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Fang J, Cai R, Hu Y, Wang Y, Ling Y, Lv Y, Fang X, Zhang X, Zhou C. Aberrant brain functional connectivity mediates the effects of negative symptoms on cognitive function in schizophrenia: A structural equation model. J Psychiatr Res 2024; 177:109-117. [PMID: 39004002 DOI: 10.1016/j.jpsychires.2024.07.006] [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: 02/22/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Schizophrenia is a severe psychiatric disorder, characterized by positive symptoms, negative symptoms, and cognitive deficits. Elucidating the mechanism of negative symptom and cognitive deficits could contribute to the treatment and prognosis of schizophrenia. We hypothesized that abnormal functional connectivity would be involved in the indirect effects of negative symptoms on cognitive function. METHODS A total of 150 schizophrenia male patients and 108 healthy controls matched for age, education and gender were enrolled in the study. The scores of Brief Negative Symptom Scale were divided into two factors: motivation and pleasure deficits (MAP) and diminished expression (EXP). Subsequently, a series of classic neurocognitive tests were used to evaluate cognitive functions. Resting-state fMRI data was collected from all participants. The Anatomical Automatic Labeling template was employed to establish regions of interest, thereby constructing the functional connectivity network across the entire brain. Eventually, scores of patients' negative symptoms scale, cognitive function, and strengths of abnormal functional connectivity were incorporated into a structural equation model to explore the interactions among variables. RESULTS MAP exhibited a distinctly and significantly negative impact on cognitive function. The functional connectivity between the left insula and left precuneus, along with that between the left precuneus and right angular gyrus, collectively served as intermediaries, contributing to the indirect effects of MAP and EXP on cognitive function. CONCLUSIONS Our findings demonstrated the moderating role of aberrant brain functional connectivity between negative symptoms and cognitive function, providing clues about the neural correlates of negative symptoms and cognitive deficits in schizophrenia.
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Affiliation(s)
- Jin Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Renliang Cai
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yunshan Hu
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yuru Ling
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yiding Lv
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Li M, Luo G, Qiu Y, Zhang X, Sun X, Li Y, Zhao Y, Sun W, Yang S, Li J. Negative symptoms and neurocognition in drug-naïve schizophrenia: moderating role of plasma neutrophil gelatinase-associated lipocalin (NGAL) and interferon-gamma (INF-γ). Eur Arch Psychiatry Clin Neurosci 2024; 274:1071-1081. [PMID: 37490111 DOI: 10.1007/s00406-023-01650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
Previous studies reported that peripheral inflammation was associated with cognitive performance and brain structure in schizophrenia. However, the moderating effect of inflammation has not been extensively studied. This study investigated whether inflammation markers moderated the association between negative symptoms and neurocognition in schizophrenia. This cross-sectional study included 137 drug-naïve schizophrenia patients (DNS) and 67 healthy controls (HC). We performed the Measurements and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for cognitive assessment and the Positive and Negative Syndrome Scale (PANSS) for psychiatric symptoms. Plasma concentrations of interferon-gamma (IFN-γ), neutrophil gelatinase-associated lipocalin (NGAL), and nuclear factor kappa B (NF-κB) were measured. The MCCB neurocognition score, social cognition score, and total score; the plasma concentrations of NGAL, IFN-γ, and NF-κB were significantly decreased in DNS than in HC (all P's < 0.001). PANSS negative subscale (PNS), PANSS reduced expressive subdomain (RES) negatively correlated with neurocognition score (P = 0.007; P = 0.011, respectively). Plasma concentrations of IFN-γ and NGAL positively correlated with neurocognition score (P = 0.043; P = 0.008, relatively). The interactions of PNS × NGAL; PNS × IFN-γ; RES × IFN-γ accounted for significant neurocognition variance (P = 0.025; P = 0.029, P = 0.007, respectively). Simple slope analysis showed that all the above moderating effects only occurred in patients with near normal IFN-γ and NGAL levels. Plasma concentrations of IFN-γ and NGAL moderated the relationship between negative symptoms (especially RES) and neurocognition in schizophrenia. Treatment targeting inflammation may contribute to neurocognition improvement in schizophrenia.
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Affiliation(s)
- Meijuan Li
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Guoshuai Luo
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Yuying Qiu
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Xue Zhang
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
- Chifeng Anding Hospital, Chifeng, China
| | - Xiaoxiao Sun
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Yanzhe Li
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Yongping Zhao
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Wei Sun
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Shu Yang
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China
| | - Jie Li
- Tianjin Mental Health Institute, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Hexi District, Tianjin, 300222, China.
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Gangl N, Conring F, Federspiel A, Wiest R, Walther S, Stegmayer K. Resting-state perfusion in motor and fronto-limbic areas is linked to diminished expression of emotion and speech in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:51. [PMID: 37573445 PMCID: PMC10423240 DOI: 10.1038/s41537-023-00384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
Negative symptoms (NS) are a core component of schizophrenia affecting community functioning and quality of life. We tested neural correlates of NS considering NS factors and consensus subdomains. We assessed NS using the Clinical Assessment Interview for Negative Symptoms and the Scale for Assessment of Negative Symptoms. Arterial spin labeling was applied to measure resting-state cerebral blood flow (rCBF) in 47 schizophrenia patients and 44 healthy controls. Multiple regression analyses calculated the relationship between rCBF and NS severity. We found an association between diminished expression (DE) and brain perfusion within the cerebellar anterior lobe and vermis, and the pre-, and supplementary motor area. Blunted affect was linked to fusiform gyrus and alogia to fronto-striatal rCBF. In contrast, motivation and pleasure was not associated with rCBF. These results highlight the key role of motor areas for DE. Considering NS factors and consensus subdomains may help identifying specific pathophysiological pathways of NS.
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Affiliation(s)
- Nicole Gangl
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Frauke Conring
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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Cai R, Huang C, Ni L, Liu Z, Zhang S, Qiu Y, Hu J, Gao J, Yu M, Tang X, Zhou C, Zhang X, Zhang X, Fang X. The motivation and pleasure deficits but not expressivity affects social functioning through cognitive function in male patients with schizophrenia: A structural equation model. Asian J Psychiatr 2023; 85:103616. [PMID: 37163944 DOI: 10.1016/j.ajp.2023.103616] [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: 03/06/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study aims to compare cognitive function and social functioning in male schizophrenia patients with deficit syndrome (DS) and non-DS, and to explore the associations among two different dimensions of negative symptoms (motivation and pleasure (MAP) and expressivity (EXP) deficits), cognitive function and social functioning base on a Structural Equation Model (SEM). METHODS The current study enrolled 161 male schizophrenia patients and 120 age- and education- matched healthy controls. The DS and non-DS group were categorized by the Chinese version of Schedule for the Deficit Syndrome (SDS). The psychotic and negative symptoms were evaluated by the Brief Psychiatric Rating Scale (BPRS) and the Brief Negative Symptoms Scale (BNSS). The Social functioning was measured by Scale of Social function in Psychosis Inpatients (SSPI). A battery of classical neurocognitive tests was used for assessing cognition including sustained vigilance/attention, cognitive flexibility, ideation fluency and visuospatial memory. RESULTS Our study indicated that DS patients performed worser in cognitive function and social functioning than non-DS patients. The SEM model demonstrated that MAP significantly affected social functioning through direct influence and mediation of cognitive function. However, our results found that EXP had little influence on cognitive function and social function. CONCLUSION Our findings provided evidence supporting that DS may represent as a subtype of schizophrenia, and the MAP factor play a pivotal role to influence the cognitive and social functioning in schizophrenia patients.
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Affiliation(s)
- Renliang Cai
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chengbing Huang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Psychiatry, The Third People's Hospital of Huai'an, Huaian 223001, China
| | - Longyan Ni
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zihan Liu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Sijie Zhang
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Yufeng Qiu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Jianing Hu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Ju Gao
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou, Jiangsu 215008, China
| | - Miao Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaowei Tang
- Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou, Jiangsu 215008, China; Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Chan SKW, Liao Y, Hui CLM, Wong TY, Suen Y, Chang WC, Lee EHM, Chen EYH. Longitudinal changes of cognitive function and its relationship with subdomains of negative symptoms in patients with adult-onset first-episode schizophrenia: A 4-year follow up study. Schizophr Res 2023; 252:181-188. [PMID: 36657362 DOI: 10.1016/j.schres.2023.01.004] [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: 03/15/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUNDS This study explores the longitudinal changes and trajectories of cognitive functions in patients with adult-onset first-episode schizophrenia (FES) over four years and their relationships with the baseline subdomains of negative symptoms. METHODS A total of 177 patients of age 25-55 with FES were recruited. Baseline demographics, clinical, social and cognitive functions were assessed. Diminished expression and diminished motivation of negative symptoms were assessed with Scale for the Assessment of Negative Symptoms (SANS). Patients had yearly follow-up of cognitive function assessments over four years. Latent class growth analysis (LCGA) and mixed linear regression model were used to explore the longitudinal changes of cognitive functions and the effect of baseline negative symptoms on the longitudinal cognitive function changes. Relationships of baseline negative symptoms subdomains and cognitive functions were also explored. RESULTS Two trajectories of cognitive functions were identified. Longitudinal improvements were found in most cognitive functions apart from the logical memory. One trajectory of patients had significant deterioration of logical memory while the other group had significant improvement. Baseline diminished expression was associated with baseline and longitudinal changes of processing speed and verbal fluency while diminished motivation was associated with baseline and longitudinal changes of processing speed. CONCLUSIONS Adult-onset FES patients had a homogeneous longitudinal improvement in most cognitive functions but not for logical memory suggesting the unique nature of verbal memory. The distinct relationship between baseline subdomains of negative symptoms with baseline and longitudinal cognitive functions suggesting the presence of differential overlapping etiology between negative symptom subdomains and cognitive functions.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Yingqi Liao
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Ting Yat Wong
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yinam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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6
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Pillny M, Krkovic K, Buck L, Lincoln TM. From Memories of Past Experiences to Present Motivation? A Meta-analysis on the Association Between Episodic Memory and Negative Symptoms in People With Psychosis. Schizophr Bull 2022; 48:307-324. [PMID: 34635918 PMCID: PMC8886596 DOI: 10.1093/schbul/sbab120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Based on findings from cognitive science, it has been theorized that the reductions in motivation and goal-directed behavior in people with psychosis could stem from impaired episodic memory. In the current meta-analysis, we investigated this putative functional link between episodic memory deficits and negative symptoms. We hypothesized that episodic memory deficits in psychosis would be related to negative symptoms in general but would be more strongly related to amotivation than to reduced expressivity. We included 103 eligible studies (13,622 participants) in the analyses. Results revealed significant, moderate negative associations of episodic memory with negative symptoms in general (k = 103; r = -.23; z = -13.40; P ≤ .001; 95% CI [-.26; -.20]), with amotivation (k = 16; r = -.18; z = -6.6; P ≤ .001; 95% CI [-.23; -.13]) and with reduced expressivity (k = 15; r = -.18; z = -3.30; P ≤.001; 95% CI[-.29; -.07]). These associations were not moderated by sociodemographic characteristics, positive symptoms, depression, antipsychotic medication or type of negative symptom scale. Although these findings provide sound evidence for the association between episodic memory deficits and amotivation, the rather small magnitude and the unspecific pattern of this relationship also indicate that episodic memory deficits are unlikely to be the only factor relevant to amotivation. This implicates that future research should investigate episodic memory in conjunction with other factors that could account for the association of episodic memory deficits and amotivation in psychosis.
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Affiliation(s)
- Matthias Pillny
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Laura Buck
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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7
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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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8
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Giordano GM, Brando F, Perrottelli A, Di Lorenzo G, Siracusano A, Giuliani L, Pezzella P, Altamura M, Bellomo A, Cascino G, Del Casale A, Monteleone P, Pompili M, Galderisi S, Maj M. Tracing Links Between Early Auditory Information Processing and Negative Symptoms in Schizophrenia: An ERP Study. Front Psychiatry 2021; 12:790745. [PMID: 34987433 PMCID: PMC8721527 DOI: 10.3389/fpsyt.2021.790745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/19/2021] [Indexed: 01/28/2023] Open
Abstract
Background: Negative symptoms represent a heterogeneous dimension with a strong impact on functioning of subjects with schizophrenia (SCZ). Five constructs are included in this dimension: anhedonia, asociality, avolition, blunted affect, and alogia. Factor analyses revealed that these symptoms cluster in two domains: experiential domain (avolition, asociality, and anhedonia) and the expressive deficit (alogia and blunted affect), that might be linked to different neurobiological alterations. Few studies investigated associations between N100, an electrophysiological index of early sensory processing, and negative symptoms, reporting controversial results. However, none of these studies investigated electrophysiological correlates of the two negative symptom domains. Objectives: The aim of our study was to evaluate, within the multicenter study of the Italian Network for Research on Psychoses, the relationships between N100 and negative symptom domains in SCZ. Methods: Auditory N100 was analyzed in 114 chronic stabilized SCZ and 63 healthy controls (HCs). Negative symptoms were assessed with the Brief Negative Symptom Scale (BNSS). Repeated measures ANOVA and correlation analyses were performed to evaluate differences between SCZ and HCs and association of N100 features with negative symptoms. Results: Our findings demonstrated a significant N100 amplitude reduction in SCZ compared with HCs. In SCZ, N100 amplitude for standard stimuli was associated with negative symptoms, in particular with the expressive deficit domain. Within the expressive deficit, blunted affect and alogia had the same pattern of correlation with N100. Conclusion: Our findings revealed an association between expressive deficit and N100, suggesting that these negative symptoms might be related to deficits in early auditory processing in SCZ.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Brando
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Antonio Del Casale
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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9
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Giordano GM, Perrottelli A, Mucci A, Di Lorenzo G, Altamura M, Bellomo A, Brugnoli R, Corrivetti G, Girardi P, Monteleone P, Niolu C, Galderisi S, Maj M. Investigating the Relationships of P3b with Negative Symptoms and Neurocognition in Subjects with Chronic Schizophrenia. Brain Sci 2021; 11:1632. [PMID: 34942934 PMCID: PMC8699055 DOI: 10.3390/brainsci11121632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/26/2021] [Accepted: 12/08/2021] [Indexed: 01/06/2023] Open
Abstract
Neurocognitive deficits and negative symptoms (NS) have a pivotal role in subjects with schizophrenia (SCZ) due to their impact on patients' functioning in everyday life and their influence on goal-directed behavior and decision-making. P3b is considered an optimal electrophysiological candidate biomarker of neurocognitive impairment for its association with the allocation of attentional resources to task-relevant stimuli, an important factor for efficient decision-making, as well as for motivation-related processes. Furthermore, associations between P3b deficits and NS have been reported. The current research aims to fill the lack of studies investigating, in the same subjects, the associations of P3b with multiple cognitive domains and the expressive and motivation-related domains of NS, evaluated with state-of-the-art instruments. One hundred and fourteen SCZ and 63 healthy controls (HCs) were included in the study. P3b amplitude was significantly reduced and P3b latency prolonged in SCZ as compared to HCs. In SCZ, a positive correlation was found between P3b latency and age and between P3b amplitude and the Attention-vigilance domain, while no significant correlations were found between P3b and the two NS domains. Our results indicate that the effortful allocation of attention to task-relevant stimuli, an important component of decision-making, is compromised in SCZ, independently of motivation deficits or other NS.
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Affiliation(s)
- Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (G.D.L.); (C.N.)
| | - Mario Altamura
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Antonello Bellomo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (M.A.); (A.B.)
| | - Roberto Brugnoli
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (R.B.); (P.G.)
| | - Giulio Corrivetti
- Department of Mental Health, University of Salerno, 84133 Salerno, Italy;
| | - Paolo Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy; (R.B.); (P.G.)
| | - Palmiero Monteleone
- Section of Neurosciences, Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, 84081 Salerno, Italy;
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (G.D.L.); (C.N.)
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.M.G.); (A.P.); (S.G.); (M.M.)
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10
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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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11
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Barek LM, Mercy G, Gautier C, Noquet M, Legros-Lafarge E, Fiegl L, Fiard D, Allain P. The use of the French Dimensional Apathy Scale (f-DAS) to assess apathy in schizophrenia: Properties and profiles. J Affect Disord 2021; 294:181-188. [PMID: 34298224 DOI: 10.1016/j.jad.2021.06.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Apathy can be defined as a quantitative reduction of self-generated voluntary and purposeful (or goal-directed) behaviour. The literature underlines the triadic dimensional nature of apathy, but in schizophrenia there are inconsistencies due to difficulty in assessment. The Dimensional Apathy Scale (DAS) and its validation into French (f-DAS) provide measurement of three neurobehavioral apathy subtypes: Executive, Emotional and Initiation, but these subtypes have never been explored in schizophrenia. OBJECTIVE The aims of this study are to assess apathy in schizophrenia with a tri-dimensional tool (the f-DAS), to examine its psychometric properties in schizophrenia and the apathetic profiles of patients with schizophrenia. METHODS One hundred and ten subjects were recruited. Forty-five belonged to the patients' group and fifty-five to the control group. They all completed the Mini-International Neuropsychiatric Interview (M.I.N.I), the French National Reading Test (f-NART), the French Dimensional Apathy Scale (f-DAS), the Lille Apathy Rating Scale (LARS) and the Beck Depression Inventory (BDI II). RESULTS Regarding the total score of the f-DAS and the subscores for each dimension, patients appeared significantly more apathetic than healthy controls. Consistency, validity, concurrent and divergent validity were good. In the patient group, several profiles of apathy were identified. CONCLUSIONS The f-DAS has good psychometric properties and provides reliable and valid dimensional assessment of apathy in schizophrenia. From a dimensional point of view, using the f-DAS we demonstrated that prevalence of apathy could be underestimated in schizophrenia. Patients with schizophrenia are more impaired on the Executive and Initiative dimensions of apathy.
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Affiliation(s)
- Lise M' Barek
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Nantes Université, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers Cedex 01; Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France.
| | | | - Caroline Gautier
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Malika Noquet
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Emilie Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), Centre Hospitalier Esquirol, Limoges, France
| | - Lucia Fiegl
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), Centre Hospitalier Esquirol, Limoges, France
| | - Dominique Fiard
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Philippe Allain
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Nantes Université, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers Cedex 01; Département de Neurologie, Centre Hospitalier Universitaire d'Angers, Angers, France
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12
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Petrova NN, Tsyrenova KA, Dorofeikova MV. [Depression in the structure of schizophrenia: clinical and biochemical characteristics]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:84-90. [PMID: 34405662 DOI: 10.17116/jnevro202112105284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE AIM OF THE STUDY Was to investigate clinical and biochemical correlates of depression in the structure of schizophrenia to improve its diagnosis and differential diagnosis and to deepen understanding of mechanisms of schizophrenia development. Material and Methods. Forty-two inpatients at the stabilization stage of paranoid schizophrenia, aged 29.5±5.9 years, of whom 64.3% were women, were examined. The duration of the disease was 5.6±6.3 years. We used clinical and psychopathological methods, clinical scales (PANSS, SANS, BACS, Calgary Scale), catamnestic and clinic-laboratory methods (determination of brain-derived neurotrophic factor BDNF, proinflammatory cytokine interleukin-6, C-reactive protein). Results. At the stabilization stage, depression in patients with paranoid schizophrenia occurred in 19% of cases, more frequently in women. Female patients were more severely depressed, which was associated with an increased concentration of C-reactive protein, while negative symptoms predominated in male patients as compared to females. The presence of depression correlates with a lower severity of psychopathological, primarily positive symptoms and with a greater severity of neurocognitive deficit in schizophrenic patients. BDNF level directly correlates with the severity of positive and negative symptoms, and the level of interleukin 6 at the stage of remission formation does not differ from that in healthy individuals. C-reactive protein levels are associated with the characteristics of the course of schizophrenia.
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Affiliation(s)
- N N Petrova
- Saint-Petersburg State University, St. Petersburg, Russia
| | - K A Tsyrenova
- Saint-Petersburg State University, St. Petersburg, Russia
| | - M V Dorofeikova
- Sechenov Institute of Evolutionary Physiology and Biochemistry, St-Petersburg, Russia
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13
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Negative Symptoms and Behavioral Alterations Associated with Dorsolateral Prefrontal Syndrome in Patients with Schizophrenia. J Clin Med 2021; 10:jcm10153417. [PMID: 34362200 PMCID: PMC8348852 DOI: 10.3390/jcm10153417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
The present study had three main aims: (1) to explore the possible relationships between the two dimensions of negative symptoms (NS) with the three frontal behavioral syndromes (dorsolateral, orbitofrontal and the anterior or mesial cingulate circuit) in patients with schizophrenia; (2) to determine the influence of sociodemographic and clinical variables on the severity of the two dimensions of NS (expressive deficits and disordered relationships/avolition); and (3) to explore the possible relationships between the two dimensions of NS and social functioning. We evaluated a group of 33 patients with schizophrenia with a predominance of NS using the self-reported version of the Frontal System Behavior scale. To quantify the severity of NS, the Assessment of Negative Symptoms (SANS) scale was used. The results revealed that the two dimensions of NS correlate positively with the behavioral syndrome of dorsolateral prefrontal origin. Regarding the influence of sociodemographic and clinical variables, in patients with a long evolution the NS of the expressive deficits dimension were less severe than in patients with a short evolution. A negative correlation was found between the severity of NS of the disordered relationships/avolition dimension and perceived social functioning. Our results show the importance of differentiating between the two dimensions of NS to characterize better their possible frontal etiology and impact on clinical course and social functioning.
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14
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Giordano GM, Bucci P, Mucci A, Pezzella P, Galderisi S. Gender Differences in Clinical and Psychosocial Features Among Persons With Schizophrenia: A Mini Review. Front Psychiatry 2021; 12:789179. [PMID: 35002807 PMCID: PMC8727372 DOI: 10.3389/fpsyt.2021.789179] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 01/10/2023] Open
Abstract
An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.
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Affiliation(s)
| | - Paola Bucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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15
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Mørch-Johnsen L, Smelror RE, Andreou D, Barth C, Johannessen C, Wedervang-Resell K, Wortinger LA, Díaz R, Victoria G, Ueland T, Andreassen OA, Myhre AM, Rund BR, Ulloa RE, Agartz I. Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis. Front Psychiatry 2021; 12:825681. [PMID: 35069300 PMCID: PMC8777217 DOI: 10.3389/fpsyt.2021.825681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Early-onset psychosis (EOP) is among the leading causes of disease burden in adolescents. Negative symptoms and cognitive deficits predicts poorer functional outcome. A better understanding of the association between negative symptoms and cognitive impairment may inform theories on underlying mechanisms and elucidate targets for development of new treatments. Two domains of negative symptoms have been described in adult patients with schizophrenia: apathy and diminished expression, however, the factorial structure of negative symptoms has not been investigated in EOP. We aimed to explore the factorial structure of negative symptoms and investigate associations between cognitive performance and negative symptom domains in adolescents with EOP. We hypothesized that (1) two negative symptom factors would be identifiable, and that (2) diminished expression would be more strongly associated with cognitive performance, similar to adult psychosis patients. Methods: Adolescent patients with non-affective EOP (n = 169) were included from three cohorts: Youth-TOP, Norway (n = 45), Early-Onset Study, Norway (n = 27) and Adolescent Schizophrenia Study, Mexico (n = 97). An exploratory factor analysis was performed to investigate the underlying structure of negative symptoms (measured with the Positive and Negative Syndrome Scale (PANSS)). Factor-models were further assessed using confirmatory factor analyses. Associations between negative symptom domains and six cognitive domains were assessed using multiple linear regression models controlling for age, sex and cohort. The neurocognitive domains from the MATRICS Consensus Cognitive Battery included: speed of processing, attention, working memory, verbal learning, visual learning, and reasoning and problem solving. Results: The exploratory factor analysis of PANSS negative symptoms suggested retaining only a single factor, but a forced two factor solution corroborated previously described factors of apathy and diminished expression in adult-onset schizophrenia. Results from confirmatory factor analysis indicated a better fit for the two-factor model than for the one-factor model. For both negative symptom domains, negative symptom scores were inversely associated with verbal learning scores. Conclusion: The results support the presence of two domains of negative symptoms in EOP; apathy and diminished expression. Future studies on negative symptoms in EOP should examine putative differential effects of these symptom domains. For both domains, negative symptom scores were significantly inversely associated with verbal learning.
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Affiliation(s)
- Lynn Mørch-Johnsen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry and Department of Clinical Research, Østfold Hospital, Grålum, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Claudia Barth
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilie Johannessen
- Department of Neurohabilitation, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura A Wortinger
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ricardo Díaz
- Research Department, Arete Proyectos y Administración, Mexico City, Mexico
| | - Gamaliel Victoria
- Planning of Prevention Programs in the Directorate of Integral Attention to Girls, Boys and Adolescents, System for the Integral Development of the Family, Mexico City, Mexico
| | - Torill Ueland
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Anne M Myhre
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Research Department, Vestre Viken Hospital Trust, Drammen, Norway
| | - Rosa Elena Ulloa
- Developmental Psychopharmacology at the Research Division, Child Psychiatric Hospital, Mexico City, Mexico
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Institute of Clinical Medicine, K.G. Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
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16
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A cognitive model of diminished expression in schizophrenia: The interface of metacognition, cognitive symptoms and language disturbances. J Psychiatr Res 2020; 131:169-176. [PMID: 32979692 PMCID: PMC8100971 DOI: 10.1016/j.jpsychires.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 12/20/2022]
Abstract
The resistance of negative symptoms to pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. However, little is understood about the psychological processes that reinforce and sustain the negative symptoms domain of diminished expression. Prior research has shown that higher levels of diminished expression relate to deficits in metacognitive capacity. We propose a more complex model in which diminished expression occurs when impairments in metacognitive self-reflectivity, alterations in higher-order language structure, and cognitive symptoms interact and thus interfere with persons' ability to understand and express emotions in ways others can recognize. Individuals with schizophrenia-spectrum disorders (N = 201) provided personal narratives detailing their life story and reflections about their mental illness. Self-reflectivity was measured with the Metacognition Assessment Scale-Abbreviated, and situation models were extracted from participants' personal narratives via Coh-Metrix 3.0, an automated program that calculates language indices. Diminished expression and cognitive symptoms were measured with the Positive and Negative Syndrome Scale. Structural equation models (SEM) examined whether self-reflectivity mediated the impact of cognitive symptoms and situation models on diminished expression. Results of the SEM revealed that self-reflectivity partially mediated the impact of situation models on diminished expression (β = -.073, p = .008, ±95% CI [-0.126, -0.019]). and fully mediated the influence of cognitive symptoms in diminished expression (β = 0.099, p = .001, ±95% CI [0.038, 0.160]). In conclusion, results suggest that self-reflectivity, linguistic cohesion, and cognitive symptoms may be useful targets for intervention in efforts to treat diminished expression in psychosis.
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17
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Sampedro A, Peña J, Ibarretxe-Bilbao N, Sánchez P, Iriarte-Yoller N, Pavón C, Hervella I, Tous-Espelosin M, Ojeda N. Neurocognitive, social cognitive, and clinical predictors of creativity in schizophrenia. J Psychiatr Res 2020; 129:206-213. [PMID: 32781338 DOI: 10.1016/j.jpsychires.2020.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Creativity is considered an essential human accomplishment and a key component for daily life problem solving. It has been suggested that impairment in working memory, cognitive flexibility, and theory of mind could lead to lower creativity in schizophrenia. Additionally, other neurocognitive and social cognitive domains, as well as clinical symptoms could play a role in this relationship. However, the extent to which each of these domains influences creativity in schizophrenia remains unknown. Therefore, the aim of this study was to simultaneously investigate the specific contribution of neurocognitive, social cognitive, and clinical variables to creativity in schizophrenia. METHODS One hundred and one patients with schizophrenia were assessed in terms of sociodemographic, clinical, neurocognitive, social cognitive, and creativity variables. RESULTS After controlling for sociodemographic variables, regression analyses showed that higher social perception (β = 0.286, p = .004) and processing speed (β = 0.219, p = .023) predicted creativity total score. Higher social perception (β = 0.298, p = .002) and processing speed (β = 0.277, p = .004) explained figural creativity. Finally, lower negative symptoms (β = -0.302, p = .002) and higher social perception (β = 0.210, p = .029) predicted verbal creativity. CONCLUSIONS Results suggest that neurocognitive, social cognitive, as well as clinical symptoms influence creativity of patients with schizophrenia. Moreover, these findings point out the prominent role of social cognition in creativity in schizophrenia.
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Affiliation(s)
- Agurne Sampedro
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
| | - Naroa Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
| | - Pedro Sánchez
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain; Department of Neuroscience, Psychiatry Section, School of Medicine and Odontology, University of the Basque Country (UPV/EHU), Vizcaya, Spain.
| | | | - Cristóbal Pavón
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain.
| | - Isabel Hervella
- Refractory Psychosis Unit, Hospital Psiquiátrico de Alava, Vitoria, Spain.
| | - Mikel Tous-Espelosin
- Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain.
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain.
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18
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Bègue I, Kaiser S, Kirschner M. Pathophysiology of negative symptom dimensions of schizophrenia – Current developments and implications for treatment. Neurosci Biobehav Rev 2020; 116:74-88. [DOI: 10.1016/j.neubiorev.2020.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/13/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
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19
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Kirschner M, Shafiei G, Markello RD, Makowski C, Talpalaru A, Hodzic-Santor B, Devenyi GA, Paquola C, Bernhardt BC, Lepage M, Chakravarty MM, Dagher A, Mišić B. Latent Clinical-Anatomical Dimensions of Schizophrenia. Schizophr Bull 2020; 46:1426-1438. [PMID: 32744604 PMCID: PMC8496914 DOI: 10.1093/schbul/sbaa097] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Widespread structural brain abnormalities have been consistently reported in schizophrenia, but their relation to the heterogeneous clinical manifestations remains unknown. In particular, it is unclear whether anatomical abnormalities in discrete regions give rise to discrete symptoms or whether distributed abnormalities give rise to the broad clinical profile associated with schizophrenia. Here, we apply a multivariate data-driven approach to investigate covariance patterns between multiple-symptom domains and distributed brain abnormalities in schizophrenia. Structural magnetic resonance imaging and clinical data were derived from one discovery sample (133 patients and 113 controls) and one independent validation sample (108 patients and 69 controls). Disease-related voxel-wise brain abnormalities were estimated using deformation-based morphometry. Partial least-squares analysis was used to comprehensively map clinical, neuropsychological, and demographic data onto distributed deformation in a single multivariate model. The analysis identified 3 latent clinical-anatomical dimensions that collectively accounted for 55% of the covariance between clinical data and brain deformation. The first latent clinical-anatomical dimension was replicated in an independent sample, encompassing cognitive impairments, negative symptom severity, and brain abnormalities within the default mode and visual networks. This cognitive-negative dimension was associated with low socioeconomic status and was represented across multiple races. Altogether, we identified a continuous cognitive-negative dimension of schizophrenia, centered on 2 intrinsic networks. By simultaneously taking into account both clinical manifestations and neuroanatomical abnormalities, the present results open new avenues for multi-omic stratification and biotyping of individuals with schizophrenia.
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Affiliation(s)
- Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland,McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Golia Shafiei
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Ross D Markello
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Carolina Makowski
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Alexandra Talpalaru
- Cerebral Imaging Center, Douglas Mental Health University Institute, McGill University, Montréal, Canada,Department of Biological and Biomedical Engineering, McGill University, Montréal, Canada
| | - Benazir Hodzic-Santor
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Gabriel A Devenyi
- Cerebral Imaging Center, Douglas Mental Health University Institute, McGill University, Montréal, Canada,Department of Psychiatry, McGill University, Montréal, Canada
| | - Casey Paquola
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Boris C Bernhardt
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Martin Lepage
- Cerebral Imaging Center, Douglas Mental Health University Institute, McGill University, Montréal, Canada,Department of Psychiatry, McGill University, Montréal, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Center, Douglas Mental Health University Institute, McGill University, Montréal, Canada,Department of Biological and Biomedical Engineering, McGill University, Montréal, Canada,Department of Psychiatry, McGill University, Montréal, Canada
| | - Alain Dagher
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada
| | - Bratislav Mišić
- McConnell Brain Imaging Centre, Montréal Neurological Institute, McGill University, Montreal, Canada,To whom correspondence should be addressed; tel: 514-398-1857, fax: 514-398-1857, e-mail:
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Makowski C, Lewis JD, Lepage C, Malla AK, Joober R, Evans AC, Lepage M. Intersection of verbal memory and expressivity on cortical contrast and thickness in first episode psychosis. Psychol Med 2020; 50:1923-1936. [PMID: 31456533 DOI: 10.1017/s0033291719002071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Longitudinal studies of first episode of psychosis (FEP) patients are critical to understanding the dynamic clinical factors influencing functional outcomes; negative symptoms and verbal memory (VM) deficits are two such factors that remain a therapeutic challenge. This study uses white-gray matter contrast at the inner edge of the cortex, in addition to cortical thickness, to probe changes in microstructure and their relation with negative symptoms and possible intersections with verbal memory. METHODS T1-weighted images and clinical data were collected longitudinally for patients (N = 88) over a two-year period. Cognitive data were also collected at baseline. Relationships between baseline VM (immediate/delayed recall) and rate of change in two negative symptom dimensions, amotivation and expressivity, were assessed at the behavioral level, as well as at the level of brain structure. RESULTS VM, particularly immediate recall, was significantly and positively associated with a steeper rate of expressivity symptom decline (r = 0.32, q = 0.012). Significant interaction effects between baseline delayed recall and change in expressivity were uncovered in somatomotor regions bilaterally for both white-gray matter contrast and cortical thickness. Furthermore, interaction effects between immediate recall and change in expressivity on cortical thickness rates were uncovered across higher-order regions of the language processing network. CONCLUSIONS This study shows common neural correlates of language-related brain areas underlying expressivity and VM in FEP, suggesting deficits in these domains may be more linked to speech production rather than general cognitive capacity. Together, white-gray matter contrast and cortical thickness may optimally inform clinical investigations aiming to capture peri-cortical microstructural changes.
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Affiliation(s)
- Carolina Makowski
- McGill Centre for Integrative Neuroscience, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal, Canada
- Department of Psychiatry, McGill University, Verdun, Canada
| | - John D Lewis
- McGill Centre for Integrative Neuroscience, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal, Canada
| | - Claude Lepage
- McGill Centre for Integrative Neuroscience, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal, Canada
| | - Ashok K Malla
- Department of Psychiatry, McGill University, Verdun, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Verdun, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
| | - Alan C Evans
- McGill Centre for Integrative Neuroscience, McGill University, Montreal, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Montreal, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University, Verdun, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, Canada
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21
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Ang MS, Rekhi G, Lee J. Vocational Profile and Correlates of Employment in People With Schizophrenia: The Role of Avolition. Front Psychiatry 2020; 11:856. [PMID: 33192630 PMCID: PMC7481460 DOI: 10.3389/fpsyt.2020.00856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/06/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Employment was associated with recovery in individuals with schizophrenia. Our study aimed to delineate the vocational profile and investigate factors associated with likelihood of employment in individuals with schizophrenia. MATERIALS AND METHODS 276 community dwelling outpatients with schizophrenia were recruited; 274 completed the Positive and Negative Syndrome Scale (PANSS) and Brief Negative Symptom Scale (BNSS). Information on employment status, work outcomes and demographics were collected. Occupation was coded in accordance with the Singapore standard occupational classification. Either BNSS Motivation and Pleasure (MAP) and Emotional Expressivity (EE) or BNSS five-factor (Anhedonia, Asociality, Avolition, Blunted Affect, Alogia) were examined with PANSS factors and demographics in logistic regression with employment status and working full-time as outcome variables. RESULTS One-hundred and twenty-seven (46.01%) participants were employed; 65 (51.18%) worked full-time. In the model with BNSS MAP-EE, MAP (OR=0.897, CI=0.854-0.941) and presence of physical comorbidity (OR=0.533, CI=0.304-0.937) were associated with reduced likelihood of employment; female sex (OR=0.286, CI=0.128 - 0.637) was associated with working part-time. In the model with BNSS five-factor, Avolition (OR=0.541, CI=0.440-0.666), and PANSS Positive (OR=0.924, CI=0.855-0.997) were associated with reduced likelihood of employment; female sex (OR=0.289, CI=0.126 - 0.662) and Avolition (OR=0.644, CI=0.475 - 0.872) were associated with working part-time. DISCUSSION Our study described the vocational profile and correlates of employment in a developed urban Asian country. Negative symptoms, particularly MAP and Avolition, positive symptoms, and physical comorbidity reduced an individual's likelihood of employment, while female sex and Avolition were associated with working part-time. Efforts to identify and address these factors are necessary to encourage employment in individuals with schizophrenia.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore.,North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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22
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Executive dysfunctions differentially predict amotivation in first-episode schizophrenia-spectrum disorder: a prospective 1-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2019; 269:887-896. [PMID: 29934845 DOI: 10.1007/s00406-018-0918-y] [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: 03/19/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
Amotivation is a major determinant of functional outcome in schizophrenia but it is understudied in the early course of illness. There is a paucity of longitudinal research investigating predictors of amotivation. In this study, we aimed to examine baseline cognitive and clinical predictors of amotivation at 6 and 12 months of follow-up in patients aged 18-55 years presenting with first-episode DSM-IV schizophrenia-spectrum disorder (FES). Of 145 patients recruited at intake, 116 and 113 completed assessments at 6- and 12-month follow-up, respectively. Amotivation was measured by avolition-apathy and anhedonia-asociality subscale scores of the Scale of the Assessment of Negative Symptoms. Cognitive assessment was administered at baseline. As executive dysfunction has been more consistently found to be associated with negative symptoms and amotivation in prior literature, we adopted fractionated approach to subdivide executive function into distinct components encompassing switching and flexibility, response initiation, response inhibition, planning and strategy allocation, sustained attention and working memory. Our results showed that baseline amotivation (p = 0.01) and switching and flexibility (p = 0.01) were found to independently predict amotivation at 6 months follow-up. Baseline amotivation (p < 0.01) and switching and flexibility (albeit with trend-wise significance, p = 0.06) were also retained in final multivariate regression model for 12-month amotivation prediction. No other executive components or cognitive domains predicted amotivation at follow-up. Findings of our study thus indicate amotivation at initial presentation as a critical determinant of subsequent motivational deficits over 1 year of treatment for FES patients. Cognitive flexibility might be specifically related to the development of amotivation in the early stage of illness.
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Ang MS, Rekhi G, Lee J. Validation of the Brief Negative Symptom Scale and its association with functioning. Schizophr Res 2019; 208:97-104. [PMID: 30987926 DOI: 10.1016/j.schres.2019.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/21/2019] [Accepted: 04/04/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The Brief Negative Symptom Scale (BNSS) includes five domains of negative symptoms suggested by the NIMH Consensus Development Conference (anhedonia, asociality, avolition, blunted affect, and alogia), which could be clustered into two factors - Motivation-Pleasure (MAP) and Emotional Expressivity (EE). Our study aims to examine the psychometric properties of BNSS, and its association with functioning. METHODS 274 individuals with schizophrenia were assessed on the BNSS, Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment of Functioning Scale (GAF), Calgary Depression Scale for Schizophrenia (CDSS), and Simpson-Angus Extrapyramidal Side Effects Scale (SAS). Internal consistency was examined using Cronbach's alpha. Concurrent, discriminant, and construct validity were examined. Factor structure of BNSS was explored using confirmatory factor analyses. Association between GAF and BNSS was examined with GAF as the dependent variable and BNSS Total, MAP and EE, and BNSS five domains as independent variables in three multiple regression models after controlling for covariates. RESULTS BNSS showed good internal consistency (Cronbach's alpha = 0.880) and validity. The five-factor model fit the data better than the two-factor model; a second-order model was superior to both models. More severe symptoms on BNSS Total (B = -0.438, p < .001), MAP (B = -0.876, p < .001), Avolition (B = -2.503, p < .001) and Asociality (B = -0.950, p = .001) were associated with lower GAF. CONCLUSION Our results lend support to the use of BNSS in clinical practice and in future research into negative symptoms. Composite scores could be computed using either the five-factor or second-order models. Negative symptoms, particularly MAP, avolition and asociality, were associated with functioning.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, Singapore
| | - Gurpreet Rekhi
- 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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24
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Sevy S, Lindenmayer JP, Khan A, Ljuri I, Kulsa MKC, Jones O. Differential improvement of negative-symptom subfactors after cognitive remediation in low-functioning individuals with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100145. [PMID: 31828020 PMCID: PMC6889361 DOI: 10.1016/j.scog.2019.100145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Background Negative symptoms and cognitive deficits have a substantial predictive value for functional deficits and recovery in schizophrenia. However, the relationship between negative symptoms and cognitive abnormalities is unclear possibly due to the heterogeneity of negative symptoms. This study used the model of expressive and experiential negative symptoms subfactors to decrease this heterogeneity. It examined these subfactors and cognition before and after treatment with computerized cognitive remediation training (CRT) in chronically-hospitalized individuals with psychosis and predominant negative symptoms. Methods Seventy-eight adult participants with a DSM-IV-TR diagnosis of schizophrenia or schizoaffective disorder were enrolled in a 12-week CRT program. Assessments of demographic and illness variables, baseline and endpoint assessments of psychopathology (Positive and Negative Syndrome Scale) and cognition (MATRICS Consensus Cognitive Battery - MCCB) were conducted. Results The baseline expressive negative subfactor was associated with Processing Speed (r = −0.352, p ≤ 0.001) and Reasoning/Problem Solving (r = −0.338, p ≤ 0.001). Following CRT, there was a significant decrease in the experiential negative subfactor (p < 0.01) but not of the expressive negative subfactor. Change in MCCB domains after CRT accounted for 51.1% and 50.2% of the variance of change in expressive and experiential negative subfactor scores, respectively. For both subfactors, Visual Learning was a significant predictor of change (p < 0.05). Conclusion Our findings suggest that CRT has benefits for negative symptoms in very low-functioning patients and that this change may be in part mediated by change in cognitive functions after CRT.
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Affiliation(s)
- Serge Sevy
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA
| | - Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,NeuroCog Trials, 3211 Shannon Road #300, Durham, NC 27707, USA
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,Teachers College Columbia University, 525 West 120 Street, New York, NY 10027, USA
| | - Owen Jones
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
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Subtle white matter alterations in schizophrenia identified with a new measure of fiber density. Sci Rep 2019; 9:4636. [PMID: 30874571 PMCID: PMC6420505 DOI: 10.1038/s41598-019-40070-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/07/2019] [Indexed: 12/13/2022] Open
Abstract
Altered cerebral connectivity is one of the core pathophysiological mechanism underlying the development and progression of information-processing deficits in schizophrenia. To date, most diffusion tensor imaging (DTI) studies used fractional anisotropy (FA) to investigate disrupted white matter connections. However, a quantitative interpretation of FA changes is often impeded by the inherent limitations of the underlying tensor model. A more fine-grained measure of white matter alterations could be achieved by measuring fiber density (FD) - a novel non-tensor-derived diffusion marker. This study investigates, for the first time, FD alterations in schizophrenia patients. FD and FA maps were derived from diffusion data of 25 healthy controls (HC) and 21 patients with schizophrenia (SZ). Using tract-based spatial statistics (TBSS), group differences in FD and FA were investigated across the entire white matter. Furthermore, we performed a region of interest (ROI) analysis of frontal fasciculi to detect potential correlations between FD and positive symptoms. As a result, whole brain TBSS analysis revealed reduced FD in SZ patients compared to HC in several white matter tracts including the left and right thalamic radiation (TR), superior longitudinal fasciculus (SLF), corpus callosum (CC), and corticospinal tract (CST). In contrast, there were no significant FA differences between groups. Further, FD values in the TR were negatively correlated with the severity of positive symptoms and medication dose in SZ patients. In summary, a novel diffusion-weighted data analysis approach enabled us to identify widespread FD changes in SZ patients with most prominent white matter alterations in the frontal and subcortical regions. Our findings suggest that the new FD measure may be more sensitive to subtle changes in the white matter microstructure compared to FA, particularly in the given population. Therefore, investigating FD may be a promising approach to detect subtle changes in the white matter microstructure of altered connectivity in schizophrenia.
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Schneider K, Michels L, Hartmann-Riemer MN, Burrer A, Tobler PN, Stämpfli P, Kirschner M, Seifritz E, Kaiser S. Cerebral blood flow in striatal regions is associated with apathy in patients with schizophrenia. J Psychiatry Neurosci 2019; 44:102-110. [PMID: 30246686 PMCID: PMC6397041 DOI: 10.1503/jpn.170150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Striatal dysfunction has been proposed as a pathomechanism for negative symptoms in schizophrenia. There is consensus that negative symptoms can be grouped into 2 dimensions: apathy and diminished expression. Recent studies suggest that different neural mechanisms underlie these dimensions, but the relationship between regional resting-state cerebral blood flow (rCBF) and negative symptom dimensions has not been investigated. METHODS This study included 29 patients with schizophrenia and 20 healthy controls. We measured rCBF in the striatum using arterial spin labelling (ASL) MRI. We assessed negative symptoms using the Brief Negative Symptom Scale. RESULTS In the ventral and dorsal striatum, rCBF was not different between patients with schizophrenia and controls. However, we did find a positive association between the severity of apathy and increased rCBF in the ventral and dorsal striatum in patients with schizophrenia. This effect was not present for diminished expression. LIMITATIONS All patients were taking atypical antipsychotics, so an effect of antipsychotic medication on rCBF could not be excluded, although we did not find a significant association between rCBF and chlorpromazine equivalents. CONCLUSION The main finding of this study was a specific association between increased striatal rCBF and the negative symptom dimension of apathy. Our results further support the separate assessment of apathy and diminished expression when investigating the neural basis of negative symptoms. The ASL technique can provide a direct and quantitative approach to investigating the role of rCBF changes in the pathophysiology of negative symptoms.
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Affiliation(s)
- Karoline Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Lars Michels
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Matthias N Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Achim Burrer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Philippe N Tobler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich (Schneider, Hartmann-Riemer, Burrer, Stämpfli, Kirschner, Seifritz); Institute of Neuroradiology, University Hospital Zurich (Michels); Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich (Hartmann-Riemer, Tobler); MR Center of the Psychiatric University Hospital and the Department of Child and Adolescent Psychiatry, University of Zurich (Stämpfli); and the Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals (Kaiser)
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27
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Richter J, Hesse K, Schreiber L, Burmeister CP, Eberle MC, Eckstein KN, Zimmermann L, Wildgruber D, Klingberg S. Evidence for two distinct domains of negative symptoms: Confirming the factorial structure of the CAINS. Psychiatry Res 2019; 271:693-701. [PMID: 30791343 DOI: 10.1016/j.psychres.2018.12.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 01/04/2023]
Abstract
Negative symptoms are an important predictor of course of illness as well as social and occupational functioning. Clinically effective interventions are scarce. For negative symptoms to become a reliable primary endpoint in treatment studies, clear operationalization and construct validation is needed. Recent factor analyses mostly find two main factors for negative symptoms: diminished expression und amotivation/anhedonia. The Clinical Assessment Interview for Negative Symptoms (CAINS) consists of the subscales "motivation and pleasure" and "expression". We assessed three samples of subjects with schizophrenia (n = 105) for different aspects of the scale's reliability and validity. A confirmatory factor analysis (CFA) of the CAINS confirmed its two-factorial structure. The subscales had distinct correlational profiles: "Motivation and pleasure" was strongly associated with functional outcome and depression and further with neurocognition, positive symptoms and social cognition. "Expression" seems independent of sources of secondary negative symptoms and neurocognition. We found good internal consistency and interrater agreement. Test-retest reliability (two-week interval) was moderate for the CAINS and its "expression" subscale and low for the "motivation and pleasure" subscale. Our findings indicate that the CAINS differentiates reliably between the two main domains of negative symptoms with some questions remaining concerning the validity of the "motivation and pleasure" subscale.
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Affiliation(s)
- Janina Richter
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Lisa Schreiber
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Carolin P Burmeister
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Mark-Christian Eberle
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Kathrin N Eckstein
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Lina Zimmermann
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
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Apathy in schizophrenia: A review of neuropsychological and neuroanatomical studies. Neuropsychologia 2018; 118:22-33. [DOI: 10.1016/j.neuropsychologia.2017.09.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/28/2017] [Accepted: 09/26/2017] [Indexed: 01/28/2023]
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Neurocognitive Effects of Agomelatine Treatment in Schizophrenia Patients Suffering From Comorbid Depression: Results From the AGOPSYCH Study. J Clin Psychopharmacol 2018; 38:357-361. [PMID: 29912792 DOI: 10.1097/jcp.0000000000000909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment in schizophrenia is highly disabling and remains one of the major therapeutic challenges. Agomelatine (AGO), an agonist at melatonergic MT1/MT2 receptors and antagonist at 5-HT2C receptors, increases dopamine and norepinephrine in the prefrontal cortex and may therefore have the potential of improving neurocognition in patients with schizophrenia. METHODS Twenty-seven patients with schizophrenia and comorbid depression were treated with AGO in addition to stable doses of antipsychotic drugs. Cognitive abilities were assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) at study entry and after 12 weeks of AGO treatment after the intention-to-treat principle. RESULTS We observed statistically significant yet clinically negligible increases of the MCCB composite score and the reasoning/problem solving subscore. Patients with unimpaired sleep at baseline showed greater improvements over time than those with sleep disturbances. Changes on the MCCB were not correlated with other psychometric variables. CONCLUSIONS Despite statistically significant, cognitive improvements after 12 weeks of AGO treatment were clinically irrelevant. Our findings may be limited by baseline properties of the study sample and the study design. In particular, lacking a control group, it cannot be ruled out that improvements were unrelated to AGO treatment. That is why randomized controlled trials are needed to validate the relevance of AGO as a cognitive enhancer in schizophrenia.
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Craddock KES, Zhou X, Liu S, Gochman P, Dickinson D, Rapoport JL. Symptom dimensions and subgroups in childhood-onset schizophrenia. Schizophr Res 2018; 197:71-77. [PMID: 29146021 PMCID: PMC5949241 DOI: 10.1016/j.schres.2017.10.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/29/2017] [Accepted: 10/29/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study investigated symptom dimensions and subgroups in the National Institute of Mental Health (NIMH) childhood-onset schizophrenia (COS) cohort and their similarities to adult-onset schizophrenia (AOS) literature. METHOD Scores from the Scales for the Assessment of Positive and Negative Symptoms (SAPS & SANS) from 125 COS patients were assessed for fit with previously established symptom dimensions from AOS literature using confirmatory factor analysis (CFA). K-means cluster analysis of each individual's scores on the best fitting set of dimensions was used to form patient clusters, which were then compared using demographic and clinical data. RESULTS CFA showed the SAPS & SANS data was well suited to a 2-dimension solution, including positive and negative dimensions, out of five well established models. Cluster analysis identified three patient groups characterized by different dimension scores: (1) low scores on both dimensions, (2) high negative, low positive scores, and (3) high scores on both dimensions. These groups had different Full scale IQ, Children's Global Assessment Scale (CGAS) scores, ages of onset, and prevalence of some co-morbid behavior disorders (all p<3.57E-03). CONCLUSION Our analysis found distinct symptom-based subgroups within the NIMH COS cohort using an established AOS symptom structure. These findings confirm the heterogeneity of COS and were generally consistent with AOS literature.
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Affiliation(s)
- Kirsten E S Craddock
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
| | - Xueping Zhou
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
| | - Siyuan Liu
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States.
| | - Peter Gochman
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
| | - Dwight Dickinson
- Clinical and Translational Neuroscience Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 3C115, Bethesda, MD 20814, United States
| | - Judith L Rapoport
- Child Psychiatry Branch, Intramural Research Program, National Institute of Mental Health, NIH, 10 Center Drive, Bldg. 10- Rm. 4N244, Bethesda, MD 20814, United States
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31
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Stiekema APM, Islam MA, Liemburg EJ, Castelein S, van den Heuvel ER, van Weeghel J, Aleman A, Bruggeman R, van der Meer L. Long-term course of negative symptom subdomains and relationship with outcome in patients with a psychotic disorder. Schizophr Res 2018. [PMID: 28648915 DOI: 10.1016/j.schres.2017.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The longitudinal course of the negative symptoms subdomains social amotivation (SA) and expressive deficits (ED) remains largely unknown. We investigated i) the longitudinal course of SA and ED subdomain scores, ii) whether subgroups based on the course of SA and ED subdomain scores could be identified, iii) whether baseline SA and ED subdomain scores were related to functioning and quality of life six years later and iv) the longitudinal relationship between subgroups and outcomes. METHODS Measurements at baseline, three and six years from 1067 patients participating in the Genetic Risk and Outcome of Psychosis (GROUP) project were used. We applied mixed models analysis, regression analysis and trajectory analyses. RESULTS SA and ED subdomain scores decreased over time. Within both subdomains, four subgroups were identified: for both SA and ED a steady low course (±60%), increased (±15%) and decreased course (±15%). Within SA only, a higher level decreased course (±6%) and within ED only, a course with relatively stable high ED scores (±6%) was found. Lower symptom levels at baseline were related to better functioning (SA & ED) and quality of life (SA) at six years. Overall, low SA and low ED subgroups showed better outcomes than the other subgroups. CONCLUSION In many patients the course of negative symptoms is unstable and related to the course of outcome. Patients who do show steady low negative symptom levels (60%) may complicate the interpretation of treatment evaluation studies, as they may average out possible effects in subgroups with fluctuating symptom levels.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Md Atiqul Islam
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands; Department of Statistics, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Edith J Liemburg
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Department of Neuroscience, Groningen, University Medical Center Groningen, The Netherlands; Research Department, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Stynke Castelein
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Research Department, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Parnassia Group, Dijk en Duin Mental Health Center, Castricum, The Netherlands; Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - André Aleman
- University of Groningen, Department of Neuroscience, Groningen, University Medical Center Groningen, The Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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Farreny A, Usall J, Cuevas-Esteban J, Ochoa S, Brébion G. Amendment of traditional assessment measures for the negative symptoms of schizophrenia. Eur Psychiatry 2018; 49:50-55. [PMID: 29366848 DOI: 10.1016/j.eurpsy.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 01/24/2023] Open
Abstract
Schizophrenia research based on traditional assessment measures for negative symptoms appears to be, to some extent, unreliable. The limitations of the Positive and Negative Syndrome Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS) have been extensively acknowledged and should be taken into account. The aim of this study is to show how the PANSS and the SANS conflate negative symptoms and cognition and to offer alternatives for the limitations found. METHODS A sample of 117 participants with schizophrenia from two independent studies was retrospectively investigated. Linear regression models were computed to explore the effect of negative symptoms and illness duration as predictors of cognitive performance. RESULTS For the PANSS, the item "abstract thinking" accounted for the association between negative symptoms and cognition. For the SANS, the "attention" subscale predicted the performance in verbal memory, but illness duration emerged as a stronger predictor than negative symptoms for outcomes of processing speed, verbal and working memory. CONCLUSION Utilizing alternative models to the traditional PANSS and SANS formats, and accounting for illness duration, provide more precise evidence on the relationship between negative symptoms and cognition. Since these measures are still extensively utilized, we recommend adopting more rigorous approaches to avoid misleading results.
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Affiliation(s)
- Aida Farreny
- Parc Sanitari Sant Joan de Déu, CIBERSAM(1), Sant Boi de Llobregat, Barcelona, Spain; Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom.
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, CIBERSAM(1), Sant Boi de Llobregat, Barcelona, Spain
| | - Jorge Cuevas-Esteban
- Parc Sanitari Sant Joan de Déu, CIBERSAM(1), Sant Boi de Llobregat, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, CIBERSAM(1), Sant Boi de Llobregat, Barcelona, Spain
| | - Gildas Brébion
- Parc Sanitari Sant Joan de Déu, CIBERSAM(1), Sant Boi de Llobregat, Barcelona, Spain
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Lincoln TM, Riehle M, Pillny M, Helbig-Lang S, Fladung AK, Hartmann-Riemer M, Kaiser S. Using Functional Analysis as a Framework to Guide Individualized Treatment for Negative Symptoms. Front Psychol 2017; 8:2108. [PMID: 29259567 PMCID: PMC5723417 DOI: 10.3389/fpsyg.2017.02108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/17/2017] [Indexed: 12/19/2022] Open
Abstract
Although numerous interventions are available for negative symptoms, outcomes have been unsatisfactory with pharmacological and psychological interventions producing changes of only limited clinical significance. Here, we argue that because negative symptoms occur as a complex syndrome caused and maintained by numerous factors that vary between individuals they are unlikely to be treated effectively by the present "one size fits all" approaches. Instead, a well-founded selection of those interventions relevant to each individual is needed to optimize both the efficiency and the efficacy of existing approaches. The concept of functional analysis (FA) can be used to structure existing knowledge so that it can guide individualized treatment planning. FA is based on stimulus-response learning mechanisms taking into account the characteristics of the organism that contribute to the responses, their consequences and the contingency with which consequences are tied to the response. FA can thus be flexibly applied to the level of individual patients to understand the factors causing and maintaining negative symptoms and derive suitable interventions. In this article we will briefly introduce the concept of FA and demonstrate-exemplarily-how known psychological and biological correlates of negative symptoms can be incorporated into its framework. We then outline the framework's implications for individual assessment and treatment. Following the logic of FA, we argue that a detailed assessment is needed to identify the key factors causing or maintaining negative symptoms for each individual patient. Interventions can then be selected according to their likelihood of changing these key factors and need to take interactions between different factors into account. Supplementary case vignettes exemplify the usefulness of functional analysis for individual treatment planning. Finally, we discuss and point to avenues for future research guided by this model.
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Affiliation(s)
- Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Marcel Riehle
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Sylvia Helbig-Lang
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Anne-Katharina Fladung
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Sciences, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Matthias Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospital, Geneva, Switzerland
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Deserno L, Heinz A, Schlagenhauf F. Computational approaches to schizophrenia: A perspective on negative symptoms. Schizophr Res 2017; 186:46-54. [PMID: 27986430 DOI: 10.1016/j.schres.2016.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 09/22/2016] [Accepted: 10/01/2016] [Indexed: 12/30/2022]
Abstract
Schizophrenia is a heterogeneous spectrum disorder often associated with detrimental negative symptoms. In recent years, computational approaches to psychiatry have attracted growing attention. Negative symptoms have shown some overlap with general cognitive impairments and were also linked to impaired motivational processing in brain circuits implementing reward prediction. In this review, we outline how computational approaches may help to provide a better understanding of negative symptoms in terms of the potentially underlying behavioural and biological mechanisms. First, we describe the idea that negative symptoms could arise from a failure to represent reward expectations to enable flexible behavioural adaptation. It has been proposed that these impairments arise from a failure to use prediction errors to update expectations. Important previous studies focused on processing of so-called model-free prediction errors where learning is determined by past rewards only. However, learning and decision-making arise from multiple cognitive mechanisms functioning simultaneously, and dissecting them via well-designed tasks in conjunction with computational modelling is a promising avenue. Second, we move on to a proof-of-concept example on how generative models of functional imaging data from a cognitive task enable the identification of subgroups of patients mapping on different levels of negative symptoms. Combining the latter approach with behavioural studies regarding learning and decision-making may allow the identification of key behavioural and biological parameters distinctive for different dimensions of negative symptoms versus a general cognitive impairment. We conclude with an outlook on how this computational framework could, at some point, enrich future clinical studies.
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Affiliation(s)
- Lorenz Deserno
- Max Planck Fellow Group 'Cognitive and Affective Control of Behavioral Adaptation', Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany.
| | - Andreas Heinz
- Max Planck Fellow Group 'Cognitive and Affective Control of Behavioral Adaptation', Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Schlagenhauf
- Max Planck Fellow Group 'Cognitive and Affective Control of Behavioral Adaptation', Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Kaiser S, Lyne J, Agartz I, Clarke M, Mørch-Johnsen L, Faerden A. Individual negative symptoms and domains - Relevance for assessment, pathomechanisms and treatment. Schizophr Res 2017; 186:39-45. [PMID: 27453425 DOI: 10.1016/j.schres.2016.07.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Abstract
The negative symptoms of schizophrenia can be divided into two domains. Avolition/apathy includes the individual symptoms of avolition, asociality and anhedonia. Diminished expression includes blunted affect and alogia. Until now, causes and treatment of negative symptoms have remained a major challenge, which is partially related to the focus on negative symptoms as a broad entity. Here, we propose that negative symptoms may become more tractable when the different domains and individual symptoms are taken into account. There is now increasing evidence that the relationship with clinical variables - in particular outcome - differs between the domains of avolition/apathy and diminished expression. Regarding models of negative symptom formation, those relevant to avolition/apathy are now converging on processes underlying goal-directed behavior and dysfunctions of the reward system. In contrast, models of the diminished expression domains are only beginning to emerge. The aim of this article is to review the specific clinical, behavioral and neural correlates of individual symptoms and domains as a better understanding of these areas may facilitate specific treatment approaches.
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Affiliation(s)
- Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - John Lyne
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland; North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team (DETECT) Services, Dublin, Ireland
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Services, Dublin, Ireland; College of Life Sciences, University College Dublin, Dublin, Ireland
| | - Lynn Mørch-Johnsen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Ann Faerden
- NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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38
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Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. WORLD PSYCHIATRY : OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA) 2017. [PMID: 28127915 DOI: 10.1002/wps.20385.] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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39
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Katthagen T, Dammering F, Kathmann N, Kaminski J, Walter H, Heinz A, Schlagenhauf F. Validating the construct of aberrant salience in schizophrenia - Behavioral evidence for an automatic process. SCHIZOPHRENIA RESEARCH-COGNITION 2016; 6:22-27. [PMID: 28740821 PMCID: PMC5514317 DOI: 10.1016/j.scog.2016.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 01/05/2023]
Abstract
Suspecting significance behind ordinary events is a common feature in psychosis and it is assumed to occur due to aberrant salience attribution. The Salience Attribution Test (SAT; Roiser et al., 2009) measures aberrant salience as a bias towards one out of two equally reinforced cue features as opposed to adaptive salience towards features indicating high reinforcement. This is the first study to validate the latent constructs involved in salience attribution in patients. Forty-nine schizophrenia patients and forty-four healthy individuals completed the SAT, a novel implicit salience paradigm (ISP), a reversal learning task and a neuropsychological test battery. First, groups were compared on raw measures. Second and within patients, these were correlated and then used for a principal component analysis (PCA). Third, sum scores matching the correlation and component pattern were correlated with psychopathology. Compared to healthy individuals, patients exhibited more implicit aberrant salience in the SAT and ISP and less implicit and explicit adaptive salience attribution in the SAT. Implicit aberrant salience from the SAT and ISP positively correlated with each other and negatively with reversal learning. Whereas explicit aberrant salience was associated with cognition, implicit and explicit adaptive salience were positively correlated. A similar pattern emerged in the PCA and implicit aberrant salience was associated with negative symptoms. Taken together, implicit aberrant salience from the SAT and ISP seems to reflect an automatic process that is independent from deficient salience ascription to relevant events. Its positive correlation with negative symptoms might reflect motivational deficits present in chronic schizophrenia patients.
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Affiliation(s)
- Teresa Katthagen
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany.,Berlin School of Mind and Brain, Berlin, Germany
| | - Felix Dammering
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Norbert Kathmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jakob Kaminski
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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40
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Lim J, Lee SA, Lam M, Rapisarda A, Kraus M, Keefe RSE, Lee J. The relationship between negative symptom subdomains and cognition. Psychol Med 2016; 46:2169-2177. [PMID: 27087476 DOI: 10.1017/s0033291716000726] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Negative symptoms and cognitive deficits in schizophrenia are partially overlapping. However, the nature of the relationship between negative symptoms and cognition remains equivocal. Recent reviews have demonstrated the presence of two negative symptom subdomains, diminished emotional expression (DEE) and avolition. In view of this, we sought to clarify the relationship between negative symptoms and cognitive domains. METHOD A total of 687 participants with schizophrenia were assessed on measures of psychopathology and cognition. Three cognitive factors, namely executive function, fluency/memory and speed/vigilance were computed from the cognitive tests. Confirmatory factor analysis was utilized to examine if a one-factor or two-factor negative model was applicable to our sample. Subsequently, the relationships between negative symptoms and cognition were examined using structural equation modeling. RESULTS Results demonstrated that the two-factor model fitted the data well. While negative symptoms were mildly to moderately associated with cognition, we found that DEE had unique associations with cognition compared to social avolition, contributing to the validity of the constructs and suggesting the possibility of common underlying substrates in negative symptoms and cognition. CONCLUSIONS Our study highlighted the need to classify DEE and social avolition separately as both are necessary in refining the complex relationship between negative symptoms and cognition as well as potentially guiding treatment and management of schizophrenia.
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Affiliation(s)
- J Lim
- Research Division,Institute of Mental Health,Singapore
| | - S-A Lee
- Research Division,Institute of Mental Health,Singapore
| | - M Lam
- Research Division,Institute of Mental Health,Singapore
| | - A Rapisarda
- Research Division,Institute of Mental Health,Singapore
| | - M Kraus
- Department of Psychiatry & Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - R S E Keefe
- Department of Psychiatry & Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - J Lee
- Research Division,Institute of Mental Health,Singapore
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