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Cernvall M, Bengtsson J, Bodén R. The Swedish version of the Motivation and Pleasure Scale self-report (MAP-SR): psychometric properties in patients with schizophrenia or depression. Nord J Psychiatry 2024; 78:339-346. [PMID: 38436927 DOI: 10.1080/08039488.2024.2324060] [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: 12/22/2021] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Negative symptoms are commonly regarded as a symptom dimension belonging to schizophrenia spectrum disorders but are also present in depression. The recently developed Clinical Assessment Interview for Negative Symptoms (CAINS) has shown to be reliable and valid. A corresponding self-report questionnaire has also been developed, named the Motivation and Pleasure Scale - Self Report (MAP-SR). The purpose was to evaluate the psychometric properties of the Swedish version of the MAP-SR in patients with either schizophrenia or depression. MATERIALS AND METHODS The MAP-SR was translated to Swedish. Participants were 33 patients with schizophrenia spectrum disorders and 52 patients with a depressive disorder and they completed the MAP-SR, the CAINS and other measures assessing adjacent psychopathology, functioning and cognition. RESULTS The internal consistency for the MAP-SR was adequate in both groups (schizophrenia spectrum α = .93, depressive disorder α = .82). Furthermore, the MAP-SR had a large correlation to the motivation and pleasure subscale of the CAINS in patients with schizophrenia disorders (r = -0.75, p < .001), however among patients with depression this correlation was medium-to-large (r = -0.48, p < 0.001). CONCLUSIONS Findings suggest that the Swedish version of the MAP-SR shows promise as a useful measure of motivation and pleasure, especially in patients with schizophrenia spectrum disorders. Furthermore, results also suggest that the MAP-SR does not assess negative symptoms specifically, but that there is an overlap between depressive and negative symptoms.
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Affiliation(s)
- Martin Cernvall
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Johan Bengtsson
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
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Green MF, Wynn JK, Eisenberger NI, Horan WP, Lee J, McCleery A, Miklowitz DJ, Reavis EA, Reddy LF. Social cognition and social motivation in schizophrenia and bipolar disorder: are impairments linked to the disorder or to being socially isolated? Psychol Med 2024:1-9. [PMID: 38314526 DOI: 10.1017/s0033291724000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND People with schizophrenia on average are more socially isolated, lonelier, have more social cognitive impairment, and are less socially motivated than healthy individuals. People with bipolar disorder also have social isolation, though typically less than that seen in schizophrenia. We aimed to disentangle whether the social cognitive and social motivation impairments observed in schizophrenia are a specific feature of the clinical condition v. social isolation generally. METHODS We compared four groups (clinically stable patients with schizophrenia or bipolar disorder, individuals drawn from the community with self-described social isolation, and a socially connected community control group) on loneliness, social cognition, and approach and avoidance social motivation. RESULTS Individuals with schizophrenia (n = 72) showed intermediate levels of social isolation, loneliness, and social approach motivation between the isolated (n = 96) and connected control (n = 55) groups. However, they showed significant deficits in social cognition compared to both community groups. Individuals with bipolar disorder (n = 48) were intermediate between isolated and control groups for loneliness and social approach. They did not show deficits on social cognition tasks. Both clinical groups had higher social avoidance than both community groups. CONCLUSIONS The results suggest that social cognitive deficits in schizophrenia, and high social avoidance motivation in both schizophrenia and bipolar disorder, are distinct features of the clinical conditions and not byproducts of social isolation. In contrast, differences between clinical and control groups on levels of loneliness and social approach motivation were congruent with the groups' degree of social isolation.
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Affiliation(s)
- Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Los Angeles, CA, USA
| | - Jonathan K Wynn
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Los Angeles, CA, USA
| | | | - William P Horan
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Karuna Therapeutics, Boston, MA, USA
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amanda McCleery
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Eric A Reavis
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Los Angeles, CA, USA
| | - L Felice Reddy
- VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, Los Angeles, CA, USA
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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Dark F, Galloway G, Gray M, Cella M, De Monte V, Gore-Jones V, Ritchie G. Reward Learning as a Potential Mechanism for Improvement in Schizophrenia Spectrum Disorders Following Cognitive Remediation: Protocol for a Clinical, Nonrandomized, Pre-Post Pilot Study. JMIR Res Protoc 2024; 13:e52505. [PMID: 38252470 PMCID: PMC10845020 DOI: 10.2196/52505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Cognitive impairment is common with schizophrenia spectrum disorders. Cognitive remediation (CR) is effective in improving global cognition, but not all individuals benefit from this type of intervention. A better understanding of the potential mechanism of action of CR is needed. One proposed mechanism is reward learning (RL), the cognitive processes responsible for adapting behavior following positive or negative feedback. It is proposed that the structure of CR enhances RL and motivation to engage in increasingly challenging tasks, and this is a potential mechanism by which CR improves cognitive functioning in schizophrenia. OBJECTIVE Our primary objective is to examine reward processing in individuals with schizophrenia before and after completing CR and to compare this with a group of matched clinical controls. We will assess whether RL mediates the relationship between CR and improved cognitive function and reduced negative symptoms. Potential differences in social RL and nonsocial RL in individuals with schizophrenia will also be investigated and compared with a healthy matched control group. METHODS We propose a clinical, nonrandomized, pre-post pilot study comparing the impact of CR on RL and neurocognitive outcomes. The study will use a combination of objective and subjective measures to assess neurocognitive, psychiatric symptoms, and neurophysiological domains. A total of 40 individuals with schizophrenia spectrum disorders (aged 18-35 years) will receive 12 weeks of CR therapy (n=20) or treatment as usual (n=20). Reward processing will be evaluated using a reinforcement learning task with 2 conditions (social reward vs nonsocial reward) at baseline and the 12-week follow-up. Functional magnetic resonance imaging responses will be measured during this task. To validate the reinforcement learning task, RL will also be assessed in 20 healthy controls, matched for age, sex, and premorbid functioning. Mixed-factorial ANOVAs will be conducted to evaluate treatment group differences. For the functional magnetic resonance imaging analysis, computational modeling will allow the estimation of learning parameters at each point in time, during each task condition, for each participant. We will use a variational Bayesian framework to measure how learning occurred during the experimental task and the subprocesses that underlie this learning. Second-level group analyses will examine how learning in patients differs from that observed in control participants and how CR alters learning efficiency and the underlying neural activity. RESULTS As of September 2023, this study has enrolled 15 participants in the CR group, 1 participant in the treatment-as-usual group, and 11 participants in the healthy control group. Recruitment is expected to be completed by September 2024. Data analysis is expected to be completed and published in early 2025. CONCLUSIONS The results of this study will contribute to the knowledge of CR and RL processes in severe mental illness and the understanding of the systems that impact negative symptoms and cognitive impairments within this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52505.
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Affiliation(s)
- Frances Dark
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Graham Galloway
- Translational Research Institute, Woolloongabba, Australia
- Herston Imaging Research Facility, The University of Queensland, Brisbane, Australia
| | - Marcus Gray
- Translational Research Institute, Woolloongabba, Australia
| | | | - Veronica De Monte
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
| | | | - Gabrielle Ritchie
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Wehr S, Weigel L, Davis J, Galderisi S, Mucci A, Leucht S. Clinical Assessment Interview for Negative Symptoms (CAINS): A Systematic Review of Measurement Properties. Schizophr Bull 2023:sbad137. [PMID: 37951838 DOI: 10.1093/schbul/sbad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Negative symptoms are very important for the overall loss of functioning observed in patients with schizophrenia. There is a need for valid tools to assess these symptoms. STUDY DESIGN We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review guideline to evaluate the quality of the clinical assessment interview for negative symptoms (CAINS) as a clinician-rated outcome measurement (ClinROM). STUDY RESULTS The search strategy resulted in the retrieval of 13 articles, 11 of which were included in this evaluation. In terms of risk of bias, most articles reported on measures of internal consistency and construct validity, which were overall of good quality. Structural validity, reliability, measurement error, and cross-cultural validity were reported with less than optimum quality. There was a risk of bias in ClinROM development. According to the updated criteria of good measurement properties, structural validity, internal consistency, and reliability showed good results. In contrast, hypothesis testing was somewhat poorer. Results for cross-cultural validity were indeterminate. According to the updated GRADE approach from the COSMIN group the scale received a moderate grade. CONCLUSIONS The COSMIN standard allows a judgment of the CAINS as an instrument with the potential to be recommended for use, but which requires further research to assess its quality, in particular in the domains of content validity, internal consistency, and cross-cultural validity.
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Affiliation(s)
- Sophia Wehr
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lucia Weigel
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL
- Maryland Psychiatric Research Center, Baltimore, MD
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Kirkpatrick B, Fernandez-Egea E. Assessment and the concept of negative symptoms. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00052-2. [PMID: 38591771 DOI: 10.1016/j.sjpmh.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Brian Kirkpatrick
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Emilio Fernandez-Egea
- Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK
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Evans J, Tinch-Taylor R, Csipke E, Cella M, Pickles A, McCrone P, Stringer D, Oliver A, Reeder C, Birchwood M, Fowler D, Greenwood K, Johnson S, Perez J, Ritunnano R, Thompson A, Upthegrove R, Wilson J, Kenny A, Isok I, Joyce EM, Wykes T. Satisfaction with cognitive remediation therapy: its effects on implementation and outcomes using the cognitive remediation satisfaction scale. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:67. [PMID: 37777545 PMCID: PMC10542804 DOI: 10.1038/s41537-023-00390-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/17/2023] [Indexed: 10/02/2023]
Abstract
Cognitive Remediation (CR) improves cognition and functioning but is implemented in a variety of ways (independent, group and one-to-one). There is no information on whether service users find these implementation methods acceptable or if their satisfaction influences CR outcomes. We used mixed participatory methods, including focus groups, to co-develop a CR satisfaction scale. This was refined using three psychometric criteria (Cronbach's alpha, item discrimination, test-retest agreement) to select items. Factor analysis explored potential substructures. The refined measure was used in structural equation joint modelling to evaluate whether satisfaction with CR is affected by implementation method and treatment engagement or influences recovery outcome, using data from a randomised controlled trial. Four themes (therapy hours, therapist, treatment effects, computer use) generated a 31-item Cognitive Remediation Satisfaction scale (CRS) that reduced to 18 Likert items, 2 binary and 2 open-ended questions following psychometric assessment. CRS had good internal consistency (Alpha = 0.814), test-retest reliability (r= 0.763), and concurrent validity using the Working Alliance Inventory (r = 0.56). A 2-factor solution divided items into therapy engagement and therapy effects. Satisfaction was not related to implementation method but was significantly associated with CR engagement. Therapy hours were significantly associated with recovery, but there was no direct effect of satisfaction on outcome. Although satisfaction is important to therapy engagement, it has no direct effect on outcome. CR therapy hours directly affect outcome irrespective of which implementation model is used, so measuring satisfaction early might help to identify those who are likely to disengage. The study has mixed methods design.
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Affiliation(s)
- Joanne Evans
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose Tinch-Taylor
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emese Csipke
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul McCrone
- School of Health Sciences, University of Greenwich, London, UK
| | - Dominic Stringer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abigail Oliver
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Clare Reeder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Sonia Johnson
- Faculty of Brain Sciences, University College London, London, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Rosa Ritunnano
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alex Kenny
- Patient Advisory Board, King's College London, London, UK
| | - Iris Isok
- Patient Advisory Board, King's College London, London, UK
| | - Eileen M Joyce
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Barch DM, Culbreth AJ, Ben Zeev D, Campbell A, Nepal S, Moran EK. Dissociation of Cognitive Effort-Based Decision Making and Its Associations With Symptoms, Cognition, and Everyday Life Function Across Schizophrenia, Bipolar Disorder, and Depression. Biol Psychiatry 2023; 94:501-510. [PMID: 37080416 PMCID: PMC10755814 DOI: 10.1016/j.biopsych.2023.04.007] [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: 01/25/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Anhedonia and amotivation are symptoms of many different mental health disorders that are frequently associated with functional disability, but it is not clear whether the same processes contribute to motivational impairments across disorders. This study focused on one possible factor, the willingness to exert cognitive effort, referred to as cognitive effort-cost decision making. METHODS We examined performance on the deck choice task as a measure of cognitive effort-cost decision making, in which people choose to complete an easy task for a small monetary reward or a harder task for larger rewards, in 5 groups: healthy control (n = 80), schizophrenia/schizoaffective disorder (n = 50), bipolar disorder with psychosis (n = 58), current major depression (n = 60), and past major depression (n = 51). We examined cognitive effort-cost decision making in relation to clinician and self-reported motivation symptoms, working memory and cognitive control performance, and life function measured by ecological momentary assessment and passive sensing. RESULTS We found a significant diagnostic group × reward interaction (F8,588 = 4.37, p < .001, ηp2 = 0.056). Compared with the healthy control group, the schizophrenia/schizoaffective and bipolar disorder groups, but not the current or past major depressive disorder groups, showed a reduced willingness to exert effort at the higher reward values. In the schizophrenia/schizoaffective and bipolar disorder groups, but not the major depressive disorder groups, reduced willingness to exert cognitive effort for higher rewards was associated with greater clinician-rated motivation impairments, worse working memory and cognitive control performance, and less engagement in goal-directed activities measured by ecological momentary assessment. CONCLUSIONS These findings suggest that the mechanisms contributing to motivational impairments differ among individuals with psychosis spectrum disorders versus depression.
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Affiliation(s)
- Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Adam J Culbreth
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore, Maryland
| | - Dror Ben Zeev
- Department of Psychiatry, University of Washington, Seattle, Washington
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
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Weigel L, Wehr S, Galderisi S, Mucci A, Davis J, Giordano GM, Leucht S. The Brief negative Symptom Scale (BNSS): a systematic review of measurement properties. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:45. [PMID: 37500628 PMCID: PMC10374652 DOI: 10.1038/s41537-023-00380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Negative symptoms of schizophrenia are linked with poor functioning and quality of life. Therefore, appropriate measurement tools to assess negative symptoms are needed. The NIMH-MATRICS Consensus defined five domains for negative symptoms, which The Brief Negative Symptom Scale (BNSS) covers. METHODS We used the COSMIN guidelines for systematic reviews to evaluate the quality of psychometric data of the BNSS scale as a Clinician-Rated Outcome Measure (ClinROM). RESULTS The search strategy resulted in the inclusion of 17 articles. When using the risk of bias checklist, there was a generally good quality in reporting of structural validity and hypothesis testing. Internal consistency, reliability and cross-cultural validity were of poorer quality. ClinROM development and content validity showed inadequate results. According to the updated criteria of good measurement properties, structural validity, internal consistency and interrater reliability showed good results, while hypothesis testing showed poorer results. Cross-cultural validity and test-retest reliability were indeterminate. The updated GRADE approach resulted in a moderate grade. CONCLUSIONS We can potentially recommend the use of the BNSS as a concise tool to rate negative symptoms. Due to weaknesses in certain domains further validations are warranted.
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Affiliation(s)
- Lucia Weigel
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Sophia Wehr
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago (mc 912), 1601 W. Taylor St., Chicago, Il 60612, and Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Giulia Maria Giordano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany.
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Hogoboom A, Rouch M, Lauerman D, Pauselli L, Compton MT. Initial evidence of vowel space reduction in a subset of individuals with schizophrenia. Schizophr Res 2023; 255:158-164. [PMID: 36989674 DOI: 10.1016/j.schres.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Acoustic phonetic measures have been found to correlate with negative symptoms of schizophrenia, thus offering a path toward quantitative measurement of such symptoms. These acoustic properties include F1 and F2 measurements (affected by tongue height and tongue forward/back position, respectively), which determine a general "vowel space." Among patients and controls, we consider two phonetic measures of vowel space: average Euclidean distance from a participant's mean F1 and mean F2, and density of vowels around one standard deviation of mean F1 and of F2. METHODS Structured and spontaneous speech of 148 participants (70 patients and 78 controls) was recorded and measured acoustically. We examined correlations between the phonetic measures of vowel space and ratings of aprosody obtained using two clinical research measures, the Scale for the Assessment of Negative Symptoms (SANS) and the Clinical Assessment Interview for Negative Symptoms (CAINS). RESULTS Vowel space measurements were significantly associated with patient/control status, attributed to a cluster of 13 patients whose phonetic values correspond to reduced vowel space as assessed by both phoenetic measures. No correlation was found between phonetic measures and relevant items and averages of ratings on the SANS and CAINS. Reduced vowel space appears to affect only a subset of patients with schizophrenia, potentially those on higher antipsychotic dosages. CONCLUSIONS Acoustic phonetic measures may be more sensitive measures of constricted vowel space than clinical research rating scales of aprosody or monotone speech. Replications are needed before further interpretation of this novel finding, including potential medication effects.
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Affiliation(s)
- Anya Hogoboom
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Megan Rouch
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Diana Lauerman
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, Morningside/West Hospitals, Department of Psychiatry, New York, NY, USA
| | - Michael T Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
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10
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Li SB, Liu C, Zhang JB, Wang LL, Hu HX, Chu MY, Wang Y, Lv QY, Lui SSY, Cheung EFC, Yi ZH, Chan RCK. Revisiting the latent structure of negative symptoms in schizophrenia: Evidence from two second-generation clinical assessments. Schizophr Res 2022; 248:131-139. [PMID: 36037646 DOI: 10.1016/j.schres.2022.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Negative symptoms are core symptom of schizophrenia, and many previous research studied the latent structure of negative symptoms based on a single measurement scale. Applying two second-generation negative symptom scales to the same sample can address measurement-invariance of latent structure. METHODS Three-hundred-and-five schizophrenia patients were assessed using the CAINS and the BNSS. Confirmatory Factor Analysis (CFA) tested four competing factor-models: (1) a 1-factor model; (2) a 2-factor model comprising the motivation and pleasure (MAP) domain and the diminished expression (EXP) domain; (3) a 5-factor model comprising anhedonia, avolition, asociality, blunted affect and alogia; (4) a hierarchical model comprising the "first-order" 5-domain factors and the "second-order" MAP & EXP factors. RESULTS The CFA results for the data of the CAINS showed that the 2-factor model had the best data fit over the other competing models. The CFA using the BNSS data in the same sample also supported the superiority of the 2-factor model. Lastly, after combining the items of the BNSS and CAINS together in the same sample for CFA, the 2-factor model prevailed over the other competing models. CONCLUSIONS The 2-factor model appears to be measurement-invariant latent structure of negative symptoms. The novel method of combining the items of the CAINS and BNSS might have circumvented the possible imperfect construct of a single scale. Our findings support the MAP and EXP factors as the latent structure for negative symptoms.
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Affiliation(s)
- Shuai-Biao Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Liu
- Nantong Fourth People's Hospital, Jiangsu, China
| | | | - Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hui-Xin Hu
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Min-Yi Chu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qin-Yu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, Shanghai, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Zheng-Hui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, Shanghai, China; Institute of Mental Health, Fudan University, Shanghai, China.
| | - Raymond C K Chan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Strauss GP, Raugh IM, Zhang L, Luther L, Chapman HC, Allen DN, Kirkpatrick B, Cohen AS. Validation of accelerometry as a digital phenotyping measure of negative symptoms in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:37. [PMID: 35853890 PMCID: PMC9261099 DOI: 10.1038/s41537-022-00241-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/24/2022] [Indexed: 05/05/2023]
Abstract
Negative symptoms are commonly assessed via clinical rating scales; however, these measures have several inherent limitations that impact validity and utility for their use in clinical trials. Objective digital phenotyping measures that overcome some of these limitations are now available. The current study evaluated the validity of accelerometry (ACL), a passive digital phenotyping method that involves collecting data on the presence, vigor, and variability of movement. Outpatients with schizophrenia (SZ: n = 50) and demographically matched healthy controls (CN: n = 70) had ACL continuously recorded from a smartphone and smartband for 6 days. Active digital phenotyping assessments, including surveys related to activity context, were also collected via 8 daily surveys throughout the 6 day period. SZ participants had lower scores on phone ACL variables reflecting vigor and variability of movement compared to CN. ACL variables demonstrated convergent validity as indicated by significant correlations with active digital phenotyping self-reports of time spent in goal-directed activities and clinical ratings of negative symptoms. The discriminant validity of ACL was demonstrated by low correlations with clinical rating scale measures of positive, disorganized, and total symptoms. Collectively, findings suggest that ACL is a valid objective measure of negative symptoms that may complement traditional approaches to assessing the construct using clinical rating scales.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Luyu Zhang
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Hannah C Chapman
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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12
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Mavituna S, Hahn E, Hahne I, Bergmann N, Pijnenborg M, Ta TMT, Tafelski L, Böge K. Compassion-based approaches: a systematic review of their effectiveness and acceptability in schizophrenia spectrum disorders. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractThe purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.
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13
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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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14
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Huang Z, Ruan D, Huang B, Zhou T, Shi C, Yu X, Chan RCK, Wang Y, Pu C. Negative symptoms correlate with altered brain structural asymmetry in amygdala and superior temporal region in schizophrenia patients. Front Psychiatry 2022; 13:1000560. [PMID: 36226098 PMCID: PMC9548644 DOI: 10.3389/fpsyt.2022.1000560] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Negative symptoms play an important role in development and treatment of schizophrenia. However, brain changes relevant to negative symptoms are still unclear. This study examined brain structural abnormalities and their asymmetry in schizophrenia patients and the association with negative symptoms. Fifty-nine schizophrenia patients and 66 healthy controls undertook structural brain scans. Schizophrenia patients were further divided into predominant negative symptoms (PNS, n = 18) and non-PNS (n = 34) subgroups. Negative symptoms were assessed by the Negative Symptom Assessment (NSA). T1-weighted images were preprocessed with FreeSurfer to estimate subcortical volumes, cortical thickness and surface areas, asymmetry Index (AI) was then calculated. MANOVA was performed for group differences while partial correlations in patients were analyzed between altered brain structures and negative symptoms. Compared to healthy controls, schizophrenia patients exhibited thinner cortices in frontal and temporal regions, and decreased leftward asymmetry of superior temporal gyrus (STG) in cortical thickness. Patients with PNS exhibited increased rightward asymmetry of amygdala volumes than non-PNS subgroup. In patients, AI of cortical thickness in the STG was negatively correlated with NSA-Emotion scores (r = -0.30, p = 0.035), while AI of amygdala volume was negatively correlated with NSA-Communication (r = -0.30, p = 0.039) and NSA-Total scores (r = -0.30, p = 0.038). Our findings suggested schizophrenia patients exhibited cortical thinning and altered lateralization of brain structures. Emotion and communication dimensions of negative symptoms also correlated with the structural asymmetry of amygdala and superior temporal regions in schizophrenia patients.
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Affiliation(s)
- Zetao Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Dun Ruan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Bingjie Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tianhang Zhou
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Chengcheng Pu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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15
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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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16
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Bengtsson J, Bodén R, Neider D, Cernvall M. A blinded validation of the Swedish version of the Clinical Assessment Interview for Negative Symptoms (CAINS). Nord J Psychiatry 2022; 76:44-51. [PMID: 34126848 DOI: 10.1080/08039488.2021.1933174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed in order to advance the assessment of negative symptoms. The aim of this study was to validate the Swedish version of the CAINS. MATERIALS AND METHODS Thirty-four out-patients with a schizophrenia spectrum disorder were recruited. All patients were videotaped while interviewed with the CAINS and the Brief Psychiatric Rating Scale (BPRS). Another rater watched the video recordings in the reverse order, enabling a blinded design. The patients also filled in self-reported measures of depression, quality of life, and social and vocational functioning. We calculated inter-rater agreement and internal consistency for the CAINS. We also calculated validity measures by correlating the subscales Motivation and Pleasure (CAINS-MAP) and Expression (CAINS-EXP) to subscales of the BPRS. RESULTS The blinded inter-rater agreement for the CAINS total score was high (ICC = 0.92) but slightly lower for the expression subscale (ICC = 0.76). Cronbach's alpha was 0.84 for the total score. Convergent validity with the negative symptoms subscale of BPRS was different for the blinded and the unblinded data, with a CAINS-MAP correlation of 0.10 (p = 0.580) and a CAINS-EXP correlation of 0.48 (p = 0.004) in the blinded data. The unblinded data had a CAINS-MAP correlation of 0.38 (p = 0.026) and a CAINS-EXP correlation of 0.87 (p < 0.001). Self-rated measures of anhedonia correlated to CAINS-MAP with a coefficient of 0.68 (p < 0.001), while the CAINS-EXP only had a correlation of 0.16 (p = 0.366) to these measures. CONCLUSION The Swedish version of the CAINS displays adequate psychometric properties in line with earlier validation studies.
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Affiliation(s)
- Johan Bengtsson
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Martin Cernvall
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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17
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Kulenović AD, Mešević ES, Ribić E, Repišti S, Radojičić T, Jovanović N. Factor structure and internal consistency of the Clinical Assessment Interview for Negative Symptoms (CAINS) on a sample of persons with psychotic disorders in Bosnia and Herzegovina. J Neural Transm (Vienna) 2021; 129:905-911. [PMID: 34878600 PMCID: PMC9217762 DOI: 10.1007/s00702-021-02435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022]
Abstract
The assessment of negative symptoms is crucial for development of adequate therapeutic interventions. This is a challenging task due to complex clinical presentation and lack of reliable and valid instruments. This study examined the psychometric characteristics of the Clinical Assessment Interview for Negative Symptoms (CAINS). The sample consisted of 81 persons with schizophrenia or schizoaffective disorder recruited from two health institutions in the Sarajevo Canton: the Clinical Center of the University of Sarajevo and the Psychiatric Hospital of the Sarajevo Canton. The 13 CAINS items grouped into four factors (expression, motivation and satisfaction in the recreational domain, motivation and satisfaction with social relationships, motivation and satisfaction with job and education). The four-factor solution accounted for 87.83% of the variance of manifest items. The reliabilities of extracted factors were as follows: for motivation and satisfaction with social relationships α = 0.897, for motivation and satisfaction with job and education α = 0.961, for Motivation and satisfaction in the recreation domain α = 0.981, and for expression α = 0.938. The highest correlation between factors was found between Motivation and satisfaction with recreation and Motivation and satisfaction with social relationships. On the other hand, the lowest correlation was found between motivation and satisfaction with social relations and motivation and satisfaction with job and education. In conclusion, the study showed that the latent structure of CAINS is adequate, clearly interpretable, and consisted of four factors. The measure can be used for assessment of the negative symptoms in outpatients with psychosis in Bosnia and Herzegovina.
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Affiliation(s)
- Alma Džubur Kulenović
- Department for Psychiatry, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
| | - Eldina Smajic Mešević
- Department for Research and Development, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emina Ribić
- Department for Research and Development, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Selman Repišti
- Clinic for Psychiatry, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Tamara Radojičić
- Clinic for Psychiatry, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Bart's and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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18
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Cuesta MJ, Sánchez-Torres AM, Lorente-Omeñaca R, Moreno-Izco L, Peralta V. Cognitive, community functioning and clinical correlates of the Clinical Assessment Interview for Negative Symptoms (CAINS) in psychotic disorders. Eur Arch Psychiatry Clin Neurosci 2021; 271:1537-1546. [PMID: 32895741 DOI: 10.1007/s00406-020-01188-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022]
Abstract
Negative symptoms are a core dimension of schizophrenia and other psychoses that account for a large degree of the poor functional outcomes related to these disorders. Newer assessment scales for negative symptoms, such as the Clinical Assessment Interview for Negative Symptoms (CAINS), provide evidence for separate dimensions of motivational and pleasure (MAP) and expression (EXP) dimensions. This study was aimed at extending the analysis of the clinical, functional and cognitive correlates of CAINS dimensions in a sample of patients with psychotic disorders (n = 98) and 50 healthy controls.A psychopathological evaluation was conducted by using the Comprehensive Assessment of Symptoms and History (CASH). To assess the extrapyramidal signs, the UKU scale was used. Community functioning was evaluated by means of real-world and functional attainment measures. Additionally, a full neuropsychological test battery was administered. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the influencing and predictive factors associated with the CAINS dimensions.The MAP and EXP dimensions showed strong associations with the Scale for the Assessment of Negative Symptoms (SANS) items and were not significantly associated with extra-pyramidal or cognitive deficits. The MAP and EXP CAINS dimensions revealed good predictive validity for real-world functioning and functional attainment measures.These findings suggest that the CAINS scale endorses good convergent validity for the assessment of negative symptoms and is very useful in the prediction of psychosocial functioning. In addition, the CAINS dimensions might provide advantages over old assessment scales on disentangling the complex associations between negative symptoms and cognitive impairment.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
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19
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Stull SW, Bertz JW, Panlilio LV, Kowalczyk WJ, Phillips KA, Moran LM, Lin JL, Vahabzadeh M, Finan PH, Preston KL, Epstein DH. I feel good? Anhedonia might not mean "without pleasure" for people treated for opioid use disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2021; 130:537-549. [PMID: 34472889 DOI: 10.1037/abn0000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anhedonia is usually defined as partial or total loss of the capacity for pleasure. People with anhedonia in the context of major depressive disorder may have an unexpected capacity for event-related mood brightening, observable when mood is assessed dynamically (with smartphone-based ecological momentary assessment [EMA]) rather than only statically via questionnaire. We used EMA to monitor mood and pleasant events for 4 weeks in 54 people being treated with opioid agonist medication for opioid-use disorder (OUD), which is also associated with anhedonia, said to manifest especially as loss of pleasure from nondrug reward. We compared OUD patients' EMA reports with those of 47 demographically similar controls. Background positive mood was lower in OUD patients than in controls, as we hypothesized (Cohen ds = .85 to 1.32, 95% CIs [.66, 1.55]), although, contrary to our hypothesis, background negative mood was also lower (ds = .82 to .85, 95% CIs [.73, .94]). As hypothesized, instances of nondrug pleasure were as frequent in OUD patients as in controls-and were not rated much less pleasurable (d = .18, 95% CI [-.03, .35]). Event-related mood brightening occurred in both abstinent and nonabstinent OUD patients (ds = .18 to .37, CIs [-.01, .57]) and controls (ds = .04 to .60, CIs [-.17, .79]), brightening before each event began earlier for controls than OUD patients, but faded similarly postevent across groups. Our findings add to the evidence that anhedonia does not rule out reactive mood brightening, which, for people with OUD being treated on opioid agonist medication, can be elicited by nondrug activities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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20
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Latent structure of self-report negative symptoms in patients with schizophrenia: A preliminary study. Asian J Psychiatr 2021; 61:102680. [PMID: 34000499 DOI: 10.1016/j.ajp.2021.102680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Negative symptoms are associated with poor outcomes and functioning. Latent structure of negative symptoms is important for identifying potential intervention targets for novel treatments. Self-report instruments have been developed to measure negative symptoms. Previous findings on latent structure of negative symptoms are inconsistently and mainly rely on clinician-rated instruments. METHOD We aimed to explore the latent structure of the Self-Evaluation of Negative Symptoms Scale (SNS) in 204 clinically-stable outpatients with schizophrenia. Confirmatory factor analysis (CFA) was used to compare the competing models (i.e., one-factor, two-factor and five-factor models), and estimated goodness-of-fit indexes. Other clinician-rated scales for psychopathology and medication side-effects were also collected. RESULTS The CFA found the five-factor model performing best, with a comparative fit index (CFI) of > 0.95, a Tucker Lewis Index (TLI) of > 0.95, and a root mean square error of approximation (RMSEA) of < 0.06. The robust chi-square difference test for the weighted least squares with mean and variance adjusted estimation (WLSMV) also indicated a significant better fit for the five-factor model. DISCUSSION Our preliminary findings support a five-factor latent structure of self-report negative symptoms in schizophrenia patients. Further research in this area should utilize multiple clinician-rated and self-report measures, and recruit large and homogeneous samples with schizophrenia.
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21
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Wellan SA, Daniels A, Walter H. State Anhedonia in Young Healthy Adults: Psychometric Properties of the German Dimensional Anhedonia Rating Scale (DARS) and Effects of the COVID-19 Pandemic. Front Psychol 2021; 12:682824. [PMID: 34248783 PMCID: PMC8260844 DOI: 10.3389/fpsyg.2021.682824] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/25/2021] [Indexed: 01/18/2023] Open
Abstract
Healthy reward processing is a complex interplay of several components. Recent self-report measures of anhedonia, the decrease or loss of hedonic capacity, take this complexity into account. The Dimensional Anhedonia Rating Scale (DARS) measures interest, motivation, effort and consummatory pleasure across four domains: hobbies, food/drink, social activities and sensory experiences. In the present cross-sectional survey study, we validated the German version of the DARS in a sample of 557 young healthy adults. Factor structure as well as convergent and divergent validity were assessed. As a secondary aim, we examined the effects of the COVID-19 pandemic on state anhedonia and depression severity. Our results suggest good convergent and divergent validity and high internal consistency of the German DARS. The original differentiation of four factors mapping onto the four domains was confirmed and measurement invariance before and during the COVID-19 pandemic was established. We conclude that the DARS is a valid instrument to comprehensively assess state anhedonia in healthy German samples. Future studies should further assess the utility of the German DARS in clinical contexts. In line with many previous studies, participants during the pandemic reported significantly higher levels of depressive symptoms compared to participants in the months before. We found no indication that the COVID-19 pandemic affected state hedonic capacity.
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Affiliation(s)
- Sarah A. Wellan
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Faculty of Philosophy, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna Daniels
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Faculty of Philosophy, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henrik Walter
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Faculty of Philosophy, Humboldt-Universität zu Berlin, Berlin, Germany
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22
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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: 79] [Impact Index Per Article: 26.3] [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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23
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Khan WU, Ghazala Z, Brooks HJ, Subramaniam P, Mulsant BH, Kumar S, Voineskos AN, Blumberger DM, Kern RS, Rajji TK. The Impact of Anticholinergic Burden on Functional Capacity in Persons With Schizophrenia Across the Adult Life Span. Schizophr Bull 2021; 47:249-257. [PMID: 32619225 PMCID: PMC7825090 DOI: 10.1093/schbul/sbaa093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19-79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.
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Affiliation(s)
- Waqas Ullah Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zaid Ghazala
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Ponnusamy Subramaniam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert S Kern
- Department of Psychiatry, University of California–Los Angeles, Los Angeles, CA
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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24
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Rekhi G, Ang MS, Lee J. Association between negative symptom domains and happiness in schizophrenia. Gen Hosp Psychiatry 2021; 68:83-89. [PMID: 33412469 DOI: 10.1016/j.genhosppsych.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study aimed to examine the association between levels of self-reported happiness and different domains and subdomains of negative symptoms (NS), as well as symptomatic remission in schizophrenia. METHODS 274 individuals with schizophrenia were assessed on the Subjective Happiness Scale (SHS), Positive and Negative Syndrome Scale and Clinical Assessment Interview for Negative Symptoms (CAINS). Multiple linear regressions were used to examine the association between levels of happiness and increasingly specific CAINS NS domains and subdomains, as well as symptomatic remission. RESULTS 177 (64.6%) participants rated themselves as happy. NS, specifically motivation and pleasure related to social activities (MAP Social) (B=-0.402, t=-4.805, p<0.001), and depressive symptoms (B=-0.760, t=-7.102, p<0.001) were significantly associated with levels of happiness. Individuals in symptomatic remission rated themselves happier than those who were not in remission (mean composite SHS: 5.10 [SD=1.18] versus 4.61 [SD=1.16], p=0.002). CONCLUSIONS In this largest study on happiness in schizophrenia, we found that the MAP domain of NS, MAP social subdomain and depressive symptoms were significantly associated with levels of happiness. Additionally, individuals in symptomatic remission rated themselves happier than those who were not in remission. Symptom management remains important in the holistic care plan for individuals with schizophrenia.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore.
| | - Mei San Ang
- Research Division, Institute of Mental Health, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; North Region & Department of Psychosis, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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25
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Ristić I, Jerotić S, Zebić M, Savić B, Vuković V, Russo M, Voskresenski T, Jovanović N, Marić NP. Factorial Structure of the Serbian Version of the Clinical Assessment Interview for Negative Symptoms - Evidence for Three Factors of Negative Symptoms. Front Psychol 2020; 11:570356. [PMID: 33192856 PMCID: PMC7649283 DOI: 10.3389/fpsyg.2020.570356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: Negative symptoms are a common occurrence in patients with psychosis spectrum disorders. Previous analysis of the latent structure of the Clinical Assessment Interview for Negative Symptoms (CAINS) - which was developed to advance the assessment of negative symptomatology - showed two underlying sub-domains (Motivation and Pleasure; Expression). Recent findings indicate that a more complex structure might be more applicable. Aim: To evaluate the psychometric properties of the Serbian version of the CAINS in a sample of outpatients (N = 67) with psychosis spectrum disorders. Materials and Methods: Negative symptoms and general level of psychopathology were assessed with Serbian translations of the CAINS, the 53-item version of the Brief Symptom Inventory (BSI), and the 24-item version of the Brief Psychiatric Rating Scale (BPRS). Principal component analysis (PCA) was carried out on the CAINS items, and correlation analyses were done to assess its convergent and discriminant validity. Results: Our results showed an excellent internal consistency (Cronbach's alpha = 0.92). PCA revealed a three-component solution consisting of Expressiveness and Motivation for Social and Family Relationships (Factor 1), Motivation for Vocational Activities (Factor 2), and Motivation for Recreation (Factor 3). Convergent validity was supported by significant correlations with the Negative symptoms domain of the BPRS (Factor 1, 0.695, p < 0.01; Factor 2, 0.352, p < 0.05; Factor 3, 0.452, p < 0.01). When assessing discriminant validity, weak correlations were found with BPRS and BSI scores. Conclusion: The Serbian version of CAINS is a valid, reliable and useful tool for the assessment of negative symptomatology. Our findings support a three-factor structure of CAINS, which indicates that the construct is more complex than envisaged by the original conceptualization of two distinct factors.
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Affiliation(s)
- Ivan Ristić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Stefan Jerotić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Mirjana Zebić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Bojana Savić
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Vuk Vuković
- Special Hospital for Psychiatric Diseases 'Dr Slavoljub Bakalović', Psychiatry, Vršac, Serbia
| | - Manuela Russo
- Unit for Social and Community Psychiatry - WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Tatjana Voskresenski
- Special Hospital for Psychiatric Diseases 'Dr Slavoljub Bakalović', Psychiatry, Vršac, Serbia
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry - WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Nađa P Marić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Mental Health, Psychiatry, Belgrade, Serbia
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26
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Gesture deficits and apraxia in schizophrenia. Cortex 2020; 133:65-75. [PMID: 33099076 DOI: 10.1016/j.cortex.2020.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
Aberrant performance of skilled action has long been noted in schizophrenia and relatedly, recent reports have demonstrated impaired use, performance, and perception of hand gestures in this group. Still, this deficit is not acknowledged as apraxia, which to the broader medical field, characterizes impairments in skilled actions. Understanding the relationship between apraxia and schizophrenia may shed an invaluable new perspective on disease mechanism, and highlight novel treatment opportunities as well. To examine this potential link, we reviewed the evidence for the types of praxis errors, associated psychopathology, and cerebral correlates of the praxis deficit in schizophrenia. Notably, the review indicated that gesture deficits are severe enough to be considered genuine apraxia in a substantial proportion of patients (about 25%). Further, other potential contributors (e.g., hypokinetic motor abnormalities, cognitive impairment) are indeed associated with gesture deficits in schizophrenia, but do not sufficiently explain the abnormality. Finally, patients with praxis deficits have altered brain structure and function including the left parieto-premotor praxis network and these neural correlates are specific to the praxis deficit. Therefore, we argue that the gestural disorder frequently observed in schizophrenia shares both the clinical and neurophysiological features of true apraxia, as in other neuropsychiatric disorders with impaired higher order motor control, such as Parkinson's disease.
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27
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Rekhi G, Alphs L, Ang MS, Lee J. Clinical utility of the Negative Symptom Assessment-16 in individuals with schizophrenia. Eur Neuropsychopharmacol 2019; 29:1433-1441. [PMID: 31761524 DOI: 10.1016/j.euroneuro.2019.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 01/07/2023]
Abstract
This study examined the clinical utility of the Negative Symptom Assessment-16 (NSA-16) in schizophrenia. 274 individuals with schizophrenia were assessed on the NSA-16, Positive and Negative Syndrome Scale (PANSS), Clinical Assessment for Negative Symptoms (CAINS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Assessment Scale (SOFAS) and the Simpson-Angus Extrapyramidal Side Effects Scale (SAS). Factor analyses were conducted and Cronbach's alpha was computed. Correlations were assessed using Spearman's correlation coefficient. The 5-factor model of the NSA-16 did not give good fit statistics from our sample. Exploratory factor analysis on a randomly selected split-half of the sample followed by confirmatory factor analysis on the remaining sample supported a 4-factor structure with 12 items. The factors were: Restricted speech, Poor quality of speech, Affective blunting and Amotivation. The NSA-16 with the 12 items was termed as the NSA-12. The NSA-12 showed good internal reliability. The NSA-12 total score and global negative symptom rating had strong correlations with CAINS total and PANSS negative factor scores, suggesting good convergent validity. Weak correlations of the NSA-12 total score and global negative symptom rating with PANSS positive, CDSS and SAS scores suggested good divergent validity. The NSA-12 total score and global negative symptom rating were strongly and inversely associated with SOFAS and positively associated with NSA-12 global level of functioning. In conclusion, the NSA-12 is useful to evaluate negative symptoms in clinical and research settings in individuals with schizophrenia. Our study results also support a 4-factor structure of the NSA-12 in outpatients with schizophrenia.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Larry Alphs
- Newron Pharmaceuticals, LLC, New Jersey, United States of America
| | - Mei San Ang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore; North Region & Department of Psychosis, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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28
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Clinical determinants of social media use in individuals with schizophrenia. PLoS One 2019; 14:e0225370. [PMID: 31747434 PMCID: PMC6867641 DOI: 10.1371/journal.pone.0225370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022] Open
Abstract
This study aimed to examine the prevalence of social media use and its association with symptoms in individuals with schizophrenia. 265 individuals with schizophrenia were assessed. Symptoms were assessed on the Positive and Negative Syndrome Scale (PANSS) and the Clinical Assessment Interview for Negative Symptoms (CAINS). Information on social media use was collected. Logistic regressions were used to explore the association between social media use and socio-demographic and clinical characteristics of the participants. Of the 265 study participants, 139 (52.5%) used social media in the last week. Fifty-six (21.1%) of the study participants used more than one social media site in the last week. Facebook was the most popular social media site. Age, highest education level, monthly household income, PANSS negative and depression factor scores were significantly associated with social media use. Amongst negative symptoms, the CAINS motivation-pleasure (MAP) social factor scores were found to be significantly associated with social media use. Our study results suggested that the assessment of social interactions via social media should be considered in the clinical assessment of individuals with schizophrenia. Secondly, our results suggested that the development of treatment programs supported by social media platforms may be useful for certain groups of individuals with schizophrenia. Younger patients with above secondary level education, higher family income and lower symptom severity are likely to be avid users of social media and would be suitable candidates to receive illness related information or clinical interventions via social media.
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29
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Edwards CJ, Garety P, Hardy A. The relationship between depressive symptoms and negative symptoms in people with non-affective psychosis: a meta-analysis. Psychol Med 2019; 49:2486-2498. [PMID: 31530319 DOI: 10.1017/s0033291719002381] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The negative symptoms of psychosis and depressive symptomatology share several features, e.g. low motivation, apathy and reduced activity. Understanding the associations between these two sets of symptoms will support improved assessment and the development of interventions targeting these difficulties in people with psychosis. This is the first large systematic review and meta-analysis to quantify the relationship between these two categories of symptoms, as measured in studies to date. PsycInfo, Embase and Medline were systematically searched to identify eligible studies. Inclusion criteria ensured the studies measured both depression and negative symptoms using validated measures in a sample of over 8000 participants with non-affective psychosis diagnoses. The search led to 2020 records being screened and 56 included in the meta-analysis and review. Both meta-analyses and meta-regressions were conducted to explore the main effect and potential moderating variables. A clear pattern emerges showing that higher ratings of negative symptoms are associated with higher levels of depressive symptoms, with a small effect [standardised effect size = 0.19, p < 0.05). This did not vary greatly with the measures used (SES = 0.19-0.26) and was not moderated by demographic variables or quality ratings. Interestingly, higher depressive symptoms predict a significant relationship with co-occurring negative symptoms. However, higher negative symptoms predict that it is less likely there will be a relationship with co-occurring depressive symptoms. Heterogeneity was high across these analyses. The findings support the adoption of a symptom-specific approach to understanding the interplay between negative and depressive symptoms in psychosis, to improve assessment and intervention.
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Affiliation(s)
- Clementine Jane Edwards
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Philippa Garety
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
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30
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Assessing negative symptoms in schizophrenia: Validity of the clinical assessment interview for negative symptoms in Singapore. Schizophr Res 2019; 206:177-182. [PMID: 30558979 DOI: 10.1016/j.schres.2018.11.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/25/2018] [Accepted: 11/23/2018] [Indexed: 11/20/2022]
Abstract
This study aimed to examine the validity of the Clinical Assessment Interview for Negative Symptoms (CAINS) in Singapore. 274 participants with schizophrenia were assessed on the CAINS, Scale for the Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Assessment Scale (SOFAS) and the Simpson-Angus Extrapyramidal Side Effects Scale (SES). Factor analyses were conducted and Cronbach's coefficient alpha was calculated. Spearman's correlation coefficient was used to assess correlations. The 2-factor model of the CAINS failed to fit our data. Exploratory factor analysis of a randomly selected split-half of the sample yielded four factors: motivation-pleasure (MAP) social, MAP vocational, MAP recreational and expression (EXP), accounting for 73.94% of the total variance. Confirmatory factor analysis on the remaining sample supported this factor structure. Cronbach's alpha for the CAINS was 0.770. Significant correlations were observed between the CAINS total and the SANS total and PANSS negative subscale scores. Good divergent validity was shown by insignificant correlations with PANSS positive subscale score and CDSS total score. The MAP social and recreational factor scores had moderate correlations with the SANS anhedonia-asociality subscale scores, whereas the MAP vocational factor had the highest correlation with the avolition-apathy subscale of the SANS. EXP factor score correlated strongly with the SANS affective flattening and alogia subscales scores. In conclusion, the CAINS has good psychometric properties and can be used by clinicians to assess negative symptoms in individuals with schizophrenia in the local population.
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31
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Compton MT, Lunden A, Cleary SD, Pauselli L, Alolayan Y, Halpern B, Broussard B, Crisafio A, Capulong L, Balducci PM, Bernardini F, Covington MA. The aprosody of schizophrenia: Computationally derived acoustic phonetic underpinnings of monotone speech. Schizophr Res 2018; 197:392-399. [PMID: 29449060 PMCID: PMC6087691 DOI: 10.1016/j.schres.2018.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acoustic phonetic methods are useful in examining some symptoms of schizophrenia; we used such methods to understand the underpinnings of aprosody. We hypothesized that, compared to controls and patients without clinically rated aprosody, patients with aprosody would exhibit reduced variability in: pitch (F0), jaw/mouth opening and tongue height (formant F1), tongue front/back position and/or lip rounding (formant F2), and intensity/loudness. METHODS Audiorecorded speech was obtained from 98 patients (including 25 with clinically rated aprosody and 29 without) and 102 unaffected controls using five tasks: one describing a drawing, two based on spontaneous speech elicited through a question (Tasks 2 and 3), and two based on reading prose excerpts (Tasks 4 and 5). We compared groups on variation in pitch (F0), formant F1 and F2, and intensity/loudness. RESULTS Regarding pitch variation, patients with aprosody differed significantly from controls in Task 5 in both unadjusted tests and those adjusted for sociodemographics. For the standard deviation (SD) of F1, no significant differences were found in adjusted tests. Regarding SD of F2, patients with aprosody had lower values than controls in Task 3, 4, and 5. For variation in intensity/loudness, patients with aprosody had lower values than patients without aprosody and controls across the five tasks. CONCLUSIONS Findings could represent a step toward developing new methods for measuring and tracking the severity of this specific negative symptom using acoustic phonetic parameters; such work is relevant to other psychiatric and neurological disorders.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA.
| | - Anya Lunden
- College of William and Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Sean D Cleary
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Luca Pauselli
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA
| | - Yazeed Alolayan
- Case Western Reserve University, Department of Neurology, Cleveland, OH, USA
| | | | | | - Anthony Crisafio
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Francesco Bernardini
- Université Libre de Bruxelles, Erasme Hospital, Department of Psychiatry, Anderlecht, Belgium
| | - Michael A Covington
- The University of Georgia, Institute for Artificial Intelligence, Athens, GA, USA
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32
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Kim BH, Shin YB, Kyeong S, Lee SK, Kim JJ. Disrupted salience processing involved in motivational deficits for real-life activities in patients with schizophrenia. Schizophr Res 2018; 197:407-413. [PMID: 29395610 DOI: 10.1016/j.schres.2018.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/29/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
Motivational deficits in patients with schizophrenia adversely affect various domains of daily living. This symptom in everyday life situations manifests in a complex behavioral pattern whose root cannot be simplified to an impaired reward-motivation scheme. This study aimed to identify impairment of the salience network that underlies motivational deficits seen in patients with schizophrenia in real-life situations. During the functional magnetic resonance imaging scan, 20 patients with schizophrenia and 20 normal controls performed a task mimicking real-life situations, in which an avatar proposed participation in a daily activity with either an intrinsic or extrinsic reward. Group and type-of-reward effects were evaluated with respect to brain activity. Further, psychophysiological interactions were analyzed for the dorsal anterior cingulate cortex (dACC) and insula, which are the key nodes of the salience network. The acceptance of the proposal was significantly higher for intrinsic than for extrinsic rewards in controls, whereas patients showed no difference. The imaging results showed a group effect in the dACC, right insula, thalamus, and lingual gyrus. The dACC showed negative contrast interaction with regions of the left dorsolateral prefrontal cortex, and the right insula showed positive contrast interaction with the occipital gyrus and precentral gyrus. These results suggest that patients exhibit no different participation behavior between activities with intrinsic and extrinsic rewards, which can be explained by the floor effect. Disrupted salience processing in schizophrenia including aberrant salience network and a disconnection of the salience and reward networks may account for the lack of motivation for daily activities.
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Affiliation(s)
- Byung-Hoon Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Bin Shin
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunghyon Kyeong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seon-Koo Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jae-Jin Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Rosen AFG, Roalf DR, Ruparel K, Blake J, Seelaus K, Villa LP, Ciric R, Cook PA, Davatzikos C, Elliott MA, Garcia de La Garza A, Gennatas ED, Quarmley M, Schmitt JE, Shinohara RT, Tisdall MD, Craddock RC, Gur RE, Gur RC, Satterthwaite TD. Quantitative assessment of structural image quality. Neuroimage 2017; 169:407-418. [PMID: 29278774 DOI: 10.1016/j.neuroimage.2017.12.059] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/12/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022] Open
Abstract
Data quality is increasingly recognized as one of the most important confounding factors in brain imaging research. It is particularly important for studies of brain development, where age is systematically related to in-scanner motion and data quality. Prior work has demonstrated that in-scanner head motion biases estimates of structural neuroimaging measures. However, objective measures of data quality are not available for most structural brain images. Here we sought to identify quantitative measures of data quality for T1-weighted volumes, describe how these measures relate to cortical thickness, and delineate how this in turn may bias inference regarding associations with age in youth. Three highly-trained raters provided manual ratings of 1840 raw T1-weighted volumes. These images included a training set of 1065 images from Philadelphia Neurodevelopmental Cohort (PNC), a test set of 533 images from the PNC, as well as an external test set of 242 adults acquired on a different scanner. Manual ratings were compared to automated quality measures provided by the Preprocessed Connectomes Project's Quality Assurance Protocol (QAP), as well as FreeSurfer's Euler number, which summarizes the topological complexity of the reconstructed cortical surface. Results revealed that the Euler number was consistently correlated with manual ratings across samples. Furthermore, the Euler number could be used to identify images scored "unusable" by human raters with a high degree of accuracy (AUC: 0.98-0.99), and out-performed proxy measures from functional timeseries acquired in the same scanning session. The Euler number also was significantly related to cortical thickness in a regionally heterogeneous pattern that was consistent across datasets and replicated prior results. Finally, data quality both inflated and obscured associations with age during adolescence. Taken together, these results indicate that reliable measures of data quality can be automatically derived from T1-weighted volumes, and that failing to control for data quality can systematically bias the results of studies of brain maturation.
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Affiliation(s)
- Adon F G Rosen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - David R Roalf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Jason Blake
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Kevin Seelaus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Lakshmi P Villa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Rastko Ciric
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Philip A Cook
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA; Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia PA, USA
| | - Mark A Elliott
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Angel Garcia de La Garza
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Efstathios D Gennatas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Megan Quarmley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - J Eric Schmitt
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia PA, USA
| | - M Dylan Tisdall
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - R Cameron Craddock
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA; Department of Diagnostic Medicine, University of Texas at Austin, Austin TX, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - Theodore D Satterthwaite
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA.
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Dollfus S, Lyne J. Negative symptoms: History of the concept and their position in diagnosis of schizophrenia. Schizophr Res 2017; 186:3-7. [PMID: 27401529 DOI: 10.1016/j.schres.2016.06.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 06/19/2016] [Indexed: 11/18/2022]
Abstract
Current conceptualizations of schizophrenia have been introduced over centuries and continue to progress in recent decades. Symptoms have been divided into several domains, contrasting negative and positive symptoms which are different in their nature, onset, progression and response to treatment. An account of the different historical changes of the concept – essentially nosographic – has led to models attempting to integrate findings for each dimension of the disorder. This paper reviews the history of negative symptoms in diagnosis and how different approaches have been utilised to consider negative symptoms in the concept of schizophrenia. The paper also bridges various international classifications which have evolved and modified the role of negative symptoms in their diagnostic criteria for schizophrenia, which highlights the challenge of defining this disease.
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Affiliation(s)
- Sonia Dollfus
- CHU de Caen, Service de psychiatrie, Centre Esquirol, Caen F-14000, France; Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS), Normandie Univ, Faculté de médecine, Caen F-14000, France; ISTCT, Normandie Univ, UNICAEN, CEA, CNRS,14000 Caen, France.
| | - John Lyne
- Royal College of Surgeons in Ireland and North Dublin Mental Health Service, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team, Avila House, Blackrock Business Park, Blackrock, Co., Dublin, Ireland
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35
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Lincoln TM, Dollfus S, Lyne J. Current developments and challenges in the assessment of negative symptoms. Schizophr Res 2017; 186:8-18. [PMID: 26960948 DOI: 10.1016/j.schres.2016.02.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
Reliable and valid assessment of negative symptoms is crucial to further develop etiological models and improve treatments. Our understanding of the concept of negative symptoms has undergone significant advances since the introduction of quantitative assessments of negative symptoms in the 1980s. These include the conceptualization of cognitive dysfunction as separate from negative symptoms and the distinction of two main negative symptom factors (avolition and diminished expression). In this review we provide an overview of existing negative symptom scales, focusing on both observer-rated and self-rated measurement of negative symptoms. We also distinguish between measures that assess negative symptoms as part of a broader assessment of schizophrenia symptoms, those specifically developed for negative symptoms and those that assess specific domains of negative symptoms within and beyond the context of psychotic disorders. We critically discuss strengths and limitations of these measures in the light of some existing challenges, i.e. observed and subjective symptom experiences, the challenge of distinguishing between primary and secondary negative symptoms, and the overlap between negative symptoms and related factors (e.g. personality traits and premorbid functioning). This review is aimed to inform the ongoing development of negative symptom scales.
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Affiliation(s)
- Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Sonia Dollfus
- CHU de Caen, Service universitaire de Psychiatrie, Centre Esquirol, Avenue Côte de Nacre, Caen F-14000, France; UNICAEN, UFR Médecine, F-14074 Caen, France
| | - John Lyne
- Royal College of Surgeons in Ireland, North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team, Avila House, Blackrock Business Park, Blackrock, Co. Dublin, Ireland
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36
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Bischof M, Obermann C, Hartmann MN, Hager OM, Kirschner M, Kluge A, Strauss GP, Kaiser S. The brief negative symptom scale: validation of the German translation and convergent validity with self-rated anhedonia and observer-rated apathy. BMC Psychiatry 2016; 16:415. [PMID: 27876020 PMCID: PMC5118879 DOI: 10.1186/s12888-016-1118-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/07/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Negative symptoms are considered core symptoms of schizophrenia. The Brief Negative Symptom Scale (BNSS) was developed to measure this symptomatic dimension according to a current consensus definition. The present study examined the psychometric properties of the German version of the BNSS. To expand former findings on convergent validity, we employed the Temporal Experience Pleasure Scale (TEPS), a hedonic self-report that distinguishes between consummatory and anticipatory pleasure. Additionally, we addressed convergent validity with observer-rated assessment of apathy with the Apathy Evaluation Scale (AES), which was completed by the patient's primary nurse. METHODS Data were collected from 75 in- and outpatients from the Psychiatric Hospital, University Zurich diagnosed with either schizophrenia or schizoaffective disorder. We assessed convergent and discriminant validity, internal consistency and inter-rater reliability. RESULTS We largely replicated the findings of the original version showing good psychometric properties of the BNSS. In addition, the primary nurses evaluation correlated moderately with interview-based clinician rating. BNSS anhedonia items showed good convergent validity with the TEPS. CONCLUSIONS Overall, the German BNSS shows good psychometric properties comparable to the original English version. Convergent validity extends beyond interview-based assessments of negative symptoms to self-rated anhedonia and observer-rated apathy.
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Affiliation(s)
- Martin Bischof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Matthias N. Hartmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland ,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Bluemlisalpstrasse 10, 8006 Zurich, Switzerland
| | - Oliver M. Hager
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland ,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Bluemlisalpstrasse 10, 8006 Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Agne Kluge
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Gregory P. Strauss
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY 13902-6000 USA
| | - Stefan Kaiser
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Bluemlisalpstrasse 10, 8006 Zurich, Switzerland
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37
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Strauss GP, Gold JM. A Psychometric Comparison of the Clinical Assessment Interview for Negative Symptoms and the Brief Negative Symptom Scale. Schizophr Bull 2016; 42:1384-1394. [PMID: 27174556 PMCID: PMC5049528 DOI: 10.1093/schbul/sbw046] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 2005, the National Institute of Mental Health held a consensus development conference on negative symptoms of schizophrenia. Among the important conclusions of this meeting were that there are at least 5 commonly accepted domains of negative symptoms (blunted affect, alogia, avolition, anhedonia, asociality) and that new rating scales were needed to adequately assess these constructs. Two next-generation negative symptom scales resulted from this meeting: the Brief Negative Symptom Scale (BNSS) and Clinical Assessment Interview for Negative Symptoms (CAINS). Both measures are becoming widely used and studies have demonstrated good psychometric properties for each scale. The current study provides the first direct psychometric comparison of these scales. Participants included 65 outpatients diagnosed with schizophrenia or schizoaffective disorder who completed clinical interviews, questionnaires, and neuropsychological testing. Separate raters completed the BNSS and CAINS within the same week. Results indicated that both measures had good internal consistency, convergent validity, and discriminant validity. High correspondence was observed between CAINS and BNSS blunted affect and alogia items. Moderate convergence occurred for avolition and asociality items, and low convergence was seen among anhedonia items. Findings suggest that both scales have good psychometric properties, but that there are important distinctions among the items related to motivation and pleasure.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY;
| | - James M Gold
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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38
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Walther S, Eisenhardt S, Bohlhalter S, Vanbellingen T, Müri R, Strik W, Stegmayer K. Gesture Performance in Schizophrenia Predicts Functional Outcome After 6 Months. Schizophr Bull 2016; 42:1326-1333. [PMID: 27566843 PMCID: PMC5049539 DOI: 10.1093/schbul/sbw124] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The functional outcome of schizophrenia is heterogeneous and markers of the course are missing. Functional outcome is associated with social cognition and negative symptoms. Gesture performance and nonverbal social perception are critically impaired in schizophrenia. Here, we tested whether gesture performance or nonverbal social perception could predict functional outcome and the ability to adequately perform relevant skills of everyday function (functional capacity) after 6 months. In a naturalistic longitudinal study, 28 patients with schizophrenia completed tests of nonverbal communication at baseline and follow-up. In addition, functional outcome, social and occupational functioning, as well as functional capacity at follow-up were assessed. Gesture performance and nonverbal social perception at baseline predicted negative symptoms, functional outcome, and functional capacity at 6-month follow-up. Gesture performance predicted functional outcome beyond the baseline measure of functioning. Patients with gesture deficits at baseline had stable negative symptoms and experienced a decline in social functioning. While in patients without gesture deficits, negative symptom severity decreased and social functioning remained stable. Thus, a simple test of hand gesture performance at baseline may indicate favorable outcomes in short-term follow-up. The results further support the importance of nonverbal communication skills in subjects with schizophrenia.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland;,*To whom correspondence should be addressed; University Hospital of Psychiatry Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland; tel: +41-31-930-9483; fax: +41-31-930-9958, e-mail:
| | - Sarah Eisenhardt
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland;,Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - Tim Vanbellingen
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland;,Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - René Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
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Oya K, Matsuda Y, Matsunaga S, Kishi T, Iwata N. Efficacy and safety of oxytocin augmentation therapy for schizophrenia: an updated systematic review and meta-analysis of randomized, placebo-controlled trials. Eur Arch Psychiatry Clin Neurosci 2016; 266:439-50. [PMID: 26303414 DOI: 10.1007/s00406-015-0634-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
Abstract
The aim of this study was to perform a systematic review and an updated and comprehensive meta-analysis of oxytocin augmentation therapy in patients with schizophrenia who received antipsychotic agents. Data published up to 07/11/2015 were obtained from PubMed, PsycINFO, and Cochrane Library databases. We conducted a systematic review and meta-analysis of patients' data from randomized controlled trials (RCTs) comparing oxytocin with placebo. Relative risk (RR), standardized mean difference (SMD), and 95 % confidence intervals (95 % CI) based on the random-effects model were calculated. We included seven RCTs; the total sample size was 206 patients. Oxytocin was superior to placebo for decreasing the Positive and Negative Syndrome Scale (PANSS) general subscale scores (SMD = -0.44, 95 % CI -0.82 to -0.06, p = 0.02, I (2) = 0 %, N = 4, n = 112); however, it was not different from placebo for total symptoms (SMD = -0.46, 95 % CI -1.20 to 0.28, p = 0.22, I (2) = 80 %, N = 6, n = 162), positive symptoms (SMD = -0.18, 95 % CI -0.87 to 0.51, p = 0.60, I (2) = 81 %, N = 6, n = 192), and negative symptoms (SMD = -0.34, 95 % CI -0.76 to 0.08, p = 0.12, I (2) = 55 %, N = 7, n = 214). However, a sensitivity analysis including only oxytocin administration on consecutive days studies was superior to placebo in negative symptoms (SMD = -0.44, 95 % CI -0.87 to -0.01, p = 0.04, I (2) = 51 %, N = 6 n = 192). There were no significant differences for all-cause discontinuation (RR = 1.02) and individual side effects such as headache and dizziness between oxytocin and placebo. Oxytocin may improve PANSS general subscale scores in schizophrenia and seems to be well tolerated. However, because the number of studies in the current analysis was small, further study will be required using larger sample sizes.
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Affiliation(s)
- Kazuto Oya
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Yuki Matsuda
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Shinji Matsunaga
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan.
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
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40
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Albrecht MA, Waltz JA, Frank MJ, Gold JM. Probability and magnitude evaluation in schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2016; 5:41-46. [PMID: 28740816 PMCID: PMC5514296 DOI: 10.1016/j.scog.2016.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022]
Abstract
Alterations in reinforcement learning and decision making in schizophrenia have been linked with orbitofrontal cortex (OFC) dysfunction, a region critical for weighing reward magnitude in the calculation of expected value (EV). However, much of this work has used complex tasks that require combined learning and EV calculation. Here we used a simple "Roulette" task that examined the calculation of EV directly through a combination of text and/or pictorial representation of reward probability and magnitude. Forty-four people with schizophrenia and 30 controls were recruited. Patients were less sensitive to adjustments in a parameter combining probability and magnitude into one EV construct. Breaking down the construct into independent contributions of probability and magnitude, we found that negative symptoms were associated with magnitude sensitivity. This is consistent with the hypothesized role of OFC in actively representing magnitude and the notion that negative symptoms may involve a failure to appropriately estimate and use future reward magnitude to guide decision making.
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Affiliation(s)
- Matthew A. Albrecht
- Maryland Psychiatric Research Center, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Curtin Health Innovation Research Institute - Biosciences, Curtin University, Perth, Western, Australia
- Corresponding author at: Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Avenue Catonsville, MD 21228, USA. Tel.: +1 402 410 6053; fax: +1 410 788 3837.Maryland Psychiatric Research Center, Department of PsychiatryUniversity of Maryland School of Medicine55 Wade Avenue CatonsvilleMD21228USA
| | - James A. Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Michael J. Frank
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, RI, United States
- Department of Psychiatry and Brown Institute for Brain Science, Brown University, Providence, RI, United States
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, United States
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41
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Kim JS, Jang SK, Park SC, Yi JS, Park JK, Lee JS, Choi KH, Lee SH. Measuring negative symptoms in patients with schizophrenia: reliability and validity of the Korean version of the Motivation and Pleasure Scale-Self-Report. Neuropsychiatr Dis Treat 2016; 12:1167-72. [PMID: 27274251 PMCID: PMC4869782 DOI: 10.2147/ndt.s107775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Clinical Assessment Interview for Negative Symptoms (CAINS) is one of the validated interview measures of negative symptoms in psychotic disorders. The Motivation and Pleasure Scale-Self-Report (MPSR) is a self-report measure that assesses the motivation and pleasure domains of negative symptoms based on the CAINS. This study evaluated the reliability and validity of a Korean version of the MPSR. METHODS A total of 139 patients with schizophrenia completed the MPSR, CAINS, Scale for the Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scales, Calgary Depression Scale for Schizophrenia, and other measures of trait and cognitive function. RESULTS The 15-item MPSR showed good internal consistency. In addition, it also had a good convergent validity with the Motivation and Pleasure subscale of the CAINS and the anhedonia/avolition subscale of the SANS. The scale was not associated with psychotic symptoms, agitation/mania, and depression/anxiety, and it showed good discriminant validity. MPSR scores were significantly correlated with Behavioral Activation System total score for trait measure. CONCLUSION The Korean version of the MPSR is a notable self-report method for examining the severity of negative symptoms in schizophrenia.
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Affiliation(s)
- Ji-Sun Kim
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea
| | - Seon-Kyeong Jang
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jung-Seo Yi
- Department of Psychiatry, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Joong-Kyu Park
- Department of Rehabilitation Psychology, Daegu University, Daegu, Republic of Korea
| | - Jung Suk Lee
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
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42
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Sarkar S, Hillner K, Velligan DI. Conceptualization and treatment of negative symptoms in schizophrenia. World J Psychiatry 2015; 5:352-361. [PMID: 26740926 PMCID: PMC4694548 DOI: 10.5498/wjp.v5.i4.352] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/07/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
Negative symptoms of schizophrenia including social withdrawal, diminished affective response, lack of interest, poor social drive, and decreased sense of purpose or goal directed activity predict poor functional outcomes for patients with schizophrenia. They may develop and be maintained as a result of structural and functional brain abnormalities, particularly associated with dopamine reward pathways and by environmental and psychosocial factors such as self-defeating cognitions and the relief from overstimulation that accompanies withdrawal from social and role functioning. Negative symptoms are more difficult to treat than the positive symptoms of schizophrenia and represent an unmet therapeutic need for large numbers of patients with schizophrenia. While antipsychotic medications to treat the symptoms of schizophrenia have been around for decades, they have done little to address the significant functional impairments in the disorder that are associated with negative symptoms. Negative symptoms and the resulting loss in productivity are responsible for much of the world-wide personal and economic burden of schizophrenia. Pharmacologic treatments may be somewhat successful in treating secondary causes of negative symptoms, such as antipsychotic side effects and depression. However, in the United States there are no currently approved treatments for severe and persistent negative symptoms (PNS) that are not responsive to treatments for secondary causes. Pharmacotherapy and psychosocial treatments are currently being developed and tested with severe and PNS as their primary targets. Academia, clinicians, the pharmaceutical industry, research funders, payers and regulators will need to work together to pursue novel treatments to address this major public health issue.
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43
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Adida M, Azorin JM, Belzeaux R, Fakra E. [Negative symptoms: clinical and psychometric aspects]. L'ENCEPHALE 2015; 41:6S15-7. [PMID: 26776385 DOI: 10.1016/s0013-7006(16)30004-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent investigations performing exploratory and confirmatory factor analysis have suggested that negative symptoms are multidimensional, including evidence for at least two distinct negative symptom subdomains: diminished expression and amotivation. Guidance for selection of instruments for measurement of negative symptoms is rapidly evolving. As there are continuing advances in the description of negative symptoms, new instruments are under development, and new data on the performance of instruments emerge from clinical trials. The Scale for Assessment of Negative Symptoms (SANS), the Positive and Negative Syndrome Scale (PANSS), and the Negative Symptom Assessment-16 (NSA-16) are considered to be reliable and valid measures for negative symptom trials but differ with respect to their domain coverage, use of informants, integration of global scores, administration time and comprehensiveness of their structured interviews. In response to the 2005 NIMH - MATRICS consensus statement, work groups are field testing and refining two new measures, the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Brief Negative Symptom Scale (BNSS). Both address the five currently recognized domains of negative symptoms, differentiate appetitive from consummatory aspects of anhedonia and address desire for social relationships. Thus far, both have exhibited promising psychometric properties.
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Affiliation(s)
- M Adida
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France.
| | - J-M Azorin
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - R Belzeaux
- SHU Psychiatrie adultes, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - E Fakra
- Service de Psychiatrie adultes, CHU Saint-Étienne, 5 Chemin de la Marandière, 42055 Saint-Étienne cedex 2, France
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Garcia-Portilla MP, Garcia-Alvarez L, Saiz PA, Al-Halabi S, Bobes-Bascaran MT, Bascaran MT, Muñiz J, Bobes J. Psychometric evaluation of the negative syndrome of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2015; 265:559-66. [PMID: 25802109 DOI: 10.1007/s00406-015-0595-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/15/2015] [Indexed: 11/25/2022]
Abstract
In this paper, we reviewed the available instruments for assessing the negative syndrome of schizophrenia, describing their strengths and weaknesses. Current instruments were classified into two categories according to their content validity and assessment approach as first- or second-generation instruments. The BPRS, SANS, the SENS and the PANSS belong to the first generation, while the BNSS, the CAINS and the MAP-SR belong to the second generation. The NSA can be considered a transitional instrument between the two. First-generation instruments have more content validity problems than second-generation instruments do, as they do not accurately reflect the currently accepted negative syndrome (they do not include all negative symptoms and signs or they include symptoms from other dimensions). They also have more problems relative to the use of behavioural referents instead of internal experiences of deficits when assessing symptoms, which may lead to measuring functioning instead of negative symptoms. Further research needs to be done in this area in order to ensure the evaluation of primary negative symptoms and internal experiences involved in negative symptoms rather than external behaviours.
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Affiliation(s)
- Maria Paz Garcia-Portilla
- Department of Psychiatry, University of Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.,Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Leticia Garcia-Alvarez
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Pilar A Saiz
- Department of Psychiatry, University of Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.,Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Susana Al-Halabi
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - Maria Teresa Bobes-Bascaran
- Hospital Clínico, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Maria Teresa Bascaran
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain
| | - José Muñiz
- Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.,Department of Psychology, University of Oviedo, Plaza de Feijóo, 33003, Oviedo, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain. .,Department of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM Oviedo, c/Julián Clavería 6, 33006, Oviedo, Spain.
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45
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Hovington CL, Bodnar M, Chakravarty MM, Joober R, Malla AK, Lepage M. Investigation of white matter abnormalities in first episode psychosis patients with persistent negative symptoms. Psychiatry Res 2015. [PMID: 26211621 DOI: 10.1016/j.pscychresns.2015.06.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aberrant white matter structures in fronto-temporal regions have previously been identified in patients with schizophrenia. However, scant research has focused on white matter integrity in patients presenting with a first episode of psychosis (FEP) with persistent negative symptoms (PNS). This study aimed to explore microstructure in the neurocircuitry proposed to be involved in PNS, by using a region-of-interest approach. Secondly, the relationship between individual negative symptoms and white matter were explored. Fractional anisotropy (FA) was measured in the fornix and three other tracts bilaterally including the uncinate fasciculus, superior longitudinal fasciculus and the cingulum bundle. Twelve patients with PNS were compared to a non-PNS group (52) and a healthy control group (51). Results showed that the PNS group had significantly lower FA values in the fornix when compared to healthy controls and that the non-PNS group had significantly lower FA values in the right uncinate fasciculus compared to healthy controls. Significant correlations were observed between SANS global score for anhedonia-asociality and lower FA values in the right cingulum bundle. Our results suggest that fronto-temporal white matter might be more closely related to PNS and that this relationship may possibly be mediated by greater anhedonia in PNS patients.
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Affiliation(s)
- Cindy L Hovington
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Michael Bodnar
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - M Mallar Chakravarty
- Kimel Family Translational Imaging-Genetics Research Laboratory, The Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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46
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Edwards CJ, Cella M, Tarrier N, Wykes T. Predicting the future in schizophrenia: The discrepancy between anticipatory and consummatory pleasure. Psychiatry Res 2015; 229:462-9. [PMID: 26233824 DOI: 10.1016/j.psychres.2015.05.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 04/21/2015] [Accepted: 05/20/2015] [Indexed: 01/23/2023]
Abstract
When predicting future emotions we use inaccurate biases which rely on our most salient and recent experiences. In schizophrenia, there appears to be a specific deficit in this anticipatory process which is associated with reduced motivation and engagement. The nature of this deficit and how it differs to the general population is unclear. This study introduces a new task examining the discrepancy between anticipated and experienced pleasure and investigates its potential usefulness to characterise the pleasure deficit in people with schizophrenia. Forty-eight healthy controls and 50 individuals with schizophrenia completed the Components of Pleasure Task (COP) which uses a range of images to generate anticipatory and experiential ratings. Participants also completed measures of mood and symptoms. Individuals with schizophrenia had a larger anticipatory-consummatory discrepancy score. This was due to under-anticipating highly pleasant stimuli and over-anticipating low pleasantness stimuli. People with schizophrenia are blunted compared to controls when anticipating stimuli, considering highly and lowly rated stimuli alike. A greater discrepancy between anticipated and experienced pleasure may contribute to negative symptoms such as poor motivation and social withdrawal. Reducing the discrepancy between experienced and anticipated pleasure may be a target for interventions aiming to reduce negative symptoms.
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Affiliation(s)
- Clementine J Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Nicholas Tarrier
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK.
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47
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Velligan DI, Roberts D, Mintz J, Maples N, Li X, Medellin E, Brown M. A randomized pilot study of MOtiVation and Enhancement (MOVE) Training for negative symptoms in schizophrenia. Schizophr Res 2015; 165:175-80. [PMID: 25937461 PMCID: PMC4484604 DOI: 10.1016/j.schres.2015.04.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Among individuals with schizophrenia, those who have persistent and clinically significant negative symptoms (PNS) have the poorest functional outcomes and quality of life. The NIMH-MATRICS Consensus Statement indicated that these symptoms represent an unmet therapeutic need for large numbers of individuals with schizophrenia. No psychosocial treatment model addresses the entire constellation of PNS. METHOD 51 patients with PNS were randomized into one of two groups for a period of 9 months: 1) MOtiVation and Enhancement (MOVE) or 2) treatment as usual. MOVE is a home based, manual-driven, multi-modal treatment that employs a number of cognitive and behavioral principles to address the broad range of factors contributing to PNS and their functional consequences. The components of MOVE include: Environmental supports to prompt initiation and persistence, in-vivo skills training to ameliorate deficits and encourage interaction, cognitive behavioral techniques to address self-defeating attitudes, in-vivo training in emotional processing to address affective blunting and problems in identifying emotions, and specific techniques to address the deficits in anticipatory pleasure. Patients were assessed at baseline and each 3 months with multiple measures of negative symptoms. RESULTS Repeated measures analyses of variance for mixed models indicated significant Group by Time effects for the Negative Symptom Assessment (NSA; p<.02) and the Clinical Assessment Interview for Negative Symptoms (CAINS; p<.04). Group differences were not significant until 9 months of treatment and were not significant for the Brief Negative Symptom Scale (BNSS). CONCLUSION Further investigation of a comprehensive treatment for PNS, such as MOVE, is warranted.
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Affiliation(s)
- Dawn I. Velligan
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900,To whom correspondence should be addressed: phone: (210) 567-5508, fax (210) 567-1291,
| | - David Roberts
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900
| | - Natalie Maples
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900,University of Texas School of Public Health, Center for Health Promotion & Prevention Research
| | - Xueying Li
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900
| | - Elisa Medellin
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900
| | - Matt Brown
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, M.S. # 7792, 7703 Floyd Curl Drive, San Antonio, Texas, 78229-3900
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Walther S, Stegmayer K, Sulzbacher J, Vanbellingen T, Müri R, Strik W, Bohlhalter S. Nonverbal social communication and gesture control in schizophrenia. Schizophr Bull 2015; 41:338-45. [PMID: 25646526 PMCID: PMC4332963 DOI: 10.1093/schbul/sbu222] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Schizophrenia patients are severely impaired in nonverbal communication, including social perception and gesture production. However, the impact of nonverbal social perception on gestural behavior remains unknown, as is the contribution of negative symptoms, working memory, and abnormal motor behavior. Thus, the study tested whether poor nonverbal social perception was related to impaired gesture performance, gestural knowledge, or motor abnormalities. Forty-six patients with schizophrenia (80%), schizophreniform (15%), or schizoaffective disorder (5%) and 44 healthy controls matched for age, gender, and education were included. Participants completed 4 tasks on nonverbal communication including nonverbal social perception, gesture performance, gesture recognition, and tool use. In addition, they underwent comprehensive clinical and motor assessments. Patients presented impaired nonverbal communication in all tasks compared with controls. Furthermore, in contrast to controls, performance in patients was highly correlated between tasks, not explained by supramodal cognitive deficits such as working memory. Schizophrenia patients with impaired gesture performance also demonstrated poor nonverbal social perception, gestural knowledge, and tool use. Importantly, motor/frontal abnormalities negatively mediated the strong association between nonverbal social perception and gesture performance. The factors negative symptoms and antipsychotic dosage were unrelated to the nonverbal tasks. The study confirmed a generalized nonverbal communication deficit in schizophrenia. Specifically, the findings suggested that nonverbal social perception in schizophrenia has a relevant impact on gestural impairment beyond the negative influence of motor/frontal abnormalities.
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Affiliation(s)
| | | | | | - Tim Vanbellingen
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland; Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - René Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry, Bern, Switzerland
| | - Stephan Bohlhalter
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland; Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
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49
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Walther S, Stegmayer K, Horn H, Rampa L, Razavi N, Müller TJ, Strik W. The Longitudinal Course of Gross Motor Activity in Schizophrenia - Within and between Episodes. Front Psychiatry 2015; 6:10. [PMID: 25698981 PMCID: PMC4318415 DOI: 10.3389/fpsyt.2015.00010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/21/2015] [Indexed: 01/03/2023] Open
Abstract
Schizophrenia is associated with heterogeneous course of positive and negative symptoms. In addition, reduced motor activity as measured by wrist actigraphy has been reported. However, longitudinal studies of spontaneous motor activity are missing. We aimed to explore whether activity levels were stable within and between psychotic episodes. Furthermore, we investigated the association with the course of negative symptoms. In 45 medicated patients, we investigated motor behavior within a psychotic episode. In addition, we followed 18 medicated patients across 2 episodes. Wrist actigraphy and psychopathological ratings were applied. Within an episode symptoms changed but activity levels did not vary systematically. Activity at baseline predicted the course of negative symptoms. Between two episodes activity recordings were much more stable. Again, activity at the index episode predicted the outcome of negative symptoms. In sum, spontaneous motor activity shares trait and state characteristics, the latter are associated with negative symptom course. Actigraphy may therefore become an important ambulatory instrument to monitor negative symptoms and treatment outcome in schizophrenia.
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Affiliation(s)
- Sebastian Walther
- University Hospital of Psychiatry, University of Bern , Bern , Switzerland
| | | | - Helge Horn
- University Hospital of Psychiatry, University of Bern , Bern , Switzerland
| | - Luca Rampa
- University Hospital of Psychiatry, University of Bern , Bern , Switzerland
| | - Nadja Razavi
- University Hospital of Psychiatry, University of Bern , Bern , Switzerland
| | - Thomas J Müller
- University Hospital of Psychiatry, University of Bern , Bern , Switzerland
| | - Werner Strik
- University Hospital of Psychiatry, University of Bern , Bern , Switzerland
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50
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Engel M, Fritzsche A, Lincoln TM. Validation of the German version of the Clinical Assessment Interview for Negative Symptoms (CAINS). Psychiatry Res 2014; 220:659-63. [PMID: 25138895 DOI: 10.1016/j.psychres.2014.07.070] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 04/29/2014] [Accepted: 07/27/2014] [Indexed: 10/25/2022]
Abstract
Validated assessment instruments could contribute to a better understanding and assessment of negative symptoms and advance treatment research. The aim of this study was to examine the psychometric properties of a German version of the Clinical Assessment Interview for Negative Symptoms (CAINS). In- and outpatients (N=53) with schizophrenia or schizoaffective disorder were assessed with standardized interviews and questionnaires on negative and positive symptoms and general psychopathology in schizophrenia, depression, the ability to experience anticipatory and consummatory pleasure, and global functioning. The results indicated good psychometric properties, high internal consistency and promising inter-rater agreement for the German version of the CAINS. The two-factor solution of the original version of the CAINS was confirmed, indicating good construct validity. Convergent validity was supported by significant correlations between the CAINS subscales with the negative symptom scale of the Positive and Negative Syndrome Scale, and with consummatory pleasure. The CAINS also exhibited discriminant validity indicated by its non-significant correlations with positive symptoms, general psychopathology and depression that are in line with the findings for the original version of the CAINS. In addition, the CAINS correlated moderately with global functioning. The German version of the CAINS appears to be a valid and suitable diagnostic tool for measuring negative symptoms in schizophrenia.
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Affiliation(s)
- Maike Engel
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Anja Fritzsche
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania Marie Lincoln
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
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