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Bismark AW, Mikhael T, Mitchell K, Holden J, Granholm E. Pupillary responses as a biomarker of cognitive effort and the impact of task difficulty on reward processing in schizophrenia. Schizophr Res 2024; 267:216-222. [PMID: 38569395 DOI: 10.1016/j.schres.2024.03.025] [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: 11/09/2023] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
Negative symptoms of schizophrenia robustly predict functional outcomes but remain relatively resistant to available treatments. Better measures of negative symptoms, especially motivational deficits, are needed to better understand these symptoms and improve treatment development. Recent research shows promise in linking behavioral effort tasks to motivational negative symptoms, reward processing deficits, and defeatist attitudes, but few studies account for individual or group (patient v. control) differences in cognitive ability to perform the tasks. Individuals with poorer abilities might be less motivated to perform tasks because they find them more difficult to perform. This study used a personalized digit span task to control task difficulty while measuring task effort via pupillary responses (greater dilation indicates greater cognitive effort) at varying monetary rewards ($1 & $2). Participants with schizophrenia (N = 34) and healthy controls (N = 41) performed a digit span task with personalized max span lengths and easy (max- 2 digits) and overload (max+ 2 digits) conditions. Consistent with many studies, pupillary responses (cognitive effort) increased with greater difficulty until exceeding capacity. A similar pattern of reward responsivity was seen in both groups, such that greater reward increased dilation (effort) comparably for both groups when difficulty was within capacity. Neither patients nor controls exerted increased effort for greater reward when difficulty exceeded capacity. In patients, positive relationships were found between pupil dilation and defeatist performance beliefs if task difficulty was within capacity; a relationship that reversed if the task was too difficult. The findings demonstrate the importance of accounting for cognitive capacity and task difficulty when evaluating motivation and reward sensitivity and illustrate the utility of pupillary responses as an objective measure of effort in schizophrenia.
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Affiliation(s)
- Andrew W Bismark
- Department of Psychiatry, University of California, San Diego, USA; VA San Diego Healthcare System, USA
| | - Tanya Mikhael
- VA San Diego Healthcare System, USA; Central Texas Veterans Healthcare System, USA
| | - Kyle Mitchell
- Department of Psychiatry, University of California, San Diego, USA; Johns Hopkins University School of Nursing, USA
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, USA; VA San Diego Healthcare System, USA.
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2
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Granholm E, Holden J, Dwyer K, Mikhael T, Link P, Depp C. Mobile-Assisted Cognitive Behavioral Therapy for Negative Symptoms: Open Single-Arm Trial With Schizophrenia Patients. JMIR Ment Health 2020; 7:e24406. [PMID: 33258792 PMCID: PMC7738249 DOI: 10.2196/24406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Negative symptoms are an important unmet treatment need for schizophrenia. This study is a preliminary, open, single-arm trial of a novel hybrid intervention called mobile-assisted cognitive behavioral therapy for negative symptoms (mCBTn). OBJECTIVE The primary aim was to test whether mCBTn was feasible and could reduce severity of the target mechanism, defeatist performance attitudes, which are associated with experiential negative symptoms and poor functioning in schizophrenia. METHODS Participants with schizophrenia or schizoaffective disorder (N=31) who met prospective criteria for persistent negative symptoms were enrolled. The blended intervention combines weekly in-person group therapy with a smartphone app called CBT2go. The app extended therapy group skills, including recovery goal setting, thought challenging, scheduling of pleasurable activities and social interactions, and pleasure-savoring interventions to modify defeatist attitudes and improve experiential negative symptoms. RESULTS Retention was excellent (87% at 18 weeks), and severity of defeatist attitudes and experiential negative symptoms declined significantly in the mCBTn intervention with large effect sizes. CONCLUSIONS The findings suggest that mCBTn is a feasible and potentially effective treatment for experiential negative symptoms, if confirmed in a larger randomized controlled trial. The findings also provide support for the defeatist attitude model of experiential negative symptoms and suggest that blended technology-supported interventions such as mCBTn can strengthen and shorten intensive psychosocial interventions for schizophrenia. TRIAL REGISTRATION ClinicalTrials.gov NCT03179696; https://clinicaltrials.gov/ct2/show/NCT03179696.
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Affiliation(s)
- Eric Granholm
- VA San Diego Healthcare System, San Diego, CA, United States
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Kristen Dwyer
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Tanya Mikhael
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Peter Link
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Colin Depp
- VA San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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3
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Dinakaran D, Sreeraj VS, Venkatasubramanian G. Measurement based care in schizophrenia-Feasibility in routine clinical practice. Asian J Psychiatr 2020; 49:101954. [PMID: 32065965 DOI: 10.1016/j.ajp.2020.101954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/30/2019] [Accepted: 02/09/2020] [Indexed: 12/18/2022]
Abstract
Measurement based care (MBC) implies the utilization of structured objective scales/batteries in the assessment and monitoring of an illness. Patients with schizophrenia with heterogeneous presentation would potentially benefit better through MBC. Time constraints and additional work burden are frequently cited as barriers in implementing objective assessments. In this selective review, the authors discuss the available standard scales for assessment in schizophrenia, the advantages and disadvantages in implementing MBC and a feasible approach to overcome the barriers by adapting shorter versions of structured scales.
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Affiliation(s)
- Damodharan Dinakaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Raffard S, Bortolon C, Yazbek H, Lançon C, Benoit M, Norton J, Capdevielle D. The cognitive, affective motivational and clinical longitudinal determinants of apathy in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2019; 269:911-920. [PMID: 29948250 DOI: 10.1007/s00406-018-0907-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/22/2018] [Indexed: 11/28/2022]
Abstract
Apathy is a frequent and debilitating condition with few treatment options available in schizophrenia patients. Despite evidence of its multidimensional structure, most of past studies have explored apathy through a categorical approach. The main objective of this study was to identify the cognitive, emotional, motivational, and clinical factors at baseline that best predicted the three subtypes of apathy dimensions at follow-up. In a longitudinal study, 137 participants diagnosed with schizophrenia underwent different assessments including clinical, motivational, affective and cognitive measurements, at 1-month (referred to as baseline) and 12-month follow-ups. Data were analyzed using partial least squares variance-based structural equation modeling. Three latent variables representing the three previously described domains of apathy reaching consensus in the literature were extracted from the Lille Apathy Rating Scale. Results showed that in addition to baseline apathy, positive symptoms, anticipatory pleasure and sensibility to punishment at baseline predicted cognitive apathy at follow-up. Likewise, both baseline apathy and sensibility to punishment predicted emotional apathy at follow-up. Finally, baseline anhedonia and episodic memory were the main variables the predicted behavioral apathy at follow-up. This is the first study to show specific associations between apathy subtypes and clinical and cognitive motivational dysfunction in individual with schizophrenia, indicating possible distinct underlying mechanisms to these demotivational symptoms. Treatment for apathy should address both types of processes. Importantly, our results demonstrate the interest of multidimensional approaches in the understanding of apathy in schizophrenia.
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Affiliation(s)
- Stéphane Raffard
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHU Montpellier, Montpellier, France. .,Epsylon Laboratory EA 4556, Université Paul Valéry Montpellier 3, Université Montpellier, Montpellier, France.
| | - Catherine Bortolon
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHU Montpellier, Montpellier, France.,Epsylon Laboratory EA 4556, Université Paul Valéry Montpellier 3, Université Montpellier, Montpellier, France
| | - Hanan Yazbek
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHU Montpellier, Montpellier, France.,Epsylon Laboratory EA 4556, Université Paul Valéry Montpellier 3, Université Montpellier, Montpellier, France
| | - Christophe Lançon
- Aix-Marseille Univ., EA 3279-Public Health, Chronic Diseases and Quality of Life-Research Unit, 13005, Marseille, France
| | - Michel Benoit
- Psychiatry-Clinical Neuroscience Department, Pasteur Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Joanna Norton
- INSERM U1061, Montpellier, France.,University of Montpellier, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, Hôpital de la Colombière, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,University of Montpellier, Montpellier, France
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5
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Fervaha G, Takeuchi H, Foussias G, Hahn MK, Agid O, Remington G. Achievement motivation in early schizophrenia: Relationship with symptoms, cognition and functional outcome. Early Interv Psychiatry 2018; 12:1038-1044. [PMID: 28230315 DOI: 10.1111/eip.12405] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/15/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals with schizophrenia engage in goal-directed activities significantly less often compared to healthy individuals in the community. There is ample evidence documenting the presence of motivational deficits in schizophrenia using observer-based ratings; however, purely self-reported accounts of patients' motivation are less well understood. This study examined subjective accounts of trait achievement motivation among relatively young, clinically stable, early-course outpatients with schizophrenia. METHODS Thirty-nine early-course patients and 39 healthy comparison subjects completed clinical and cognitive assessments in addition to a self-report inventory measuring achievement motivation. RESULTS Patients were found to endorse significantly lower levels of motivation, a mean difference which translated to a large effect size (Cohen's d = 1.1). Patients' self-reported motivation was significantly related to clinician ratings of motivational deficits which were based on behavioural output, and to vocational functioning. Within the patient sample, 33.3% of individuals were found to experience prominent or clinically significant levels of amotivation based on patients' own self-report. Self-reported achievement motivation was not associated with other clinical variables such as positive symptom severity or expressive negative symptoms. CONCLUSIONS Our results serve to highlight the occurrence and prevalence of motivational deficits in patients with schizophrenia who are in the early stages of their illness. Subjective accounts of motivation in this population were found to be related to important outcomes such as community functioning, highlighting the importance of this domain of illness. Targeting these deficits early in the course of the illness offers the potential to curb potential prospective poor outcomes and sets the stage for recovery.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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6
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de Pinho L, Pereira A, Chaves C, Batista P. Quality of Life Scale and symptomatology of schizophrenic patients – A systematic review. EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fervaha G, Agid O, Takeuchi H, Foussias G, Remington G. Life satisfaction and happiness among young adults with schizophrenia. Psychiatry Res 2016; 242:174-179. [PMID: 27288735 DOI: 10.1016/j.psychres.2016.05.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/29/2016] [Accepted: 05/29/2016] [Indexed: 11/30/2022]
Abstract
People with schizophrenia often experience persistent symptoms and impairments in community functioning; however, despite this, many individuals with the illness report high levels of well-being. We explored the level of subjective well-being in a sample of relatively young outpatients with schizophrenia and matched healthy controls. Seventy-five outpatients with schizophrenia and 72 demographically matched healthy controls, aged 18-35 years, participated in the present study. Subjective well-being was defined as a combination of happiness and satisfaction with life, each of which were measured using validated instruments. Symptom severity, insight, and cognition were also evaluated. People with schizophrenia endorsed significantly lower levels of subjective well-being than healthy controls although, there was substantial overlap in scores, and many participants with schizophrenia endorsed a high level of well-being. Both depressive symptoms and motivational deficits demonstrated significant independent predictive value for determining level of well-being. At a group level, the mean level of happiness and life satisfaction was lower among people with schizophrenia than healthy comparison participants. However, despite this mean difference, there exists marked overlap in individual scores between those with and without schizophrenia, demonstrating that many young people with schizophrenia do, in fact, endorse high levels of subjective well-being.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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8
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Roth RM, Garlinghouse MA, Flashman LA, Koven NS, Pendergrass JC, Ford JC, McAllister TW, Saykin AJ. Apathy Is Associated With Ventral Striatum Volume in Schizophrenia Spectrum Disorder. J Neuropsychiatry Clin Neurosci 2016; 28:191-4. [PMID: 26900738 PMCID: PMC5023440 DOI: 10.1176/appi.neuropsych.15100241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Apathy is prevalent in schizophrenia, but its etiology has received little investigation. The ventral striatum (VS), a key brain region involved in motivated behavior, has been implicated in studies of apathy. We therefore evaluated whether apathy is associated with volume of the VS on MRI in 23 patients with schizophrenia using voxel-based morphometry. Results indicated that greater self-reported apathy severity was associated with smaller volume of the right VS even when controlling for age, gender, depression, and total gray matter volume. The finding suggests that apathy is related to abnormality of brain circuitry subserving motivated behavior in patients with schizophrenia.
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Affiliation(s)
- Robert M Roth
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
| | - Matthew A Garlinghouse
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
| | - Laura A Flashman
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
| | - Nancy S Koven
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
| | - J Cara Pendergrass
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
| | - James C Ford
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
| | - Thomas W McAllister
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
| | - Andrew J Saykin
- From the Brain Imaging Laboratory, Dept. of Psychiatry, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH (RMR, MAG, LAF, JCP, JCF); Program in Neuroscience, Dept. of Psychology, Bates College, Lewiston, ME (NSK); Dept. of Psychiatry, Indiana University School of Medicine, Indianapolis, IN (TWM); and the Center for Neuroimaging, Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (AJS)
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Fervaha G, Foussias G, Agid O, Remington G. Motivational deficits in early schizophrenia: prevalent, persistent, and key determinants of functional outcome. Schizophr Res 2015; 166:9-16. [PMID: 25982811 DOI: 10.1016/j.schres.2015.04.040] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/26/2015] [Accepted: 04/29/2015] [Indexed: 01/31/2023]
Abstract
Negative symptoms, in particular motivational deficits, are reported as impediments to functional recovery in patients with schizophrenia. This study examined the prevalence of motivational deficits in patients early in the illness, and the impact these deficits have on community functioning. Patients with schizophrenia between the ages of 18 and 35years, and within 5years of initiating antipsychotic treatment were included in the present investigation (N=166). The impact of motivation and cognition on concurrent and longitudinal functioning was evaluated. Motivational impairments were found in more than 75% of participants, and were not associated with receipt of social support. These deficits served as the most robust and reliable predictor of functional outcome, while neurocognition demonstrated significantly weaker associations with outcome. When considered together, motivational deficits demonstrated a reliable link with concurrent and longitudinal functioning, with cognition not offering any independent predictive value. Moreover, motivation was found to mediate the relationship between cognition and outcome. Changes in motivation were linked to changes in functioning; however, this was not the case for changes in cognitive performance. Motivation emerged as a significant predictor of functioning even after selected demographic and clinical characteristics (e.g., positive symptoms) were accounted for. These data indicate that motivational deficits are prevalent in patients with schizophrenia, even in the early stages of the illness, and these deficits stand as one of the most robust barriers to people with schizophrenia achieving functional recovery. Greater understanding of the mechanisms underlying these deficits is critical to effective treatment innovation.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Revicki DA, Kleinman L, Cella D. A history of health-related quality of life outcomes in psychiatry. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25152652 PMCID: PMC4140507 DOI: 10.31887/dcns.2014.16.2/drevicki] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health-related quality of life (HRQoL) is a multidimensional concept that includes subjective reports of symptoms, side effects, functioning in multiple life domains, and general perceptions of life satisfaction and quality. Rather than estimating it from external observations, interview, or clinical assessment, it is best measured by direct query. Due to a perception that respondents may not be reliable or credible, there has been some reluctance to use self-report outcomes in psychiatry. More recently, and increasingly, HRQoL assessment through direct patient query has become common when evaluating a range of psychiatric, psychological, and social therapies. With few exceptions, psychiatric patients are credible and reliable reporters of this information. This article summarizes studies that highlight the development, validation, and application of HRQoL measures in psychiatry. Thoughtful application of these tools in psychiatric research can provide a much-needed patient perspective in the future of comparative effectiveness research, patient-centered outcomes research, and clinical care.
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Affiliation(s)
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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11
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Mucci A, Rucci P, Rocca P, Bucci P, Gibertoni D, Merlotti E, Galderisi S, Maj M. The Specific Level of Functioning Scale: construct validity, internal consistency and factor structure in a large Italian sample of people with schizophrenia living in the community. Schizophr Res 2014; 159:144-50. [PMID: 25182540 DOI: 10.1016/j.schres.2014.07.044] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The study aimed to assess the construct validity, internal consistency and factor structure of the Specific Levels of Functioning Scale (SLOF), a multidimensional instrument assessing real life functioning. METHODS The study was carried out in 895 Italian people with schizophrenia, all living in the community and attending the outpatient units of 26 university psychiatric clinics and/or community mental health departments. The construct validity of the SLOF was analyzed by means of the multitrait-multimethod approach, using the Personal and Social Performance (PSP) Scale as the gold standard. The factor structure of the SLOF was examined using both an exploratory principal component analysis and a confirmatory factor analysis. RESULTS The six factors identified using exploratory principal component analysis explained 57.1% of the item variance. The examination of the multitrait-multimethod matrix revealed that the SLOF factors had high correlations with PSP factors measuring the same constructs and low correlations with PSP factors measuring different constructs. The confirmatory factor analysis (CFA) corroborated the 6-factor structure reported in the original validation study. Loadings were all significant and ranged from a minimum of 0.299 to a maximum of 0.803. The CFA model was adequately powered and had satisfactory goodness of fit indices (comparative fit index=0.927, Tucker-Lewis index=0.920 and root mean square error of approximation=0.047, 95% CI 0.045-0.049). CONCLUSION The present study confirms, in a large sample of Italian people with schizophrenia living in the community, that the SLOF is a reliable and valid instrument for the assessment of social functioning. It has good construct validity and internal consistency, and a well-defined factor structure.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | | | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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12
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Fervaha G, Foussias G, Agid O, Remington G. Motivational and neurocognitive deficits are central to the prediction of longitudinal functional outcome in schizophrenia. Acta Psychiatr Scand 2014; 130:290-9. [PMID: 24850369 DOI: 10.1111/acps.12289] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Functional impairment is characteristic of most individuals with schizophrenia; however, the key variables that undermine community functioning are not well understood. This study evaluated the association between selected clinical variables and one-year longitudinal functional outcomes in patients with schizophrenia. METHOD The sample included 754 patients with schizophrenia who completed both baseline and one-year follow-up visits in the CATIE study. Patients were evaluated with a comprehensive battery of assessments capturing symptom severity and cognitive performance among other variables. The primary outcome variable was functional status one-year postbaseline measured using the Heinrichs-Carpenter Quality of Life Scale. RESULTS Factor analysis of negative symptom items revealed two factors reflecting diminished expression and amotivation. Multivariate regression modeling revealed several significant independent predictors of longitudinal functioning scores. The strongest predictors were baseline amotivation and neurocognition. Both amotivation and neurocognition also had independent predictive value for each of the domains of functioning assessed (e.g., vocational). CONCLUSION Both motivational and neurocognitive deficits independently contribute to longitudinal functional outcomes assessed 1 year later among patients with schizophrenia. Both of these domains of psychopathology impede functional recovery; hence, it follows that treatments ameliorating each of these symptoms should promote community functioning among individuals with schizophrenia.
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Affiliation(s)
- G Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
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