 to 0.52, 2 RCTs, n = 86, low-quality evidence; I² = 61%I). No data were reported for quality life or number of days in hospital.In addition to the main outcomes of interest, there was evidence relating to adverse events that the mirtazapine adjunct groups were associated with an increased risk of weight gain (RR 3.19, 95% CI 1.17 to 8.65, 4 RCTs, n = 127) and sedation/drowsiness (RR 1.64, 95% CI 1.01 to 2.68, 7 RCTs, n = 223).

AUTHORS' CONCLUSIONS

The available evidence is primarily of very low quality and indicates that mirtazapine adjunct is not clearly associated with an effect for negative symptoms, but there is some indication of a positive effect on overall mental state and akathisia. No effect was found for global state or leaving the study early and data were not available for quality of life or service use. Due to limitations of the quality and applicability of the evidence it is not possible to make any firm conclusions, the role of mirtazapine adjunct in routine clinical practice remains unclear. This underscores the need for new high-quality evidence to further evaluate mirtazapine adjunct for schizophrenia.

Spanish validation of the Negative Symptom Assessment-16 (NSA-16) in patients with schizophrenia

INTRODUCTION

Negative symptoms are prevalent in schizophrenia and associated with a poorer outcome. Validated newer psychometric instruments could contribute to better assessment and improved treatment of negative symptoms. The Negative Symptom Assessment-16 (NSA-16) has been shown to have strong psychometric properties, but there is a need for validation in non-English languages. This study aimed to examine the psychometric properties of a Spanish version of the NSA-16 (Sp-NSA-16).

MATERIAL AND METHOD

Observational, cross-sectional validation study in a sample of 123 outpatients with schizophrenia.

ASSESSMENTS

NSA-16, PANSS, HDRS, CGI-SCH and PSP.

RESULTS

The results indicate appropriate psychometric properties, high internal consistency (Cronbach's alpha=0.86), convergent validity (PANSS negative scale, PANSS Marder Negative Factor and CGI-negative symptoms r values between 0.81 and 0.94) and divergent validity (PANSS positive scale and the HDRS r values between 0.10 and 0.34). In addition, the NSA-16 also exhibited discriminant validity (ROC curve=0.97, 95% CI=0.94 to 1.00; 94.3% sensitivity and 83.3% specificity).

CONCLUSIONS

The Sp-NSA-16 is reliable and valid for measuring negative symptoms in patients with schizophrenia. This provides Spanish clinicians with a new tool for clinical practice and research. However, it is necessary to provide further information about its inter-rater reliability.

Mutual activation of glutamatergic mGlu4 and muscarinic M4 receptors reverses schizophrenia-related changes in rodents

RATIONALE

Metabotropic glutamate receptors and muscarinic M₄ receptors have been proposed as novel targets for various brain disorders, including schizophrenia. Both receptors are coupled to G_o/i proteins and are expressed in brain circuits that are important in schizophrenia. Therefore, their mutual activation may be an effective treatment and allow minimizing the doses of ligands required for optimal activity.

OBJECTIVES

In the present studies, subactive doses of mGlu₄ and M₄ activators (LSP4-2022 and VU152100, respectively) were administered to investigate the mutual interaction between mGlu₄ and M₄ receptors in animal models of schizophrenia.

METHODS

The behavioral tests used were MK-801-induced hyperactivity, (±)-2.5-dimethoxy-4-iodoamphetamine hydrochloride (DOI)-induced head twitches, the modified forced swim test, and MK-801-induced disruptions of social interactions and novel object recognition. DOI-induced spontaneous excitatory postsynaptic currents (sEPSCs) in brain slices and positron emission tomography (PET) in were used to establish the ability of these compounds to modulate the glutamatergic and dopaminergic systems. Rotarod was used to assess putative adverse effects.

RESULTS

The mutual administration of subactive doses of LSP4-2022 and VU152100 exerted similar antipsychotic-like efficacy in animals as observed for active doses of both compounds, indicating their additive actions. VU152100 inhibited the DOI-induced frequency (but not amplitude) of sEPSCs in the frontal cortex, confirming presynaptic regulation of glutamate release. Both compounds reversed amphetamine-induced decrease in D₂ receptor levels in the striatum, as measured with [¹⁸F]fallypride. The compounds did not induce any motor impartments when measured in rotarod test.

CONCLUSIONS

Based on our results, the simultaneous activation of M₄ and mGlu₄ receptors is beneficial in reversing MK-801- and amphetamine-induced schizophrenia-related changes in animals.

Phencyclidine increased while isolation rearing did not affect progressive ratio responding in rats: Investigating potential models of amotivation in schizophrenia

BACKGROUND

Schizophrenia is a debilitating neurodevelopmental disorder affecting 1% of the global population with heterogeneous symptoms including positive, negative, and cognitive. While treatment for positive symptoms exists, none have been developed to treat negative symptoms. Animal models of schizophrenia are required to test targeted treatments and since patients exhibit reduced effort (breakpoints) for reward in a progressive ratio (PR) task, we examined the PR breakpoints of rats treated with the NMDA receptor antagonist phencyclidine or those reared in isolation - two common manipulations used to induce schizophrenia-relevant behaviors in rodents.

METHODS

In two cohorts, the PR breakpoint for a palatable food reward was examined in Long Evans rats after: 1) a repeated phencyclidine regimen; 2) A subchronic phencyclidine regimen followed by drug washout; and 3) post-weaning social isolation.

RESULTS

Rats treated with repeated phencyclidine and those following washout from phencyclidine exhibited higher PR breakpoints than vehicle-treated rats. The breakpoint of isolation reared rats did not differ from those socially reared, despite abnormalities of these rats in other schizophrenia-relevant behaviors.

CONCLUSION

Despite their common use for modeling other schizophrenia-relevant behaviors neither phencyclidine treatment nor isolation rearing recreated the motivational deficits observed in patients with schizophrenia, as measured by PR breakpoint. Other manipulations, and negative symptom-relevant behaviors, require investigation prior to testing putative therapeutics.

Molecular bases of anorexia nervosa, bulimia nervosa and binge eating disorder: shedding light on the darkness

Eating-disorders (EDs) consequences to human health are devastating, involving social, mental, emotional, physical and life-threatening aspects, concluding on impairment and death in cases of extreme anorexia nervosa. It also implies that people suffering an ED need to find psychiatric and psychological help as soon as possible to achieve a fully physical and emotional recovery. Unfortunately, to date, there is a crucial lack of efficient clinical treatment to these disorders. In this review, we present an overview concerning the actual pharmacological and psychological treatments, the knowledge of cells, circuits, neuropeptides, neuromodulators and hormones in the human brain- and other organs- underlying these disorders, the studies in animal models and, finally, the genetic approaches devoted to face this challenge. We will also discuss the need for new perspectives, avenues and strategies to be developed in order to pave the way to novel and more efficient therapeutics.

An Assessment of Five (PANSS, SAPS, SANS, NSA-16, CGI-SCH) commonly used Symptoms Rating Scales in Schizophrenia and Comparison to Newer Scales (CAINS, BNSS)

Scales measuring positive and negative symptoms in schizophrenia remain the primary mo Scales measuring positive and negative symptoms in schizophrenia remain the primary mode of assessing and diagnosing schizophrenia by clinicians and researchers. The scales are mainly used to monitor the severity of positive and negative symptoms and track treatment response in schizophrenics. Although these scales are widely used, quality as well as general utility of each scale varies. The quality is determined by the validity and reliability of the scales. The utility of the scale is determined by the time of administration and the settings for which the scales can be administered in research or clinical settings. There are relatively fewer articles on the utility of newer scales like CAINS (Clinical Assessment Interview for Negative Symptoms) and the BNSS (Brief Negative Symptom Scale) that compare them to the older scales PANSS (Positive and Negative Symptoms Scale), SAPS (Scale for the Assessment of Positive Symptoms) SANS (the Scale for the Assessment of Negative Symptoms), NSA-16 (Negative Symptom Assessment-16) and CGI-SCH (Clinical Global Impression Schizophrenia.

The older scales were developed more than 30 years ago. Since then, our understanding of negative symptoms has evolved and currently there are newer rating scales evaluating the validity of negative symptoms. The older scales do not incorporate the latest research on negative symptoms. CAINS and BNSS are attractive for both their reliability and their concise accessible format, however, a scale that is simpler, accessible, user-friendly, that incorporates a multidimensional model of schizophrenia, addresses the psychosocial and cognitive component has yet to be developed.

Effectiveness of amisulpride in Chinese patients with predominantly negative symptoms of schizophrenia: a subanalysis of the ESCAPE study

BACKGROUND

Effective management strategies for the negative symptoms of schizophrenia remain an unmet need, and data on the use of antipsychotics in this population are scarce, particularly in Chinese patients. Therefore, we investigated amisulpride for the treatment of Chinese patients with predominantly negative symptoms of schizophrenia.

METHODS

This post hoc subanalysis of the prospective Effectiveness and Safety of Amisulpride in Chinese Patients with Schizophrenia (ESCAPE) study included adult Chinese patients with an International Classification of Diseases-10 diagnosis of schizophrenia and predominantly negative symptoms, who received amisulpride for 8 weeks. Effectiveness outcomes included ≥50% decrease in Positive and Negative Syndrome Scale (PANSS) negative score, and a reduction in PANSS negative symptom score and Clinical Global Impression Severity Scale (CGI-S). The study was registered at ClinicalTrials.gov (NCT01795183).

RESULTS

In total, 26 patients were included in the analysis. A ≥50% decrease in PANSS negative score from baseline to week 8 was achieved by 34.6% of patients. From baseline to week 8, the mean PANSS negative symptom score decreased by 45.2% (31.9 to 20.7) and CGI-S decreased 1.9 points (5.2 to 3.3). The mean week 8 dose of amisulpride was lower for patients who achieved a ≥50% decrease in PANSS negative score at week 8 versus those who did not (481.2 vs 704.1 mg/day). The most common treatment-related adverse events included blood prolactin increase (19.2%) and extrapyramidal disorder (19.2%). Weight gain was reported by one patient.

CONCLUSION

Amisulpride effectively reduced PANSS negative symptom score and CGI-S for Chinese patients with predominantly negative symptoms of schizophrenia. No unexpected adverse events were reported.

The Daily Activity Report (DAR) a Novel Measure of Functional Outcome for Serious Mental Illness

The assessment of real-world functional outcomes in clinical trials for medications targeting negative symptoms and cognitive impairment is extremely important. We tested the psychometric properties of the Daily Activity Report (DAR), a novel assessment of productive daily activity. We administered the DAR and additional assessments of functional outcome, functional capacity, cognition and symptomatology to 50 individuals with schizophrenia at 2 time points, 1 month apart and to 25 healthy controls. The DAR records a person's daily activity for 7 consecutive days based upon phone calls made 3 times a day. A total score and scores in 3 domains; instrumental activities (ie, independent living), social and work or school related activities are generated for the DAR. Inter-item consistency was high 0.89-0.94 for each domain and 0.88 overall. Test-retest reliability across 1 month for the total DAR score was 0.67,P< .0001. The total DAR score as well as scores for social activity and nondomestic work/school differed significantly between control and patient participants (P< .0001). DAR domain scores were associated with negative symptoms and functional outcomes, but the primary score related to these measures was the work/school dimension of the DAR. DAR scores were only weakly and nonsignificantly related to positive symptoms. This study provides preliminary support for the reliability and validity of the DAR using interviewer administration. The development of a patient reported version of the DAR using smart phone technology with automatic scoring is the next step.

Conceptualization and treatment of negative symptoms in schizophrenia

Negative symptoms of schizophrenia including social withdrawal, diminished affective response, lack of interest, poor social drive, and decreased sense of purpose or goal directed activity predict poor functional outcomes for patients with schizophrenia. They may develop and be maintained as a result of structural and functional brain abnormalities, particularly associated with dopamine reward pathways and by environmental and psychosocial factors such as self-defeating cognitions and the relief from overstimulation that accompanies withdrawal from social and role functioning. Negative symptoms are more difficult to treat than the positive symptoms of schizophrenia and represent an unmet therapeutic need for large numbers of patients with schizophrenia. While antipsychotic medications to treat the symptoms of schizophrenia have been around for decades, they have done little to address the significant functional impairments in the disorder that are associated with negative symptoms. Negative symptoms and the resulting loss in productivity are responsible for much of the world-wide personal and economic burden of schizophrenia. Pharmacologic treatments may be somewhat successful in treating secondary causes of negative symptoms, such as antipsychotic side effects and depression. However, in the United States there are no currently approved treatments for severe and persistent negative symptoms (PNS) that are not responsive to treatments for secondary causes. Pharmacotherapy and psychosocial treatments are currently being developed and tested with severe and PNS as their primary targets. Academia, clinicians, the pharmaceutical industry, research funders, payers and regulators will need to work together to pursue novel treatments to address this major public health issue.

Metabotropic glutamate receptors as targets for new antipsychotic drugs: Historical perspective and critical comparative assessment

In this review, we aim to present, discuss and clarify our current understanding regarding the prediction of possible antipsychotic effects of metabotropic glutamate (mGlu) receptor ligands. The number of preclinical trials clearly indicates, that this group of compounds constitutes an excellent alternative to presently used antipsychotic therapy, being effective not only to positive, but also negative and cognitive symptoms of schizophrenia. Although the results of clinical trials that were performed for the group of mGlu2/3 agonists were not so enthusiastic as in animal studies, they still showed that mGlu ligands do not induced variety of side effects typical for presently used antipsychotics, and were generally well tolerated. The lack of satisfactory effectiveness towards schizophrenia symptoms of mGlu2/3 activators in humans could be a result of variety of uncontrolled factors and unidentified biomarkers different for each schizophrenia patient, that should be taken into consideration in the future set of clinical trials. The subject is still open for further research, and the novel classes of mGlu5 or mGlu2/3 agonists/PAMs were recently introduced, including the large group of compounds from the third group of mGlu receptors, especially of mGlu4 subtype. Finally, more precise treatment based on simultaneous administration of minimal doses of the ligands for two or more receptors, seems to be promising in the context of symptoms-specific schizophrenia treatment.

Pharmacological treatment of negative symptoms in schizophrenia

Effective treatment of negative symptoms is one of the most important unmet needs in schizophrenic disorders. Because the evidence on current psychopharmacological treatments is unclear, the authors reviewed the findings published to date by searching PubMed with the keywords negative symptoms, antipsychotics, antidepressants, glutamatergic compounds, monotherapy and add-on therapy and identifying additional articles in the reference lists of the resulting publications. The findings presented here predominantly focus on results of meta-analyses. Evidence for efficacy of current psychopharmacological medications is difficult to assess because of methodological problems and inconsistent results. In general, the second-generation antipsychotics (SGAs) do not appear to have good efficacy in negative symptoms, although some show better efficacy than first-generation antipsychotics, some of which also demonstrated efficacy in negative symptoms. Specific trials on predominant persistent negative symptoms are rare and have been performed with only a few SGAs. More often, trials on somewhat persistent negative symptoms evaluate add-on strategies to ongoing antipsychotic treatment. Such trials, mostly on modern antidepressants, have demonstrated some efficacy. Several trials with small samples have evaluated add-on treatment with glutamatergic compounds, such as the naturally occurring amino acids glycine and D-serine and new pharmacological compounds. The results are highly inconsistent, although overall efficacy results appear to be positive. The unsatisfactory and inconsistent results can be partially explained by methodological problems. These problems need to be solved in the future, and the authors propose some possible solutions. Further research is required to identify effective treatment for the negative symptoms of schizophrenia.

Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials

OBJECTIVES

Existing treatments for schizophrenia can improve positive symptoms, but it is unclear if they have any impact on negative symptoms. This meta-analysis was conducted to assess the efficacy of available treatments for negative symptoms in schizophrenia.

METHODS

All randomized-controlled trials of interventions for negative symptoms in schizophrenia until December 2013 were retrieved; 168 unique and independent placebo-controlled trials were used. Negative symptom scores at baseline and follow-up, duration of illness, doses of medication, type of interventions, and sample demographics were extracted. Heterogeneity was addressed with the I (2) and Q statistic. Standardized mean difference in values of the Negative Symptom Rating Scale used in each study was calculated as the main outcome measure.

RESULTS

6503 patients in the treatment arm and 5815 patients in the placebo arm were included. No evidence of publication biases found. Most treatments reduced negative symptoms at follow-up relative to placebo: second-generation antipsychotics: -0.579 (-0.755 to -0.404); antidepressants: -0.349 (-0.551 to -0.146); combinations of pharmacological agents: -0.518 (-0.757 to -0.279); glutamatergic medications: -0.289 (-0.478 to -0.1); psychological interventions: -0.396 (-0.563 to -0.229). No significant effect was found for first-generation antipsychotics: -0.531 (-1.104 to 0.041) and brain stimulation: -0.228 (-0.775 to 0.319). Effects of most treatments were not clinically meaningful as measured on Clinical Global Impression Severity Scale.

CONCLUSIONS AND RELEVANCE

Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement.

Validation of the German Version of the Social Functioning Scale (SFS) for schizophrenia

Deficits in social functioning are a core symptom of schizophrenia and an important criterion for evaluating the success of treatment. However, there is little agreement regarding its measurement. A common, often cited instrument for assessing self-reported social functioning is the Social Functioning Scale (SFS). The study aimed to investigate the reliability and validity of the German translation. 101 patients suffering from schizophrenia (SZ) and 101 matched controls (C) (60 male / 41 female, 35.8 years in both groups) completed the German version. In addition, demographic, clinical, and functional data were collected. Internal consistency was investigated calculating Cronbach's alpha for SFS full scale (α: .81) and all subscales (α: .59-.88). Significant bivariate correlation coefficients were found between all subscales as well as between all subscales and full scale (p <.01). For the total sample, principal component analysis gave evidence to prefer a single-factor solution (eigenvalue ≥ 1) accounting for 48.5 % of the variance. For the subsamples, a two-component solution (SZ; 57.0 %) and a three-component solution (C; 65.6 %) fitted best, respectively. For SZ and C, significant associations were found between SFS and external criteria. The main factor "group" emerged as being significant. C showed higher values on both subscales and full scale. The sensitivity of the SFS was examined using discriminant analysis. 86.5% of the participants could be categorized correctly to their actual group. The German translation of the SFS turned out to be a reliable and valid questionnaire comparable to the original English version. This is in line with Spanish and Norwegian translations of the SFS. Concluding, the German version of the SFS is well suited to become a useful and practicable instrument for the assessment of social functioning in both clinical practice and research. It accomplishes commonly used external assessment scales.

Comparison of self-report and performance-based measures of everyday functioning in individuals with schizophrenia: implications for measure selection

INTRODUCTION

Both self-report and performance-based measures are often used in assessment of everyday functioning for individuals with schizophrenia. However, there is little evidence of overlap between them, and there are no established standards for which measures might be most appropriate. In order to better understand differences among these types of measures, we examined relationships between a self-report and two performance-based measures of everyday functioning. We also examined their patterns of interrelationships to neurocognition and psychiatric symptoms.

METHODS

Participants were 71 outpatients with schizophrenia spectrum disorder. Measures of everyday functioning (Independent Living Skill Survey-Self Report (ILSS-SR); University of California San Diego Performance-based Skills Assessment; and Medication Management Ability Assessment), cognition and psychiatric symptoms were administered. Correlation analyses were conducted to examine the relationships among the functioning measures, and their relationships to cognition and symptoms. Regression analyses further examined the unique contributions of neurocognitive and symptom variables to functional measures.

RESULTS

Consistent with the literature, the two performance-based measures were related to each other, but not to the self-report measure. Whereas the performance-based measures were related to neurocognition but not to the psychiatric symptoms, the opposite pattern was observed for the self-report measure.

CONCLUSIONS

The pattern of interrelationships among these self-report and performance-based measures suggests that they tap different aspects of everyday functioning. This has important implications for measure selection, particularly for evaluating intervention outcomes. When targeting symptoms, a self-report measure like the ILSS-SR may be more appropriate, whereas a performance-based measure may be more sensitive to functional changes subsequent to treatments targeting cognition.

Defining and measuring negative symptoms of schizophrenia in clinical trials

Recent attention has focused on negative symptoms as a target for new therapeutic approaches including pharmacological agents, medical devices, and psychosocial treatments. Each of these approaches requires an instrument for measuring the severity of negative symptoms as well as changes in severity over time. The instrument selected should provide coverage for the domains of negative symptoms; it should be sensitive to change; it should be reliable and relatively brief; and it should be useful for large international trials. These criteria were used to evaluate a number of older instruments including the Schedule for the Assessment of Negative Symptoms (SANS), the Positive and Negative Symptoms Scale (PANSS), and the Negative Symptom Assessment Scale (NSA). Two newer scales, the Brief Negative Symptom Scale (BNSS) and the Clinical Assessment Interview for Negative Symptoms (CAINS) were developed following a National Institute of Mental Health consensus meeting and addressed some of the shortcomings of earlier instruments.

The longitudinal interplay between negative and positive symptom trajectories in patients under antipsychotic treatment: a post hoc analysis of data from a randomized, 1-year pragmatic trial

BACKGROUND

Schizophrenia is a highly heterogeneous disorder with positive and negative symptoms being characteristic manifestations of the disease. While these two symptom domains are usually construed as distinct and orthogonal, little is known about the longitudinal pattern of negative symptoms and their linkage with the positive symptoms. This study assessed the temporal interplay between these two symptom domains and evaluated whether the improvements in these symptoms were inversely correlated or independent with each other.

METHODS

This post hoc analysis used data from a multicenter, randomized, open-label, 1-year pragmatic trial of patients with schizophrenia spectrum disorder who were treated with first- and second-generation antipsychotics in the usual clinical settings. Data from all treatment groups were pooled resulting in 399 patients with complete data on both the negative and positive subscale scores from the Positive and Negative Syndrome Scale (PANSS). Individual-based growth mixture modeling combined with interplay matrix was used to identify the latent trajectory patterns in terms of both the negative and positive symptoms. Pearson correlation coefficients were calculated to examine the relationship between the changes of these two symptom domains within each combined trajectory pattern.

RESULTS

We identified four distinct negative symptom trajectories and three positive symptom trajectories. The trajectory matrix formed 11 combined trajectory patterns, which evidenced that negative and positive symptom trajectories moved generally in parallel. Correlation coefficients for changes in negative and positive symptom subscale scores were positive and statistically significant (P < 0.05). Overall, the combined trajectories indicated three major distinct patterns: (1) dramatic and sustained early improvement in both negative and positive symptoms (n = 70, 18%), (2) mild and sustained improvement in negative and positive symptoms (n = 237, 59%), and (3) no improvement in either negative or positive symptoms (n = 82, 21%).

CONCLUSIONS

This study of symptom trajectories over 1 year shows that changes in negative and positive symptoms were neither inversely nor independently related with each other. The positive association between these two symptom domains supports the notion that different symptom domains in schizophrenia may depend on each other through a unified upstream pathological disease process.

Long-term effects of asenapine or olanzapine in patients with persistent negative symptoms of schizophrenia: a pooled analysis

BACKGROUND

A Phase 2 efficacy study suggested that asenapine (ASE) was superior to risperidone in decreasing negative symptoms in schizophrenia at 6 weeks, prompting design of two negative symptom studies. Two 26-week core studies with 26-week extensions compared asenapine (ASE: 5-10mg twice-daily] and olanzapine (OLA: 5-20mg once-daily) as monotherapies in reducing persistent negative symptoms (PNS). While neither study met the primary endpoint of superiority of ASE over OLA, ASE was statistically superior to OLA in one extension study. This prompted a pooled analysis of the treatment effects of both drugs.

METHODS

Data were pooled from two 26-week core studies and extensions. Efficacy endpoints: change in Negative Symptom Assessment scale-16 (NSA-16) total score at Week 26 (prespecified primary endpoint) and Week 52. Additional measures: change in Positive and Negative Syndrome Scale (PANSS)-total, Marder factors, negative subscale scores, Clinical Global Impression Severity of Illness score (CGI-S) assessments, NSA-16 factor domains, NSA global score, and individual items.

RESULTS

Pooled data from the extension studies (n=502) showed no differences between ASE and OLA at Week 26. At Week 52, ASE showed superiority over OLA in NSA-16 total score, NSA global, PANSS Marder negative and PANSS negative subscales, some NSA-16 items, and four of five factor domains. In addition, pooled data for patients who entered the core trials (n=949) were analyzed over 52weeks (whether or not patients entered the extension). No significant differences between groups were observed in change in NSA-16 total score at 26-weeks. At Week 52, ASE was significantly superior over OLA in this measure, NSA global score and PANSS Marder negative factor. There were more early dropouts due to AEs, including worsening of the disease, in the ASE group.

CONCLUSION

In this pooled analysis, ASE and OLA did not differ significantly over 26 weeks, but indicated a signal of superiority for ASE with continued treatment up to 52 weeks.

Clinical instruments to evaluate and guide treatment in schizophrenia

Treatment research in schizophrenia is focused on the development of pharmacological agents that are effective for improving community functioning and decreasing disability. As a result of this recent focus, there has been substantial activity for developing instruments that can measure functioning as well as the psychopathological domains that are related to functioning. Issues in selecting measures of real-world functioning include ensuring that the instrument measures the full range of possible outcomes and differentiating symptoms from functioning. For many treatment studies it is unrealistic to expect a change in actual functioning. Most treatment trials are too brief to permit subjects to change their level of vocational or social functioning. In addition, real-world functioning is influenced by factors such as an individual's financial status or the availability of community services. This has led to the use of functional capacity measures which monitor an individual's ability to perform functionally meaningful tasks even if they do not complete these tasks. Attention has also focused on interview-based measures of cognition and negative symptoms. Both of these psychopathological domains are related to functioning and both are the focus of drug development.Recent drug development has focused on the development of agents that target domains of psychopathology that may lead to improved functioning. This focus contrasts with the development of first and second-generation antipsychotics; these drugs were considered effective when they treated psychotic symptoms such as auditory hallucinations, suspiciousness, delusions, and disorganized behaviors. Treating these symptoms was important for reducing suffering and for allowing many patients to live in their communities. On the other hand, these agents had relatively modest effects on the ability of patients to function in their communities. This new focus on functioning has led to the development of new instruments for measuring functioning as well as the psychopathological domains that appear to be related to impaired functioning. This review will discuss the challenges that instrument developers have faced in designing these new instruments as well as the current state of the field. The measurement of typical psychopathology-particularly psychosis will not be discussed.

Effects of controlled-release formulations of atypical antipsychotics on functioning and quality of life of schizophrenic individuals

INTRODUCTION

Controlled-release formulations of atypical antipsychotics have recently been introduced into clinical practice. Clinical studies have indicated that these new therapies induce meaningful improvements in the functioning and quality of life of schizophrenic individuals.

AREAS COVERED

The present analysis makes an attempt to address the clinical relevance of these studies and their contribution to the understanding of the mechanisms of action of these new drugs. A Medline search was done using the keywords 'antipsychotic', 'plasma level', 'quality of life' and 'functioning'.

EXPERT OPINION

After reviewing the literature, it seems that symptom control and side effects may play a role in modulating the functioning and quality of life of schizophrenic individuals treated with controlled-release formulations of atypical antipsychotics. The analysis also highlights that these new drugs may possess peculiarities and similarities in regulating patient functioning. However, the low number of clinical analyses that have focused on these aspects of antipsychotic therapy limits the interpretation of the results. Additional comparative clinical trials are needed to evaluate how the pharmacokinetic/pharmacodynamic properties of antipsychotic drugs may modulate the functioning and quality of life of schizophrenic individuals, as well as to establish whether new clinical benefits may come from the use of these drugs in schizophrenia therapy.

Preliminary structure and predictive value of attenuated negative symptoms in 22q11.2 deletion syndrome

Current research in schizophrenia suggests that negative symptoms cannot be considered a unitary construct and should be divided in two dimensions: lack of motivation and impoverishment of expression. In addition, negative symptoms are particularly related to decreased daily-life functioning. In the present study, we aimed to replicate these results in a sample of participants with 22q11.2 deletion syndrome (22q11DS), a neurogenetic condition associated with high risk of developing schizophrenia. We also expected to observe an association between the COMT Val/Met polymorphism and negative symptoms. We examined the factorial structure of negative symptoms in a sample of 47 individuals with 22q11DS using the Structured Interview for Prodromal Symptoms (SIPS) and the Positive and Negative Syndrome Scale (PANSS). We also performed stepwise regression analyses to investigate the associations between negative symptoms, adaptive skills and the COMT Val/Met polymorphism. Negative symptoms were explained by a two-factor solution, namely the "amotivation and social withdrawal" and the "emotional withdrawal and expression" dimensions. The motivational dimension was significantly associated with daily-life functioning. Met carriers were rated as experiencing significantly more symptoms of amotivation. The results are interpreted in the light of existing cognitive models in the field of motivation and schizophrenia.

Social skills and behavioral problems in schizophrenia: the role of mental state attribution, neurocognition and clinical symptomatology

Poor social skills and abnormal behaviors are key features of schizophrenia and comprise important aspects of social functioning. Previous studies have shown that impairment of a social cognitive capacity for mental state attribution may be predictive of poor social skills. Poor social skills also seem to be related to the presence of negative symptoms, whereas the association with other symptom domains seems less clear. The contribution of nonsocial cognition, particularly executive functioning, to functional outcome in schizophrenia, and the relationships between social and nonsocial cognition, continue to be debated. To examine the relationships of mental state attribution with social skills, neurocognition and clinical symptomatology, we pooled data from two previous independent studies into one sample of 69 patients with schizophrenia. The sample was stratified for IQ, age range, and attention deficits. We also used a novel five-factor model of the Positive and Negative Syndrome Scale. A combined verbal and non-verbal score of mental state attribution was the best cognitive predictor of social skills, whereas neurocognition (i.e., executive planning skills) did not mediate this effect. When measures of psychopathology were included, levels of disorganized and negative symptoms predicted large proportions of variance in social functioning. Nevertheless, mental state attribution remained the sole, significant cognitive predictor variable in the equation. In conclusion, a capacity for mental state attribution is uniquely important for social skills in schizophrenia. As such, training to target social cognitive skills, including mental state attribution, may be particularly beneficial for patients' social functioning.

Is personal and social functioning associated with subjective quality of life in schizophrenia patients living in the community?

Subjective quality of life (QoL) and psychosocial functioning constitute important treatment outcomes in schizophrenia. We aimed to investigate the relationship between them in schizophrenia patients living in the community. Symptom severity and insight were assessed with the Positive and Negative Syndrome Scale (PANSS) in 76 community schizophrenia patients. Social functioning was measured with the Portuguese version of Personal and Social Performance (PSP) scale, and subjective QoL was measured with the Portuguese version of the WHO Quality of Life Measure-Abbreviated Version (WHOQOL-Bref). The majority of patients were single (78%) and unemployed/inactive (74%). Mean PSP total score was 55.5, and mean scores on WHOQOL-Bref domains ranged from 54.1 to 63.0. Greater symptom severity and worse insight were significantly associated with worse functioning in all PSP domains. Symptoms were more moderately correlated with QoL, with no significant correlations between QoL and positive symptoms and insight levels. Partial correlations controlling for symptom severity revealed no significant associations between social functioning and subjective QoL. Symptom severity may exert a greater influence on social functioning than on subjective QoL; however, social functioning was not associated with subjective QoL. The results suggest these constructs might be independent and should be assessed separately. A broader research approach, with increased attention to social and psychological factors, may help identify treatment targets to improve schizophrenia patients' social functioning and QoL.

The importance of measuring psychosocial functioning in schizophrenia

BACKGROUND

Schizophrenia is among the most disabling of mental illnesses and frequently causes impaired functioning. We explore issues of definition and terminology, and the relationship between social functioning, cognition, and psychopathology considering relevant research findings.

METHODS

The present article describes measures of social functioning and outlines their psychometric properties. It considers their usefulness in research and clinical settings. Treatment aims and objectives are explored in the context of cognitive and social functioning. Finally, we identify areas for developing research and refining the measurement of social functioning.

RESULTS

The definition and measurement of social functioning in schizophrenia remains a complex and disputed area. The relationships between symptoms, cognitive functioning and social functioning are complex but we are beginning to understand them better. Scales for measuring functioning in clinical practice must be brief and sensitive to change and the Personal and Social Performance (PSP) scale may offer several advantages in these regards. Brief cognitive assessments focusing upon the domains most commonly affected in schizophrenia, such as verbal memory and executive functions, should be coadministered with measures of functioning.

CONCLUSIONS

The use of validated scales for schizophrenia that are sensitive to change over the course of the illness and its treatment, should allow for a better understanding of patients' functional disabilities, enabling better and more comprehensive monitoring and evaluation of both pharmacological and non-pharmacological treatment strategies.

Methodological issues in negative symptom trials

Individuals from academia, the pharmaceutical industry, and the US Food and Drug Administration used a workshop format to discuss important methodological issues in the design of trials of pharmacological agents for improving negative symptoms in schizophrenia. The issues addressed included the need for a coprimary functional measure for registration trials; the characteristics of individuals who should enter negative symptom trials; the optimal duration for a proof-of-concept or registration trial; the optimal design of a study of a broad-spectrum agent that treats both positive and negative symptoms or a co-medication that is added to an antipsychotic; the relative strengths and weaknesses of available instruments for measuring negative symptoms; the definition of clinically meaningful improvement for these trials; and whether drugs can be approved for a subdomain of negative symptoms.

Psychosocial function in schizophrenia and bipolar disorder: Relationship to neurocognition and clinical symptoms

In line with a dimensional approach to psychopathology, we examined whether psychosocial function and its relationship to neurocognition and clinical symptoms differ across schizophrenia and bipolar disorder subgroups with and without a history of affective or psychotic episodes. From the TOP study, a heterogeneous sample of individuals with schizophrenia spectrum disorders without (n = 60) and with a history of affective episodes (n = 54); individuals with bipolar spectrum disorders with (n = 64) and without a history of psychosis (n = 56) and healthy controls (n = 268) participated. Psychosocial functioning was measured with the Social Functioning Scale (self-rated) and the Global Assessment of Functioning Scale (clinician-rated), neurocognition with a comprehensive neuropsychological test battery, and symptoms with Inventory of Depressive Symptomatology, Young Mania Rating Scale, and Positive and Negative Syndrome Scale. Clinician-rated functioning was poorer in schizophrenia groups than in bipolar groups, but self-rated functioning was similar across all clinical groups and poorer than in controls. Neurocognition and current clinical symptoms were associated with psychosocial function in bivariate analyses, but current symptoms had a greater independent contribution to functioning than neurocognition across clinical groups in multivariate analyses. Despite differences in neurocognition and psychosocial function, groups showed the same pattern in prediction of functioning irrespective of DSM-IV or clinical definition.