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Wehr S, Weigel L, Davis J, Galderisi S, Mucci A, Leucht S. Clinical Assessment Interview for Negative Symptoms (CAINS): A Systematic Review of Measurement Properties. Schizophr Bull 2024; 50:747-756. [PMID: 37951838 PMCID: PMC11283189 DOI: 10.1093/schbul/sbad137] [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] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Negative symptoms are very important for the overall loss of functioning observed in patients with schizophrenia. There is a need for valid tools to assess these symptoms. STUDY DESIGN We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review guideline to evaluate the quality of the clinical assessment interview for negative symptoms (CAINS) as a clinician-rated outcome measurement (ClinROM). STUDY RESULTS The search strategy resulted in the retrieval of 13 articles, 11 of which were included in this evaluation. In terms of risk of bias, most articles reported on measures of internal consistency and construct validity, which were overall of good quality. Structural validity, reliability, measurement error, and cross-cultural validity were reported with less than optimum quality. There was a risk of bias in ClinROM development. According to the updated criteria of good measurement properties, structural validity, internal consistency, and reliability showed good results. In contrast, hypothesis testing was somewhat poorer. Results for cross-cultural validity were indeterminate. According to the updated GRADE approach from the COSMIN group the scale received a moderate grade. CONCLUSIONS The COSMIN standard allows a judgment of the CAINS as an instrument with the potential to be recommended for use, but which requires further research to assess its quality, in particular in the domains of content validity, internal consistency, and cross-cultural validity.
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Affiliation(s)
- Sophia Wehr
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lucia Weigel
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL
- Maryland Psychiatric Research Center, Baltimore, MD
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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2
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Chen P, Yang HD, Wang JJ, Zhu ZH, Zhao HM, Yin XY, Cai Y, Zhu HL, Fu JL, Zhang XZ, Sun WX, Hui L, Zhang XB. Association of serum interleukin-6 with negative symptoms in stable early-onset schizophrenia. World J Psychiatry 2024; 14:794-803. [PMID: 38984340 PMCID: PMC11230098 DOI: 10.5498/wjp.v14.i6.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/28/2024] [Accepted: 05/17/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Accumulating evidence suggests that the inflammatory cytokine interleukin-6 (IL-6) contributes to the pathophysiology of psychiatric disorders. However, there was no study concerning the relationship between IL-6 concentrations and clinical features in the chronic phase of early-onset schizophrenia (EOS). AIM To investigate the relationship between serum IL-6 concentration and the clinical features of EOS. METHODS We measured serum IL-6 Levels from 74 patients with chronic schizophrenia, including 33 with age at onset < 21 years (EOS group) and 41 with onset ≥ 21 years in [adult-onset schizophrenia (AOS) group], and from 41 healthy controls. Symptom severities were evaluated using the Positive and Negative Syndrome Scale (PANSS). RESULTS Serum IL-6 concentrations were higher in both EOS and AOS groups than healthy controls (F = 22.32, P < 0.01), but did not differ significantly between EOS and AOS groups (P > 0.05) after controlling for age, body mass index, and other covariates. Negative symptom scores were higher in the EOS group than the AOS group (F = 6.199, P = 0.015). Serum IL-6 concentrations in the EOS group were negatively correlated with both total PANSS-negative symptom score (r = -0.389, P = 0.032) and avolition/asociality subscore (r = -0.387, P = 0.026). CONCLUSION Patients with EOS may have more severe negative symptoms than those with adult-onset schizophrenia during the chronic phase of the illness. IL-6 signaling may regulate negative symptoms and its avolition/asociality subsymptoms among the early-onset chronic schizophrenic patients.
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Affiliation(s)
- Peng Chen
- Suzhou Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hai-Dong Yang
- Department of Psychiatry, The Fourth People’s Hospital of Lianyungang, The Affiliated Kangda College of Nanjing Medical University, Lianyungang 222003, Jiangsu Province, China
| | - Jun-Jie Wang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Zhen-Hua Zhu
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hui-Min Zhao
- Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
| | - Xu-Yuan Yin
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Yuan Cai
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Hong-Liang Zhu
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Jia-Lin Fu
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Xin-Zhu Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Wen-Xi Sun
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Li Hui
- Research Center of Biological Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
| | - Xiao-Bin Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
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3
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El-Ashry AM, Abd Elhay ES, Taha SM, Khedr MA, Attalla Mansour FS, Alabdullah AAS, Farghaly Abdelaliem SM, El-Sayed MM. Effect of applying nursing-based cognitive defusion techniques on mindful awareness, cognitive fusion, and believability of delusions among clients with schizophrenia: a randomized control trial. Front Psychiatry 2024; 15:1369160. [PMID: 38736628 PMCID: PMC11082577 DOI: 10.3389/fpsyt.2024.1369160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
Background Applying cognitive defusion techniques to enduring psychotic symptoms, such as delusions, presents both a challenge and a promising opportunity for psychiatric nurses to manage delusions among schizophrenia clients. Objective This study aimed to examine the impact of cognitive defusion techniques on psychological flexibility, mindful awareness, cognitive fusion, and the believability of delusions in schizophrenia clients. Methodology This study used a single-blind, parallel-arm Randomized Controlled Trial design. Over five weeks, 70 clients with schizophrenia were randomized to either the cognitive defusion intervention group (n = 35) or the control group (n = 35). Findings The participants showed significant reductions in the believability of delusions, cognitive fusion, and psychological inflexibility immediately after the intervention and at follow-up. Notable enhancements were observed in cognitive defusion and mindfulness awareness abilities. Conclusion Cognitive defusion techniques positively affect schizophrenia clients who struggle with persistent delusional beliefs. This underscores the importance of further investigating this approach to decrease the intensity of delusions as part of a comprehensive therapeutic intervention. Psychiatric nurses must receive training in "cognitive defusion skills" to aid schizophrenia clients in becoming more aware of their emotions and modifying their coping strategies for delusional beliefs. On August 3, 2023, the research was retrospectively registered under the reference number NCT05759091 as a randomized clinical trial. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT05759091, identifier NCT05759091.
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Affiliation(s)
- Ayman Mohamed El-Ashry
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | | | | | - Mahmoud Abdelwahab Khedr
- Department of Nursing, College of Applied Medical Sciences, Hafr Albatin University, Hafr Albatin, Saudi Arabia
| | | | - Amany Anwar Saeed Alabdullah
- Department of Maternity and Child Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Mona Metwally El-Sayed
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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4
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Lyngstad SH, Lyne JP, Ihler HM, van der Meer L, Færden A, Melle I. Turning the Spotlight on Apathy: Identification and Treatment in Schizophrenia Spectrum Disorders. Schizophr Bull 2023; 49:1099-1104. [PMID: 37193675 PMCID: PMC10483442 DOI: 10.1093/schbul/sbad070] [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] [Indexed: 05/18/2023]
Abstract
Among negative symptoms, apathy is central to the impairments in real-life functioning in schizophrenia spectrum disorders (SSD). Thus, optimizing treatment for apathy appears key to improve outcomes. In treatment research, however, negative symptoms are typically studied as a unifactorial construct. We, therefore, aim to shed necessary light on the status of apathy identification and treatment in SSD.
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Affiliation(s)
- Siv Hege Lyngstad
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - John Paul Lyne
- Department of Psychiatry, Royal College of Surgeons in Ireland, Newcastle Hospital, Wicklow, Ireland
| | - Henrik Myhre Ihler
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Ann Færden
- Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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5
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Raugh IM, Luther L, Bartolomeo LA, Gupta T, Ristanovic I, Pelletier-Baldelli A, Mittal VA, Walker EF, Strauss GP. Negative Symptom Inventory-Self-Report (NSI-SR): Initial development and validation. Schizophr Res 2023; 256:79-87. [PMID: 37172500 PMCID: PMC10262695 DOI: 10.1016/j.schres.2023.04.015] [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: 10/03/2022] [Revised: 02/13/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Negative symptoms (i.e., anhedonia, avolition, asociality, blunted affect, alogia) are frequently observed in the schizophrenia-spectrum (SZ) and associated with functional disability. While semi-structured interviews of negative symptoms represent a gold-standard approach, they require specialized training and may be vulnerable to rater biases. Thus, brief self-report questionnaires measuring negative symptoms may be useful. Existing negative symptom questionnaires demonstrate that this approach may be promising in schizophrenia, but no measure has been devised for use across stages of psychotic illness. The present study reports initial psychometric validation of the Negative Symptom Inventory-Self-Report (NSI-SR), the self-report counterpart of the Negative Symptom Inventory-Psychosis Risk clinical interview. The NSI-SR is a novel transphasic negative symptoms measure assessing the domains of anhedonia, avolition, and asociality. The NSI-SR and related measures were administered to two samples: 1) undergraduates (n = 335), 2) community participants, including: SZ (n = 32), clinical-high risk for psychosis (CHR, n = 25), and healthy controls matched to SZ (n = 31) and CHR (n = 30). The psychometrically trimmed 11-item NSI-SR showed good internal consistency and a three-factor solution reflecting avolition, asociality, and anhedonia. The NSI-SR demonstrated convergent validity via moderate to large correlations with clinician-rated negative symptoms and related constructs in both samples. Discriminant validity was supported by lower correlations with positive symptoms in both samples; however, correlations with positive symptoms were still significant. These initial psychometric findings suggest that the NSI-SR is a reliable and valid brief questionnaire capable of measuring negative symptoms across phases of psychotic illness.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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6
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Wang LL, Tam MHW, Ho KKY, Hung KSY, Wong JOY, Lui SSY, Chan RCK. Bridge centrality network structure of negative symptoms in people with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2023; 273:589-600. [PMID: 35972557 DOI: 10.1007/s00406-022-01474-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
Negative symptoms are complex psychopathology. Although evidence generally supported the NIMH five consensus domains, research seldom examined measurement invariance of this model, and domain-specific correspondence across multiple scales. This study aimed to examine the interrelationship between negative symptom domains captured by different rating scales, and to examine the domain-specific correspondence across multiple scales. We administered the Brief Negative Symptom Scale (BNSS), the Self-evaluation of Negative Symptoms (SNS), and the Scale for Assessment of Negative Symptoms (SANS) to 204 individuals with schizophrenia. We used network analysis to examine the interrelationship between negative symptom domains. Besides regularized partial correlation network, we estimated bridge centrality indices to investigate domain-specific correspondence, while taking each scale as an independent community. The regularized partial correlation network showed that the SNS nodes clustered together, whereas the SANS and the BNSS nodes intermingled together. The SANS attention domain lied at the periphery of the network according to the Fruchterman-Reingold algorithm. The SANS anhedonia-asociality (strength = 1.48; EI = 1.48) and the SANS affective flattening (strength = 1.06; EI = 1.06) had the highest node strength and EI. Moreover, the five nodes of the BNSS bridged the nodes of the SANS and the SNS. BNSS blunted affect (strength = 0.76; EI = 0.76) and SANS anhedonia-asociality (strength = 0.76; EI = 0.74) showed the highest bridge strength and bridge EI. The BNSS captures negative symptoms and bridges the symptom domains measured by the SANS and the SNS. The three scales showed domain-specific correspondence.
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Affiliation(s)
- Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Michelle H W Tam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Karen K Y Ho
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Jessica O Y Wong
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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7
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Fleming LM, Lemonde AC, Benrimoh D, Gold JM, Taylor JR, Malla A, Joober R, Iyer SN, Lepage M, Shah J, Corlett PR. Using dimensionality-reduction techniques to understand the organization of psychotic symptoms in persistent psychotic illness and first episode psychosis. Sci Rep 2023; 13:4841. [PMID: 36964175 PMCID: PMC10039017 DOI: 10.1038/s41598-023-31909-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/17/2023] [Indexed: 03/26/2023] Open
Abstract
Psychotic disorders are highly heterogeneous. Understanding relationships between symptoms will be relevant to their underlying pathophysiology. We apply dimensionality-reduction methods across two unique samples to characterize the patterns of symptom organization. We analyzed publicly-available data from 153 participants diagnosed with schizophrenia or schizoaffective disorder (fBIRN Data Repository and the Consortium for Neuropsychiatric Phenomics), as well as 636 first-episode psychosis (FEP) participants from the Prevention and Early Intervention Program for Psychosis (PEPP-Montreal). In all participants, the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were collected. Multidimensional scaling (MDS) combined with cluster analysis was applied to SAPS and SANS scores across these two groups of participants. MDS revealed relationships between items of SAPS and SANS. Our application of cluster analysis to these results identified: 1 cluster of disorganization symptoms, 2 clusters of hallucinations/delusions, and 2 SANS clusters (asocial and apathy, speech and affect). Those reality distortion items which were furthest from auditory hallucinations had very weak to no relationship with hallucination severity. Despite being at an earlier stage of illness, symptoms in FEP presentations were similarly organized. While hallucinations and delusions commonly co-occur, we found that their specific themes and content sometimes travel together and sometimes do not. This has important implications, not only for treatment, but also for research-particularly efforts to understand the neurocomputational and pathophysiological mechanism underlying delusions and hallucinations.
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Affiliation(s)
- Leah M Fleming
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Interdepartmental Neuroscience Department, Yale University, New Haven, CT, USA
| | | | - David Benrimoh
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jane R Taylor
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Ashok Malla
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Philip R Corlett
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Psychology, Yale University, New Haven, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
- Connecticut Mental Health Center, 34 Park St, New Haven, CT, 06519, USA.
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8
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Primary and secondary negative symptoms severity and the use of psychiatric care resources in schizophrenia spectrum disorders: A 3-year follow-up longitudinal retrospective study. Schizophr Res 2022; 250:31-38. [PMID: 36252294 DOI: 10.1016/j.schres.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/18/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Negative symptoms represent one of the core features of schizophrenia spectrum disorders (SSD), strongly correlated with low remission rates, poor real-world functioning, and worse quality of life. Despite the body of evidence attesting the role of negative symptoms in determining worse outcomes in SSD, few studies have directly investigated their impact on the use of psychiatric services and even fewer research have examined the differential impact between primary versus secondary negative symptoms. The present study aims to investigate whether SSD subjects with high levels of primary and of secondary negative symptoms at an index hospitalization show a different use of psychiatric services in the subsequent 3 years. A total of 429 subjects were included in the study. Results show that SSD patients with high levels of negative symptoms are characterized by an overall greater use of high-cost resources, with more admissions in the hospital acute care psychiatric ward and in high intensity residential inpatient services. Moreover, while primary negative symptoms appear to play a role in determining a greater use of psychiatric services, high levels of secondary negative symptoms are associated with an increased use of most psychiatric resources, especially of high-cost ones. In conclusion, negative symptoms have a relevant impact on the pattern of psychiatric resources utilization in SSD patients. While scientific research continues to look for effective treatments for primary negative symptoms, clinicians should pay particular attention to secondary negative symptoms, as these also have important consequences but may benefit from appropriate treatment.
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9
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Shao T, Wang W, Hei G, Yang Y, Long Y, Wang X, Xiao J, Huang Y, Song X, Xu X, Gao S, Huang J, Wang Y, Zhao J, Wu R. Identifying and revealing different brain neural activities of cognitive subtypes in early course schizophrenia. Front Mol Neurosci 2022; 15:983995. [PMID: 36267704 PMCID: PMC9577612 DOI: 10.3389/fnmol.2022.983995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/07/2022] [Indexed: 01/10/2023] Open
Abstract
Background Cognitive subtypes of schizophrenia may exhibit different neurobiological characteristics. This study aimed to reveal the underlying neurobiological features between cognitive subtypes in the early course of schizophrenia (ECS). According to prior studies, we hypothesized to identify 2–4 distinct cognitive subtypes. We further hypothesized that the subtype with relatively poorer cognitive function might have lower brain spontaneous neural activity than the subtype with relatively better cognitive function. Method Cognitive function was assessed by the MATRICS Consensus Cognitive Battery (MCCB). Resting-state functional magnetic resonance imaging scanning was conducted for each individual. There were 155 ECS individuals and 97 healthy controls (HCs) included in the subsequent analysis. Latent profile analysis (LPA) was used to identify the cognitive subtypes in ECS individuals, and amplitude of low-frequency fluctuations (ALFFs) was used to measure brain spontaneous neural activity in ECS individuals and HCs. Results LPA identified two cognitive subtypes in ECS individuals, containing a severely impaired subtype (SI, n = 63) and a moderately impaired subtype (MI, n = 92). Compared to HCs, ECS individuals exhibited significantly increased ALFF in the left caudate and bilateral thalamus and decreased ALFF in the bilateral medial prefrontal cortex and bilateral posterior cingulate cortex/precuneus (PCC/PCu). In ECS cognitive subtypes, SI showed significantly higher ALFF in the left precentral gyrus (PreCG) and lower ALFF in the left PCC/PCu than MI. Furthermore, ALFFs of left PreCG were negatively correlated with several MCCB cognitive domains in ECS individuals, while ALFF of left PCC/PCu presented opposite correlations. Conclusion Our findings suggest that differences in the brain spontaneous neural activity of PreCG and PCC/PCu might be the potential neurobiological features of the cognitive subtypes in ECS, which may deepen our understanding of the role of PreCG and PCC/PCu in the pathogenesis of cognitive impairment in schizophrenia.
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Affiliation(s)
- Tiannan Shao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Weiyan Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Gangrui Hei
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ye Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yujun Long
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoyi Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingmei Xiao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuyan Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xijia Xu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Shuzhan Gao
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Renrong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Renrong Wu
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10
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Martinez Agulleiro L, de Filippis R, Rosson S, Patil B, Prizgint L, Talasazan N, Meltzer HY, Kane JM, Gibbons RD, Guinart D. Awareness of illness moderates self-assessment of psychotic symptoms. Aust N Z J Psychiatry 2022; 56:1287-1294. [PMID: 34784772 DOI: 10.1177/00048674211057480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis). METHODS A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders. RESULTS A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings (r = 0.517, 95% confidence interval = [0.392, 0.622], p < 0.001). Insight was found to moderate this correlation (β = -0.511, p = 0.005), yet agreement between both measures remained statistically significant for both high (r = 0.621, 95% confidence interval = [0.476, 0.733], p < 0.001) and low insight patients (r = 0.408, 95% confidence interval = [0.187, 0.589], p < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: U = 3057, z = -0.129, p = 0.897; disorganization: U = 2986.5, z = -0.274, p = 0.784 and for CAT-Psychosis: U = 2800.5, z = -1.022, p = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results. CONCLUSIONS Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.
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Affiliation(s)
- Luis Martinez Agulleiro
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Psychiatry Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Renato de Filippis
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stella Rosson
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Psychiatric Unit, Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy.,Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padua, Italy
| | - Bhagyashree Patil
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Lara Prizgint
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Nahal Talasazan
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | | | - John M Kane
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Institute for Behavioral Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Manhasset, NY, USA
| | - Robert D Gibbons
- Center for Health Statistics and Departments of Medicine, Public Health Sciences (Biostatistics), Psychiatry, Comparative Human Development, and the Committee on Quantitative Methods, University of Chicago, Chicago, IL, USA
| | - Daniel Guinart
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Institute for Behavioral Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Manhasset, NY, USA.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
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11
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Tran T, Spilka MJ, Ruiz I, Strauss GP. Implicit cognitive effort monitoring impairments are associated with expressive negative symptoms in schizophrenia. Schizophr Res 2022; 248:14-20. [PMID: 35907347 DOI: 10.1016/j.schres.2022.07.006] [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: 06/07/2021] [Revised: 03/03/2022] [Accepted: 07/10/2022] [Indexed: 10/16/2022]
Abstract
Negative symptoms are a strong predictor of functional impairment in schizophrenia (SZ). Unfortunately, mechanisms underlying negative symptoms are poorly understood and available treatments are minimally effective. The current study evaluated the novel hypothesis that negative symptoms are associated with an implicit cognitive effort monitoring impairment that manifests during tasks requiring sustained allocation of cognitive control. Outpatients with SZ (n = 33) and healthy controls (CN; n = 29) completed an adapted Demand Selection Task (DST) in which subjects made choices between pairs of cognitive tasks that were implicitly and then explicitly made discrepant in effort demands. The SZ group demonstrated a reduced probability of avoiding the high effort cognitive task in the implicit choice condition but were able to become effort avoidant when the demands of the task were made explicit. Implicit cognitive effort monitoring deficits were associated with greater severity of the expressivity dimension of negative symptoms, but not the motivation and pleasure dimension. The association between diminished expressivity and implicit cognitive effort monitoring deficits is interpreted in light of a novel cognitive resource depletion theory, whereby individuals with SZ may become less expressive due to difficulty implicitly monitoring ongoing cognitive effort exertion and dynamically adjusting effort expenditure as task demands fluctuate.
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Affiliation(s)
- Tanya Tran
- Department of Psychology, Queen's University, 62 Arch St., K7L 3L3 Kingston, ON, Canada
| | - Michael J Spilka
- Department of Psychology, University of Georgia, 125 Baldwin St., 30602 Athens, GA, USA
| | - Ivan Ruiz
- Department of Psychology, University of Georgia, 125 Baldwin St., 30602 Athens, GA, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St., 30602 Athens, GA, USA.
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12
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Polat I, Ince Guliyev E, Elmas S, Karakaş S, Aydemir Ö, Üçok A. Validation of the Turkish version of the self-evaluation of negative symptoms scale (SNS). Int J Psychiatry Clin Pract 2022; 26:221-227. [PMID: 35700173 DOI: 10.1080/13651501.2022.2082985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The Self-Evaluation of Negative Symptoms Scale (SNS) is a self-report scale that evaluates a patient's subjective experience on all five domains of the negative symptoms. This study aimed to present the adaptation and validation study of the Turkish version of SNS(SNS-TR). METHODS Seventy-five patients and 50 controls were recruited for this study. After the approval of the translation, participants were asked to fill out SNS-TR by themselves. They were interviewed with the Brief Negative Symptoms Scale (BNSS), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS). RESULTS SNS-TR showed good internal consistency in the reliability analysis with Cronbach's alpha= 0.873. Subscale-total score correlation coefficients were significant (p < 0.01). In the validity analyses, the total and subscale scores of SNS-TR showed positive correlations with the total and subscales of BNSS, with only one exception of BNSS lack of distress subscales. The total score of SNS-TR demonstrated a significant correlation with PANSS-total, PANSS-negative subscale, PANSS-general subscale, and CDSS scores. Confirmatory factor analysis showed acceptable values for the five-factor structure, similar to the original version. CONCLUSION To conclude, our study indicates that SNS-TR is an easily applicable self-evaluation tool with good psychometric properties for assessing negative symptoms. KEY POINTSSNS is a novel and easily applicable self-report scale for examining negative symptoms in schizophrenia patients, allowing them to evaluate their subjective experience on all five domains of the negative symptoms.It shows good internal consistency (α= 0.873) which is similar to the original version (α = 0.867).Confirmatory factor analysis scores were found in acceptable ranges and SNS-TR confirm the five-factor structure.Using this scale in clinical practice would empower both the physician's examinations and patient participation through treatment and follow-up course.
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Affiliation(s)
- Irmak Polat
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ezgi Ince Guliyev
- Department of Psychiatry, Erenkoy Training and Research Hospital for Mental and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Sibel Elmas
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sufiya Karakaş
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ömer Aydemir
- Department of Psychiatry, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Alp Üçok
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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13
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Maurus I, Röll L, Keeser D, Karali T, Papazov B, Hasan A, Schmitt A, Papazova I, Lembeck M, Hirjak D, Thieme CE, Sykorova E, Münz S, Seitz V, Greska D, Campana M, Wagner E, Löhrs L, Pömsl J, Roeh A, Malchow B, Keller-Varady K, Ertl-Wagner B, Stöcklein S, Meyer-Lindenberg A, Falkai P. Associations between aerobic fitness, negative symptoms, cognitive deficits and brain structure in schizophrenia-a cross-sectional study. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:63. [PMID: 35918344 PMCID: PMC9345912 DOI: 10.1038/s41537-022-00269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022]
Abstract
Negative symptoms and cognitive deficits are common in individuals with schizophrenia, greatly affect their outcome, and have been associated with alterations in cerebral gray and white matter volume (GMV, WMV). In the last decade, aerobic endurance training has emerged as a promising intervention to alleviate these symptoms and improved aerobic fitness has been suggested as a key moderator variable. In the present study, we investigated, whether aerobic fitness is associated with fewer cognitive deficits and negative symptoms and with GMVs and WMVs in individuals with schizophrenia in a cross-sectional design. In the largest study to date on the implications of fitness in individuals with schizophrenia, 111 participants at two centers underwent assessments of negative symptoms, cognitive functioning, and aerobic fitness and 69 underwent additional structural magnetic resonance imaging. Multilevel Bayesian partial correlations were computed to quantify relationships between the variables of interest. The main finding was a positive association of aerobic fitness with right hippocampal GMV and WMVs in parahippocampal and several cerebellar regions. We found limited evidence for an association of aerobic fitness with cognitive functioning and negative symptoms. In summary, our results strengthen the notion that aerobic fitness and hippocampal plasticity are interrelated which holds implications for the design of exercise interventions in individuals with schizophrenia.
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Affiliation(s)
- Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Lukas Röll
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Temmuz Karali
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Papazov
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Irina Papazova
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Dusan Hirjak
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Cristina E Thieme
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Eliska Sykorova
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Susanne Münz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Valentina Seitz
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - David Greska
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Mattia Campana
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Johannes Pömsl
- Department of Psychiatry and Psychotherapy, Medical Faculty, Technical University of Munich, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - Astrid Roeh
- Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Göttingen, Göttingen, Germany
| | | | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Sophia Stöcklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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14
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Kagan S, Cogo-Moreira H, Barbosa MG, Cavalcante D, Shinji A, Noto M, Haguiara B, Cordeiro Q, Belangeiro S, Bressan RA, Noto C, Gadelha A. Longitudinal invariance of the positive and negative syndrome scale negative dimension in antipsychotic naïve first-episode schizophrenia. Early Interv Psychiatry 2022; 16:581-586. [PMID: 34265870 DOI: 10.1111/eip.13200] [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: 08/24/2020] [Revised: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
AIM Construct stability over time is required for reliable inference, but evidence regarding the longitudinal invariance of negative symptoms is still limited. Thus, we examined the longitudinal invariance of the negative dimension using the positive and negative syndrome scale (PANSS) in an antipsychotic-naïve first-episode schizophrenia sample at baseline and after 10 weeks. METHODS Our study was conducted at a specialized early intervention service. PANSS ratings were analysed for 138 patients, and two different models were specified and tested: a unidimensional and a two-correlated factor solution. RESULTS The unidimensional model fulfilled criteria for longitudinal invariance, whilst the two-correlated did not. CONCLUSION Our study provides support for the PANSS negative unidimensional model use to evaluate negative symptoms' longitudinal change following first-episode schizophrenia.
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Affiliation(s)
- Simão Kagan
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Hugo Cogo-Moreira
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Matheus Ghossain Barbosa
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Daniel Cavalcante
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - André Shinji
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Mariane Noto
- Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Bernardo Haguiara
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Quirino Cordeiro
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Sintia Belangeiro
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Department of Morphology and Genetics, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Rodrigo A Bressan
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Center for Research and Innovation in Prevention of Mental Disorders and Drug Use (CEPIPREV), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Cristiano Noto
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Center for Research and Innovation in Prevention of Mental Disorders and Drug Use (CEPIPREV), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Ary Gadelha
- Laboratory of Integrative Neurosciences (LiNC), Department of Psychiatry, Federal University of Sao Paulo (EPM/UNIFESP), Sao Paulo, Brazil.,Schizophrenia Program (PROESQ), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Early Psychosis Group (GAPI), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.,Center for Research and Innovation in Prevention of Mental Disorders and Drug Use (CEPIPREV), Department of Psychiatry, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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15
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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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16
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Mavituna S, Hahn E, Hahne I, Bergmann N, Pijnenborg M, Ta TMT, Tafelski L, Böge K. Compassion-based approaches: a systematic review of their effectiveness and acceptability in schizophrenia spectrum disorders. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractThe purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.
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17
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Psychometric properties of the BIRT Motivation Questionnaire (BMQ), a self-measure of avolition in individuals with schizophrenia. J Psychiatr Res 2022; 147:274-282. [PMID: 35074744 DOI: 10.1016/j.jpsychires.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 11/21/2022]
Abstract
AIMS Avolition defined as a lack of interest or engagement in goal-directed behavior plays a key role in everyday functioning in schizophrenia and is considered as one of the main contributors to the burden of disease. The aim of this study was to 1) validate the self-report BIRT Motivation Questionnaire (BMQ-S) seldom used before in schizophrenia 2) examine the degree of agreement between the BMQ-S and its informant-report version 3) to assess its ability to predict real-world outcome at 12 month follow-up. METHODS One hundred and twenty-two (51.9% inpatients) adults with a diagnosis of schizophrenia were included. Exploratory Factor analysis was performed on the BMQ-S to identify the underlying structure. Real life functioning was measured with the Global Assessment of Functioning scale (GAF). Convergent validity was assessed with the Scale for Assessment of Negative Symptom (SANS) and the Lille Apathy Rating Scale (LARS). RESULTS The main psychometric properties of the BMQ-S (internal consistency, test-retest reliability) were satisfactory. Exploratory factorial analysis revealed a 4-factor model which explained 76% of the overall variance. The BMQ-S correlated significantly with the LARS and the SANS avolition subscore suggesting adequate convergent validity. The correlation between the BMQ-S and the clinician-report version was 0.48. The global score and in particular the Initiation/disorganisation dimension was a significant predictor of global functioning at 12-months even when adjusted for age, chlorpromazine intake and depression. CONCLUSION Our findings indicate that the BMQ-S has satisfactory psychometric properties and that schizophrenia patients can reliably assess their lack of motivation. Self-evaluation of avolition should be considered in the overall prediction of real-world functioning in schizophrenia.
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18
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Osugo M, Whitehurst T, Shatalina E, Townsend L, O’Brien O, Mak TLA, McCutcheon R, Howes O. Dopamine partial agonists and prodopaminergic drugs for schizophrenia: systematic review and meta-analysis of randomized controlled trials. Neurosci Biobehav Rev 2022; 135:104568. [DOI: 10.1016/j.neubiorev.2022.104568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
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19
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García-Álvarez L, Martínez-Cao C, Bobes-Bascarán T, Portilla A, Courtet P, de la Fuente-Tomás L, Velasco Á, González-Blanco L, Zurrón-Madera P, Fonseca-Pedrero E, Sáiz PA, García-Portilla MP, Bobes J. Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:14-21. [PMID: 35256068 DOI: 10.1016/j.rpsmen.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/28/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia. MATERIAL AND METHODS Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale - Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS). RESULTS RELIABILITY Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p<0.001). For PANSS-N, the correlation was 0.437 (p<0.005) and with the CAINS-Total was 0.478 (p<0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r=-0.372 (p≤0.001), and with SF-36 Physical and Mental Summary Component scores were r=-0.213 (p=0.066) and r=-0.144 (p=0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p<0.001). CONCLUSION The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.
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Affiliation(s)
- Leticia García-Álvarez
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Clara Martínez-Cao
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Teresa Bobes-Bascarán
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - Almudena Portilla
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | | | - Lorena de la Fuente-Tomás
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Ángela Velasco
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Leticia González-Blanco
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - Paula Zurrón-Madera
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - Eduardo Fonseca-Pedrero
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Departamento Ciencias de la Educación, Universidad de la Rioja, Longroño, Spain
| | - Pilar A Sáiz
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - María Paz García-Portilla
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain.
| | - Julio Bobes
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
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20
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Ribolsi M, Fiori Nastro F, Pelle M, Medici C, Sacchetto S, Lisi G, Riccioni A, Siracusano M, Mazzone L, Di Lorenzo G. Recognizing Psychosis in Autism Spectrum Disorder. Front Psychiatry 2022; 13:768586. [PMID: 35295770 PMCID: PMC8918655 DOI: 10.3389/fpsyt.2022.768586] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Abstract
There is strong evidence for the existence of a high comorbidity between autism and psychosis with percentages reaching up to 34. 8% and several significant implications for treatment and prognosis of these patients. However, the identification of comorbid psychosis in patients with Autism Spectrum Disorder represents a complex challenge from a psychopathological point of view, in particular in patients with greater deficits in verbal communication. Intercepting the onset of a psychotic breakdown in autism may be very difficult, both disorders in fact occur along a phenotypic continuum of clinical severity and in many cases, psychotic symptoms are present in an attenuated form. In this paper, we reviewed the available scientific literature about comorbidity between psychosis and autism, focusing our attention on four specific dimensions: delusions, hallucinations, negative symptoms, and clinical course. The aim of this paper is to provide clinical tools to identify these psychotic phenomena in autistic patients, even when they occur in their attenuated form.
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Affiliation(s)
- Michele Ribolsi
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Federico Fiori Nastro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Martina Pelle
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Caterina Medici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Silvia Sacchetto
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Giulia Lisi
- Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1, Rome, Italy
| | - Assia Riccioni
- Child Neurology and Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Martina Siracusano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
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21
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Bengtsson J, Bodén R, Neider D, Cernvall M. A blinded validation of the Swedish version of the Clinical Assessment Interview for Negative Symptoms (CAINS). Nord J Psychiatry 2022; 76:44-51. [PMID: 34126848 DOI: 10.1080/08039488.2021.1933174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed in order to advance the assessment of negative symptoms. The aim of this study was to validate the Swedish version of the CAINS. MATERIALS AND METHODS Thirty-four out-patients with a schizophrenia spectrum disorder were recruited. All patients were videotaped while interviewed with the CAINS and the Brief Psychiatric Rating Scale (BPRS). Another rater watched the video recordings in the reverse order, enabling a blinded design. The patients also filled in self-reported measures of depression, quality of life, and social and vocational functioning. We calculated inter-rater agreement and internal consistency for the CAINS. We also calculated validity measures by correlating the subscales Motivation and Pleasure (CAINS-MAP) and Expression (CAINS-EXP) to subscales of the BPRS. RESULTS The blinded inter-rater agreement for the CAINS total score was high (ICC = 0.92) but slightly lower for the expression subscale (ICC = 0.76). Cronbach's alpha was 0.84 for the total score. Convergent validity with the negative symptoms subscale of BPRS was different for the blinded and the unblinded data, with a CAINS-MAP correlation of 0.10 (p = 0.580) and a CAINS-EXP correlation of 0.48 (p = 0.004) in the blinded data. The unblinded data had a CAINS-MAP correlation of 0.38 (p = 0.026) and a CAINS-EXP correlation of 0.87 (p < 0.001). Self-rated measures of anhedonia correlated to CAINS-MAP with a coefficient of 0.68 (p < 0.001), while the CAINS-EXP only had a correlation of 0.16 (p = 0.366) to these measures. CONCLUSION The Swedish version of the CAINS displays adequate psychometric properties in line with earlier validation studies.
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Affiliation(s)
- Johan Bengtsson
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Martin Cernvall
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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22
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Bergmann N, Hahn E, Hahne I, Zierhut M, Ta TMT, Bajbouj M, Pijnenborg GHM, Böge K. The Relationship Between Mindfulness, Depression, Anxiety, and Quality of Life in Individuals With Schizophrenia Spectrum Disorders. Front Psychol 2021; 12:708808. [PMID: 34531796 PMCID: PMC8438172 DOI: 10.3389/fpsyg.2021.708808] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/03/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Schizophrenia spectrum disorders (SSD) are frequently accompanied by comorbid depressive and anxiety symptoms, as well as impaired quality of life (QoL). A growing body of evidence has demonstrated the relevance of mindfulness for SSD in recent years. The study examined the association between mindfulness, depression, anxiety, and QoL. Materials and Methods: A total of 83 participants with SSD were recruited at the in- and outpatient psychiatric hospital care. Participants completed the Southampton Mindfulness Questionnaire, Comprehensive Inventory for Mindful Experiences, and Freiburger Mindfulness Inventory, the Depression, Anxiety, Stress Scale to assess depression and anxiety, and the WHO-QoL Questionnaire. Multiple regression analyses examined the relationship between mindfulness and QoL and the mediating role of depression and anxiety. Results: Mindfulness had a significant statistical positive effect on QoL domains physical health, psychological, and environmental QoL in patients with SSD. Depression was identified as a significant mediator of this relationship. Conclusion: This study provides novel insight into mindfulness' mechanisms and paves the way for a process-oriented approach to treat SSD. The results provide first evidence for the process-based value of mindfulness for SSD; future studies can focus on the role of mindfulness for central therapeutic processes of change by employing longitudinal designs.
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Affiliation(s)
- Niklas Bergmann
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Inge Hahne
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marco Zierhut
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Geradina Henrika Maria Pijnenborg
- Department Clinical Psychology and Experimental Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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23
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Montvidas J, Adomaitienė V, Leskauskas D, Dollfus S. Validation of the lithuanian version of the self-evaluation of negative symptoms scale (SNS). Nord J Psychiatry 2021; 75:351-355. [PMID: 33356749 DOI: 10.1080/08039488.2020.1862295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To validate the Lithuanian version of the Self-Evaluation Negative Symptoms Scale (Lith-SNS). MATERIALS AND METHODS A double translation from French to Lithuanian and back was performed. We included patients from in-patient and out-patient settings that had a diagnosis of paranoid schizophrenia according to ICD-10 criteria and were screened as free from acute psychotic symptoms using the Mini International Neuropsychiatric Interview (MINI). Participants were evaluated using the Brief Psychiatric Rating Scale (BRPS) and completed the Lith-SNS scale. We measured internal consistency, convergent validity, and discriminant validity of Lith - SNS comparing its scores with BPRS negative and positive symptom subscores. RESULTS A total of 67 participants were evaluated. Cronbach's alpha (α) for all 20 items of Lith-SNS (α = 0.82), and for the five subscores (α = 0.76) showed good internal consistency. Factor analysis showed a 2-factor solution which accounted for 70.12% of the variance with the first factor accounting for 53.3% and the second factor accounting for 16.8% of the variance. Lith-SNS total scores and all five subscores significantly correlated with BPRS negative symptoms subscores showing good convergent validity. There was a correlation between the Positive subscore of BPRS and the alogia subscore of Lith-SNS (r = 0.39, p = 0.001), but no correlations with other subscores or the total Lith-SNS score showing adequate discriminant validity. CONCLUSIONS Lithuanian version of SNS is a valuable tool to evaluate negative symptoms of schizophrenia with good internal consistency, convergent, and discriminant validity.
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24
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Latent structure of self-report negative symptoms in patients with schizophrenia: A preliminary study. Asian J Psychiatr 2021; 61:102680. [PMID: 34000499 DOI: 10.1016/j.ajp.2021.102680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Negative symptoms are associated with poor outcomes and functioning. Latent structure of negative symptoms is important for identifying potential intervention targets for novel treatments. Self-report instruments have been developed to measure negative symptoms. Previous findings on latent structure of negative symptoms are inconsistently and mainly rely on clinician-rated instruments. METHOD We aimed to explore the latent structure of the Self-Evaluation of Negative Symptoms Scale (SNS) in 204 clinically-stable outpatients with schizophrenia. Confirmatory factor analysis (CFA) was used to compare the competing models (i.e., one-factor, two-factor and five-factor models), and estimated goodness-of-fit indexes. Other clinician-rated scales for psychopathology and medication side-effects were also collected. RESULTS The CFA found the five-factor model performing best, with a comparative fit index (CFI) of > 0.95, a Tucker Lewis Index (TLI) of > 0.95, and a root mean square error of approximation (RMSEA) of < 0.06. The robust chi-square difference test for the weighted least squares with mean and variance adjusted estimation (WLSMV) also indicated a significant better fit for the five-factor model. DISCUSSION Our preliminary findings support a five-factor latent structure of self-report negative symptoms in schizophrenia patients. Further research in this area should utilize multiple clinician-rated and self-report measures, and recruit large and homogeneous samples with schizophrenia.
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25
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Hajj A, Hallit S, Chamoun K, Sacre H, Obeid S, Haddad C, Dollfus S, Khabbaz LR. Negative symptoms in schizophrenia: correlation with clinical and genetic factors. Pharmacogenomics 2021; 22:389-399. [PMID: 33858192 DOI: 10.2217/pgs-2020-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Explore the possible association between clinical factors and genetic variants of the dopamine pathways and negative symptoms. Materials & methods: Negative symptoms were assessed in 206 patients with schizophrenia using the Arabic version of the self-evaluation of negative symptoms scale and the Positive and Negative Syndrome Scale. Genotyping for COMT, DRD2, MTHFR and OPRM1 genes was performed. Results: Multivariable analysis showed that higher self-evaluation of negative symptoms scale scores were significantly associated with higher age, higher chlorpromazine-equivalent daily dose for typical antipsychotics and in married patients. Higher negative Positive and Negative Syndrome Scale scores were significantly associated with women and having the CT genotype for MTHFR c.677C>T (β = 4.25; p = 0.008) compared with CC patients. Conclusion: Understanding both clinical/genetic factors could help improve the treatment of patients.
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Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine & Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
| | - Karam Chamoun
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, PO Box 60096, Jal Eddib, Lebanon.,Faculty of Art and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon.,Research Department, Psychiatric Hospital of the Cross, PO Box 60096, Jal Eddib, Lebanon.,INSERM, Univ. Limoges, CH Esquirol Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Sonia Dollfus
- CHU de Caen, Service de Psychiatrie, 14000, Caen, France.,Normandie University, UNICAEN, ISTS, GIP Cyceron, 14000, Caen, France
| | - Lydia Rabbaa Khabbaz
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon.,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
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26
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Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, Giordano GM, Vandevelde A, Nielsen MØ, Glenthøj LB, Sabé M, Pezzella P, Bitter I, Gaebel W. EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e23. [PMID: 33597064 PMCID: PMC8080207 DOI: 10.1192/j.eurpsy.2021.11] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
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Affiliation(s)
- S Galderisi
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - S Dollfus
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - P Pezzella
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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27
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Monsonet M, Kwapil TR, Barrantes-Vidal N. Exploring the Psychometric Properties and the Factor Structure of the Calgary Depression Scale for Schizophrenia Across the Schizotypy Continuum. Assessment 2021; 29:686-699. [PMID: 33522263 DOI: 10.1177/1073191120986622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the psychometric properties and factor structure of the Calgary Depression Scale for Schizophrenia (CDSS) across different levels of the schizotypy continuum. A combined sample of high-schizotypy, at-risk mental states, and patients with first-episode psychosis was assessed for depression and other clinical and functional outcomes. Additionally, experience sampling methodology was used to assess depressive and psychotic-like experiences in daily life. The CDSS exhibited solid internal consistency, validity, and discrimination between depressed and nondepressed participants. Confirmatory factor analyses and the associations of the resulting factors with clinical and functional measures supported a two-factor structure that included general depression and guilt factors. Furthermore, both factors of the CDSS were differentially related to positive and negative symptoms of psychosis in daily life. The CDSS appears to have two underlying psychopathological dimensions and to be a reliable and valid measure for assessing depression across the schizotypy continuum.
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Affiliation(s)
- Manel Monsonet
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Thomas R Kwapil
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Neus Barrantes-Vidal
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain.,Sant Pere Claver-Fundació Sanitària, Barcelona, Spain.,Instituto de Salud Carlos III, Madrid, Spain
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28
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Mosolov SN, Yaltonskaya PA. Primary and Secondary Negative Symptoms in Schizophrenia. Front Psychiatry 2021; 12:766692. [PMID: 35046851 PMCID: PMC8761803 DOI: 10.3389/fpsyt.2021.766692] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/22/2021] [Indexed: 01/29/2023] Open
Abstract
The negative symptoms of schizophrenia include volitional (motivational) impairment manifesting as avolition, anhedonia, social withdrawal, and emotional disorders such as alogia and affective flattening. Negative symptoms worsen patients' quality of life and functioning. From the diagnostic point of view, it is important to differentiate between primary negative symptoms, which are regarded as an integral dimension of schizophrenia, and secondary negative symptoms occurring as a result of positive symptoms, comorbid depression, side effects of antipsychotics, substance abuse, or social isolation. If secondary negative symptoms overlap with primary negative symptoms, it can create a false clinical impression of worsening deficit symptoms and disease progression, which leads to the choice of incorrect therapeutic strategy with excessive dopamine blocker loading. Different longitudinal trajectories of primary and secondary negative symptoms in different schizophrenia stages are proposed as an important additional discriminating factor. This review and position paper focuses primarily on clinical aspects of negative symptoms in schizophrenia, their definition, phenomenology, factor structure, and classification. It covers the historical and modern concepts of the paradigm of positive and negative symptoms in schizophrenia, as well as a detailed comparison of the assessment tools and psychometric tests used for the evaluation of negative symptoms.
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Affiliation(s)
- Sergey N Mosolov
- Moscow Research Institute of Psychiatry, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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29
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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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Goldring A, Borne S, Hefner A, Thanju A, Khan A, Lindenmayer JP. The psychometric properties of the Self-Evaluation of Negative Symptoms Scale (SNS) in treatment-resistant schizophrenia (TRS). Schizophr Res 2020; 224:159-166. [PMID: 33071071 DOI: 10.1016/j.schres.2020.08.008] [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: 12/13/2019] [Revised: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Clinician-administered measures of negative symptoms may not capture patients' subjective experiences. The Self-Evaluation of Negative Symptoms (SNS) has shown good psychometric properties when used in outpatients with higher-level functioning schizophrenia. We aimed to evaluate the psychometric properties of the SNS in low functioning participants with treatment-resistant schizophrenia (TRS). METHODS Participants were assessed using the following measures at two time-points; time-point 1: SNS, Wide Range Achievement Test, 4th Edition Reading Subtest (WRAT-4), and Brief Assessment of Cognition in Schizophrenia (BACS). Time-point 2 (within a week of time-point 1): SNS, Negative Symptom Assessment 16 items (NSA-16), Scale to Assess Unawareness in Mental Disorder-Abbreviated (SUMD-A), Clinical Global Impression Severity Scale (CGI-S), Simpson Angus Scale (SAS), Calgary Depression Scale for Schizophrenia (CDSS), and the Patient Feasibility Questionnaire. RESULTS Fifty participants with TRS were enrolled, a mean age of 43.8 years (SD = 11.19, min = 25, max = 64), a mean IQ of 80.62 (SD = 17.12, min = 65, max = 110), and a mean BACS Composite T-Score of 14.08 (SD = 17.16, min = -27, max = 49). Participants responded to SNS prompts with moderate consistency across two time-points. There were no significant correlations between the SNS and the NSA-16 Global Symptom score (Pearson r = 0.207, p = .150, Spearman r = 0.101, p = .483), NSA-16 Global Functioning score (Pearson r = 0.209, p = .145, Spearman r = 0.126, p = .384), nor the NSA-16 total score (Pearson r = 0.149, p = .302, Spearman r = 0.116, p = .421). However, when participants were stratified by BACS Composite T-score, there was a significant positive correlation between the SNS total and the NSA-16 Global Functioning score (Pearson r = 0.500, p = .048, Spearman r = 0.546, p = .029) among participants who demonstrated higher cognitive functioning. CONCLUSION Participants with TRS and low functioning were able to respond to questions on the SNS regarding their subjective assessment of negative symptoms. However, self-reported and clinician-rated negative symptoms were not equivalent, except in a subgroup with higher cognitive functioning. This discrepant self-reporting appeared to relate to their low levels of insight and cognitive impairments.
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Affiliation(s)
- Abraham Goldring
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America; Medgar Evers College, CUNY, United States of America.
| | - Sophia Borne
- Manhattan Psychiatric Center, United States of America; New School for Social Research, United States of America
| | - Amanda Hefner
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America; New York Medical College, United States of America
| | - Amod Thanju
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America
| | - Anzalee Khan
- Nathan Kline Institute, United States of America; Manhattan Psychiatric Center, United States of America
| | - Jean-Pierre Lindenmayer
- Nathan Kline Institute, United States of America; New York University, Department of Psychiatry, United States of America; Manhattan Psychiatric Center, United States of America
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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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García-Álvarez L, Martínez-Cao C, Bobes-Bascarán T, Portilla A, Courtet P, de la Fuente-Tomás L, Velasco Á, González-Blanco L, Zurrón-Madera P, Fonseca-Pedrero E, Sáiz PA, García-Portilla MP, Bobes J. Validation of a European Spanish-version of the Self-Evaluation of Negative Symptoms (SNS) in patients with schizophrenia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 15:S1888-9891(20)30036-7. [PMID: 32517967 DOI: 10.1016/j.rpsm.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Negative symptoms can be grouped into five domains: apathy/avolition, anhedonia, asociality, alogia, and affective flattening. There are few validate self-rated measures that assess these five dimensions. Therefore, this study aimed to validate the Self-Evaluation of Negative Symptoms (SNS) in Spanish patients with schizophrenia. MATERIAL AND METHODS Cross-sectional, validation study in 104 outpatients with schizophrenia evaluated using the Spanish version of the following scales: Clinical Assessment Interview for Negative Symptoms (CAINS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Scale for Schizophrenia (CGI-SCH), Personal and Social Performance (PSP), Motivation and Pleasure Scale - Self-Report (MAP-SR), 36-item Short-Form Health Survey (SF-36) and the Self-Evaluation of Negative Symptoms (SNS). RESULTS RELIABILITY Internal consistency (Cronbach's alpha) was 0.915. Convergent validity: The Pearson correlation coefficient between MAP-SR and SNS Total scores was 0.660 (p<0.001). For PANSS-N, the correlation was 0.437 (p<0.005) and with the CAINS-Total was 0.478 (p<0.005). Divergent validity: The Pearson correlation coefficient between SNS and PSP was r=-0.372 (p≤0.001), and with SF-36 Physical and Mental Summary Component scores were r=-0.213 (p=0.066) and r=-0.144 (p=0.219), respectively. Discriminant validity: SNS Total scores were significantly statistically different according to the severity of the negative symptomatology rated by the CGI-SCH negative scale (p<0.001). CONCLUSION The SNS is a reliable and valid instrument to self-rate the five domains of negative symptoms in patients with schizophrenia and seems to be appropriate for use in everyday clinical practice as a complementary measure to the evaluation performed by the clinician.
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Affiliation(s)
- Leticia García-Álvarez
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Clara Martínez-Cao
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Teresa Bobes-Bascarán
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - Almudena Portilla
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | | | - Lorena de la Fuente-Tomás
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Ángela Velasco
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain
| | - Leticia González-Blanco
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - Paula Zurrón-Madera
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - Eduardo Fonseca-Pedrero
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Departamento Ciencias de la Educación, Universidad de la Rioja, Longroño, Spain
| | - Pilar A Sáiz
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
| | - María Paz García-Portilla
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain.
| | - Julio Bobes
- Departamento de Psiquiatría, University of Oviedo, Oviedo, Spain; Institute of Health Research of Principado de Asturias (ISPA), Oviedo, Spain; Institute of Neurosciences of Principado de Asturias (INEUROPA), Oviedo, Spain; Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Health Service of Principado de Asturias (SESPA), Oviedo, Spain
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Hajj A, Hallit S, Chamoun K, Sacre H, Obeid S, Haddad C, Dollfus S, Rabbaa Khabbaz L. Validation of the Arabic version of the "self-evaluation of negative symptoms" scale (SNS). BMC Psychiatry 2020; 20:240. [PMID: 32408876 PMCID: PMC7227103 DOI: 10.1186/s12888-020-02647-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The self-evaluation of negative symptoms scale (SNS) is a new easy-to-use self-administered questionnaire allowing clinicians to understand the clinical and genetic factors affecting the negative symptoms in patients with schizophrenia. There was a need to translate and validate this scale in Arabic so that Arab-speaking patients benefit from it. Therefore, the aim of our study was to validate the Arabic version of the SNS in a sample of Lebanese patients with schizophrenia. METHODS The Arabic SNS was used to quantify the disability associated with negative symptoms in patients with schizophrenia (n = 206). Six weeks after completing the SNS, the participants were interviewed again to assess test-retest reproducibility. The validity was confirmed by factor analyses using the principal component analysis technique with a varimax rotation. The Positive and Negative Syndrome Scale (PANSS) was also assessed. RESULTS None of the items of the SNS scale were removed; all items converged over a solution of five factors that had an eigenvalue > 1, explaining a total of 66.01% of the variance (Cronbach's alpha = 0.879; test part). The mean total SNS score was 17.33 ± 8.43 for the "test", and 16.35 ± 7.50 for the "retest". The correlation coefficients between the SNS total score and the PANSS scale and subscales were as follows: total PANSS (r = 0.044; p = 0.530), positive PANSS score (r = - 0.106; p = 0.131), negative PANSS score (r = 0.204; p = 0.003), and general psychopathological PANSS score (r = 0.03; p = 0.530). CONCLUSION This study is the first to validate the Arabic version of the SNS in patients with schizophrenia. Using this scale would help improve treatment by correctly assessing negative symptoms, thus optimizing treatment options.
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Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon. .,Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon.
| | - Souheil Hallit
- grid.444434.70000 0001 2106 3658Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon ,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Karam Chamoun
- grid.42271.320000 0001 2149 479XFaculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon ,Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon ,Research Department, Psychiatric Hospital of the Cross, P.O Box 60096, Jal Eddib, Lebanon ,grid.444434.70000 0001 2106 3658Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Chadia Haddad
- Research Department, Psychiatric Hospital of the Cross, P.O Box 60096, Jal Eddib, Lebanon
| | - Sonia Dollfus
- grid.411149.80000 0004 0472 0160CHU de Caen, Service de Psychiatrie, 14000 Caen, France ,grid.412043.00000 0001 2186 4076Normandie Univ, UNICAEN, ISTS, GIP Cyceron, 14000 Caen, France
| | - Lydia Rabbaa Khabbaz
- grid.42271.320000 0001 2149 479XFaculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon ,grid.42271.320000 0001 2149 479XLaboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
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Lyngstad SH, Bettella F, Aminoff SR, Athanasiu L, Andreassen OA, Faerden A, Melle I. Associations between schizophrenia polygenic risk and apathy in schizophrenia spectrum disorders and healthy controls. Acta Psychiatr Scand 2020; 141:452-464. [PMID: 32091622 DOI: 10.1111/acps.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Apathy is a central predictor of a poor functional outcome in schizophrenia. Schizophrenia polygenic risk scores (PRSs) are used to detect genetic associations to key clinical phenotypes in schizophrenia. We explored the associations between schizophrenia PRS and apathy levels in schizophrenia spectrum disorders (n = 281) and matched healthy controls (n = 298), and further how schizophrenia PRS contributed in predicting apathy when added to premorbid and clinical factors in the patient sample. METHOD Schizophrenia PRSs were computed for each participant. Apathy was assessed with the Apathy Evaluation Scale. Bivariate correlation analyses were used to investigate associations between schizophrenia PRS and apathy, and between apathy and premorbid and clinical factors. Multiple hierarchical regression analyses were employed to evaluate the contributions of clinical variables and schizophrenia PRS to apathy levels. RESULTS We found no significant associations between schizophrenia PRS and apathy in patients and healthy controls. Several premorbid and clinical characteristics significantly predicted apathy in patients, but schizophrenia PRS did not. CONCLUSION Since the PRSs are based on common genetic variants, our results do not preclude associations to other types of genetic factors. The results could also indicate that environmentally based biological or psychological factors contribute to apathy levels in schizophrenia.
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Affiliation(s)
- S H Lyngstad
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bettella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S R Aminoff
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - L Athanasiu
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A Faerden
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - I Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Chun CA, Cooper S, Ellman LM. Associations of psychotic-like experiences, related symptoms, and working memory with functioning. Eur Psychiatry 2020; 63:e20. [PMID: 32093801 PMCID: PMC7315866 DOI: 10.1192/j.eurpsy.2020.21] [Citation(s) in RCA: 8] [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] [Indexed: 12/29/2022] Open
Abstract
This study examined the association of spatial working memory and attenuated psychotic-like experiences and related symptoms with social and role functioning. Findings from this study suggest that symptom dimensions and working memory impairment were associated with diminished functioning across a variety of domains. Specifically, negative symptoms and working memory impairment were inversely associated with both social and role functioning, whereas positive and disorganized symptoms showed inverse associations with social functioning only. Symptom dimensions did not moderate cognitive and functional variables, although working memory and attenuated clinical symptoms had an additive effect on functioning. Post-hoc analyses examining symptom dimensions simultaneously showed negative symptoms to be the variable most strongly predictive of overall functioning. These findings suggest that even in a non-clinical sample, sub-threshold psychosis symptoms and cognition may influence people’s social and role functioning.
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Affiliation(s)
- Charlotte A Chun
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Shanna Cooper
- Department of Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
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Vita A, Perin AP, Cavanna M, Cobelli F, Rosa J, Valsecchi P, Zanigni M, Reggiardo G, Sacchetti E. Negative symptom severity at discharge from an index hospitalization and subsequent use of psychiatric care resources: A retrospective 1-year follow-up study on 450 patients with schizophrenia spectrum disorders. Schizophr Res 2020; 216:243-248. [PMID: 31818634 DOI: 10.1016/j.schres.2019.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/15/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
Negative symptoms of schizophrenia have a great impact on patients' functioning and are among the most important contributors to subject's disability. However, few studies have assessed the role of type and severity of symptomatology of schizophrenia on the psychiatric care resource utilization. We investigated if the clinical profile of patients at discharge from an index hospitalization might be associated with a different use of psychiatric care resources in the subsequent 1-year period in a large population of patients with schizophrenia spectrum disorders. Clinical records of 450 patients with schizophrenia spectrum disorders admitted in an acute psychiatric inpatient service and subsequently followed in the outpatient services of the same Department were reviewed. Patients with more severe negative symptoms at discharge from hospital showed a higher number and duration of hospitalizations in the 1-year follow-up, as well as a higher number of rehabilitative residential admissions than patients with milder severity of negative symptoms. The same was true for patients with predominant negative symptoms. A global resource utilization index indicated a higher use of psychiatric resources in patients with higher severity of negative symptoms. In conclusion, showing moderate to severe negative symptoms versus positive symptoms at discharge from a hospitalization for an acute exacerbation of schizophrenia spectrum disorder does predict a higher use of psychiatric care resources. This underlines the importance of relieving negative symptoms even in the acute phase of treatment and the need to develop more effective treatments for this symptom dimension.
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Affiliation(s)
- A Vita
- University of Brescia, School of Medicine, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy.
| | - A P Perin
- University of Brescia, School of Medicine, Italy
| | - M Cavanna
- University of Brescia, School of Medicine, Italy
| | - F Cobelli
- University of Brescia, School of Medicine, Italy
| | - J Rosa
- University of Brescia, School of Medicine, Italy
| | - P Valsecchi
- University of Brescia, School of Medicine, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - M Zanigni
- University of Brescia, School of Medicine, Italy
| | - G Reggiardo
- Biostatistics Unit, Medi Service, Genoa, Italy
| | - E Sacchetti
- University of Brescia, School of Medicine, Italy
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Lindgren M, Holm M, Kieseppä T, Suvisaari J. Neurocognition and Social Cognition Predicting 1-Year Outcomes in First-Episode Psychosis. Front Psychiatry 2020; 11:603933. [PMID: 33343430 PMCID: PMC7746550 DOI: 10.3389/fpsyt.2020.603933] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/12/2020] [Indexed: 12/22/2022] Open
Abstract
Cognitive performance at illness onset may predict outcomes in first-episode psychosis (FEP), and the change in cognition may associate with clinical changes. Cognitive testing was administered to 54 FEP participants 2 months after entering treatment and to 39 participants after 1 year. We investigated whether baseline cognition predicted 1-year outcomes beyond positive, negative, and affective symptoms and whether the trajectory of cognition associated with clinical change. Baseline overall neurocognitive performance predicted the 1-year social and occupational level, occupational status, and maintaining of life goals. The domain of processing speed associated with the 1-year remission, occupational status, and maintaining of life goals. Baseline social cognition associated with occupational status a year later and the need for hospital treatment during the 1st year after FEP. Most of the associations were retained beyond baseline positive and affective symptom levels, but when accounting for negative symptoms, cognition no longer predicted 1-year outcomes, highlighting how negative symptoms overlap with cognition. The trajectory of neurocognitive performance over the year did not associate with changes in symptoms or functioning. Cognitive testing at the beginning of treatment provided information on the 1-year outcome in FEP beyond positive and affective symptom levels. In particular, the domains of processing speed and social cognition could be targets for interventions that aim to improve the outcome after FEP.
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Affiliation(s)
- Maija Lindgren
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Minna Holm
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Kieseppä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Rodríguez-Testal JF, Perona-Garcelán S, Dollfus S, Valdés-Díaz M, García-Martínez J, Ruíz-Veguilla M, Senín-Calderón C. Spanish validation of the self-evaluation of negative symptoms scale SNS in an adolescent population. BMC Psychiatry 2019; 19:327. [PMID: 31664965 PMCID: PMC6819523 DOI: 10.1186/s12888-019-2314-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/09/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Negative symptoms (NS) may be observed in the general population in an attenuated form and in high-risk mental states. However, they have been less studied in the general population than positive symptoms, in spite of their importance at the insidious onset of schizophrenia and their appearance before positive symptoms. This study aimed to analyze the empirical structure of the Spanish version of the Self-Evaluation of Negative Symptoms (SNS) Scale and find its psychometric properties and invariance of measurement across sex and age in a sample of adolescents. METHODS The sample consisted of 4521 adolescents (53.6% female) from 11 to 18 years of age. RESULTS Confirmatory Factor Analysis of the SNS confirmed an internal structure of five first-order factors by the characteristic dimensions of NS: avolition, social withdrawal, diminished emotional range, anhedonia, alogia, and one second-order factor which includes the total NS score. Multi-group confirmatory factor analysis showed that the scale was invariant across sex and age. Total scale reliability was adequate. A strong relationship was found between the SNS with depressive symptomatology, moderate with ideas of reference and low with aberrant salience. CONCLUSION The results back use of the Spanish version of the SNS scale for detection of NS in the general population of adolescents.
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Affiliation(s)
- Juan F. Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Seville, Spain. Av. Camilo José Cela, 41018 Seville, SN Spain
| | - Salvador Perona-Garcelán
- Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, SN Spain
| | - Sonia Dollfus
- CHU de Caen, Service universitaire de Psychiatrie, Centre Esquirol, Avenue Côte de Nacre, F-14000 Caen, France
- UNICAEN, UFR Médecine, F-14074 Caen, France
| | - María Valdés-Díaz
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
| | - Jesús García-Martínez
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
| | - Miguel Ruíz-Veguilla
- Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, SN Spain
| | - Cristina Senín-Calderón
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
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MEDEIROS HEYDRICHLOPESVIRGULINODE, SILVA ANTÔNIOMEDEIROSPEREGRINODA, RODIG RIEGMICHAELERICH, SOUZA SANDRALOPESDE, SOUGEY EVERTONBOTELHO, VASCONCELOS SELENECORDEIRO, LIMA MURILODUARTEDACOSTA. Cross-cultural adaptation, reliability, and content validity of the Brief Negative Symptom Scale (BNSS) for use in Brazil. ARCH CLIN PSYCHIAT 2019. [DOI: 10.1590/0101-60830000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dollfus S, Delouche C, Hervochon C, Mach C, Bourgeois V, Rotharmel M, Tréhout M, Vandevelde A, Guillin O, Morello R. Specificity and sensitivity of the Self-assessment of Negative Symptoms (SNS) in patients with schizophrenia. Schizophr Res 2019; 211:51-55. [PMID: 31345705 DOI: 10.1016/j.schres.2019.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/28/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Negative symptoms can be present at any stage of schizophrenia but their evaluation remains challenging. Self-evaluations may be particularly useful in screening negative symptoms quickly and effectively. The purpose of this study was to determine the sensitivity, the specificity, and the threshold beyond which the negative symptoms are considered pathological in a comparative study between patients with schizophrenia and healthy subjects using the Self-assessment of Negative Symptoms (SNS). METHODS One hundred and nine patients with schizophrenia and schizoaffective disorders (DSM-5) and 99 healthy controls were included and evaluated with the SNS. AUROC analyses were performed to assess the discriminant performance of the SNS scale for screening negative symptoms in the whole sample of patients but also in 2 patient sub-samples without high scores of depression or negative symptoms. RESULTS The SNS (AUROC = 0.942 ± 0.046; p < 0.001) appears to be an appropriate screening tool for distinguishing between SZ and HC with a threshold value of 7, and the sensitivity and specificity were 92.7% (95CI = [86.1-96.8]) and 85.9% (95CI = [77.4-92.1]) respectively. A threshold at 7 was also observed in the samples without patients with high level of depressive or negative symptoms. CONCLUSION These results indicate that SNS might be a valuable tool for screening negative symptoms in clinical practice regardless the level of depressive and negative symptoms. Further studies using SNS in subjects at high risk for psychosis or with a first psychotic episode would be useful in the detection of negative symptoms.
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Affiliation(s)
- Sonia Dollfus
- CHU de Caen, Service de Psychiatrie, 14000 Caen, France; Normandie Univ, UNICAEN, ISTS, GIP Cyceron, 14000 Caen, France; Normandie Univ, UNICAEN, UFR de Médecine, 14000 Caen, France.
| | | | | | - Cyril Mach
- CHU de Caen, Service de Psychiatrie, 14000 Caen, France
| | | | - Maud Rotharmel
- Centre Hospitalier du Rouvray, 76300 Rouen, France; CHU Charles Nicolle, 76000 Rouen, France
| | - Maxime Tréhout
- CHU de Caen, Service de Psychiatrie, 14000 Caen, France; Normandie Univ, UNICAEN, ISTS, GIP Cyceron, 14000 Caen, France; Normandie Univ, UNICAEN, UFR de Médecine, 14000 Caen, France
| | - Anaïs Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000 Caen, France; Normandie Univ, UNICAEN, ISTS, GIP Cyceron, 14000 Caen, France; Normandie Univ, UNICAEN, UFR de Médecine, 14000 Caen, France
| | - Olivier Guillin
- Centre Hospitalier du Rouvray, 76300 Rouen, France; CHU Charles Nicolle, 76000 Rouen, France; INSERM U 1079, University of Medicine, 76000 Rouen, France
| | - Rémy Morello
- CHU de Caen, Unité de Biostatistiques et de Recherche Clinique, 14000 Caen, France
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Mucci A, Vignapiano A, Bitter I, Austin SF, Delouche C, Dollfus S, Erfurth A, Fleischhacker WW, Giordano GM, Gladyshev I, Glenthøj B, Gütter K, Hofer A, Hubeňák J, Kaiser S, Libiger J, Melle I, Nielsen MØ, Papsuev O, Rybakowski JK, Sachs G, Üçok A, Wojciak P, Galderisi S. A large European, multicenter, multinational validation study of the Brief Negative Symptom Scale. Eur Neuropsychopharmacol 2019; 29:947-959. [PMID: 31255394 DOI: 10.1016/j.euroneuro.2019.05.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/11/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022]
Abstract
Negative symptoms represent an unmet need of treatment in schizophrenia. Although a consensus exists on negative symptom construct, and second generation assessment instruments reflecting the consensus are available, studies still rely upon old assessment instruments, that do not reflect recent conceptualizations and might limit progress in the search for effective treatments. This is often the case in the European context, where one of the challenges encountered in designing large studies is the availability of validated instruments in the many languages of the continent. To address this challenge and promote sound research on negative symptoms in Europe, the ECNP Schizophrenia Network coordinated a large multicenter, multinational validation study of the Brief Negative Symptom Scale (BNSS). Clinically-stable subjects with schizophrenia (SCZ, N = 249) were recruited from 10 European Countries. Apart from BNSS, subjects were administered the Positive and Negative Syndrome Scale (PANSS) and standardized instruments for depression, extrapyramidal symptoms and psychosocial functioning. Results showed an excellent internal consistency, convergent and discriminant validity of BNSS and replicated a 5 factor-model. A larger number of subjects with predominant negative symptoms, i.e. the target population for clinical trials, was identified by using the BNSS compared to the PANSS. Regression analysis showed that BNSS-avolition, a key negative symptom poorly assessed by PANSS, explained 23.9% of psychosocial functioning, while no combination of the PANSS core negative symptoms showed the same impact on functioning. The study demonstrated that BNSS has substantial advantages with respect to PANSS for the identification of the avolition domain and subjects with predominant negative symptoms.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy.
| | - Annarita Vignapiano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Hillerød, Denmark
| | - Camille Delouche
- Service de Psychiatrie, CHU de Caen, Caen, France; UFR de Médecine, UNICAEN, Normandie Université, Caen, France; ISTS, UNICAEN, Normandie Université, Caen, France
| | - Sonia Dollfus
- Service de Psychiatrie, CHU de Caen, Caen, France; UFR de Médecine, UNICAEN, Normandie Université, Caen, France; ISTS, UNICAEN, Normandie Université, Caen, France
| | - Andreas Erfurth
- 6th Psychiatric Department, Otto-Wagner-Spital, Vienna, Austria
| | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Giulia M Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Igor Gladyshev
- Department of Socio-clinical and Biological Research of Psychotic spectrum disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Gütter
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Jan Hubeňák
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Jan Libiger
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Ingrid Melle
- NORMENT Centre, Institute of Clinical Psychiatry, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mette Ø Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oleg Papsuev
- Department of Socio-clinical and Biological Research of Psychotic spectrum disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alp Üçok
- Istanbul Faculty of Medicine, Psychotic Disorders Research Program, Istanbul University, Istanbul, Turkey
| | - Pawel Wojciak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
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Functional Connectivity of Corticostriatal Circuitry and Psychosis-like Experiences in the General Community. Biol Psychiatry 2019; 86:16-24. [PMID: 30952359 DOI: 10.1016/j.biopsych.2019.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Psychotic symptoms are proposed to lie on a continuum, ranging from isolated psychosis-like experiences (PLEs) in nonclinical populations to frank disorder. Here, we investigated the neurobiological correlates of this continuum by examining whether functional connectivity of dorsal corticostriatal circuitry, which is disrupted in psychosis patients and individuals at high risk for psychosis, is associated with the severity of subclinical PLEs. METHODS A community sample of 672 adults with no history of psychiatric or neurological illnesses completed a battery of seven questionnaires spanning various PLE domains. Principal component analysis of 12 subscales taken from seven questionnaires was used to estimate major dimensions of PLEs. Dimension scores from principal component analysis were then correlated with whole-brain voxelwise functional connectivity maps of the dorsal striatum in a subset of 353 participants who completed a resting-state neuroimaging protocol. RESULTS Principal component analysis identified two dimensions of PLEs that accounted for 62.57% of variance in the measures, corresponding to positive (i.e., subthreshold delusions and hallucinations) and negative (i.e., subthreshold social and physical anhedonia) symptom-like PLEs. Reduced functional connectivity between the dorsal striatum and prefrontal and motor cortices correlated with more severe positive PLEs. Increased functional connectivity between the dorsal striatum and motor cortex was associated with more severe negative PLEs. CONCLUSIONS Consistent with past findings in patients and individuals at high risk for psychosis, subthreshold positive symptomatology is associated with reduced functional connectivity of the dorsal circuit. This finding suggests that the connectivity of this circuit tracks the expression of psychotic phenomena across a broad spectrum of severity, extending from the subclinical domain to clinical diagnosis.
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Luther L, Fischer MW, Firmin RL, Salyers MP. Clarifying the overlap between motivation and negative symptom measures in schizophrenia research: A meta-analysis. Schizophr Res 2019; 206:27-36. [PMID: 30577993 PMCID: PMC6525651 DOI: 10.1016/j.schres.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
Motivation and negative symptom research has recently been hampered by a series of inconsistent findings, leading to calls for a greater consensus on the type of measures used across studies. To inform this issue, we conducted a meta-analysis that quantified the association between motivation measures (self-report, performance-based) and clinician-rated negative symptom measures as well as a series of moderator analyses to develop a greater understanding of the measurement factors impacting this relationship. Forty-seven eligible studies with people with schizophrenia-spectrum disorders were included. Using a random-effects meta-analytic model, a small but significant overall effect size emerged between motivation and clinician-rated negative symptoms (r = -0.18). Several significant moderators were identified, including the generation of negative symptom measures such that there was a significantly stronger relationship between motivation and second-generation (r = -0.38) than first-generation negative symptom measures (r = -0.17). Further, the type of performance-based measure used moderated the relationship, with effort discounting tasks most strongly related to negative symptoms (r = -0.44). The domain of motivation assessed (intrinsic, extrinsic, amotivation) also moderated the relationship. These findings help to identify sources of inconsistencies observed in prior studies and point to both second-generation and effort discounting tasks as the most promising types of measures, particularly for those interested in validating motivation measures or assessing the effectiveness of motivation treatments. Although additional research is needed, our results suggest that using these measures may help to reduce inconsistencies across studies and move the field forward.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA; University of Illinois at Chicago, Department of Psychiatry, 1747 West Roosevelt Road, 279, Chicago, IL 60608, USA.
| | - Melanie W Fischer
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA.
| | - Ruth L Firmin
- University of California Los Angeles, Semel Institute, 760 Westwood Plaza, Los Angeles, CA 90046, USA.
| | - Michelle P Salyers
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN 46202, USA.
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Richter J, Hesse K, Eberle MC, Eckstein KN, Zimmermann L, Schreiber L, Burmeister CP, Wildgruber D, Klingberg S. Self-assessment of negative symptoms - Critical appraisal of the motivation and pleasure - Self-report's (MAP-SR) validity and reliability. Compr Psychiatry 2019; 88:22-28. [PMID: 30466014 DOI: 10.1016/j.comppsych.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/29/2018] [Accepted: 10/21/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The negative symptom domain remains a major challenge concerning treatment. A valid self-report measure could assist clinicians and researchers in identifying patients with a relevant subjective burden. The Motivation and Pleasure - Self Report (MAP-SR) derives from the CAINS and is supposed to reflect the "amotivation" factor of negative symptoms. We evaluated different aspects of the scale's reliability and validity. This is the first factorial analysis as well as the first analysis of test-retest reliability. METHODS We assessed three samples of subjects with schizophrenia or schizoaffective disorder (n = 93) and a broad spectrum of related domains. RESULTS We explored a 3-, 2- and 1-factor solution (explaining 50.93, 44.85 and 36.18% of variance, respectively). The factor "pleasure and hedonic activity" consists of eight items and was most robust; the factors "social motivation" and "motivation for work" were problematic. Test-retest reliability of the scale was adequate (rS = 0.63, p = .005). Neither the MAP-SR nor the "pleasure and hedonic activities" factor are associated with the PANSS negative symptom scale. There are significant associations with the observer-rated CAINS-MAP scale, experiences of pleasure, and social cognition but none with functional outcome. Discriminant validity could not be established with regards to depression and extrapyramidal symptoms. CONCLUSIONS We found that the MAP-SR is adequate to assess anhedonia but is less suitable when assessing motivation. Therefore, we propose using the "pleasure and hedonic activity scale" to cover the "anhedonia" subdomain. We think the "motivation" part of the instrument requires reconstruction.
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Affiliation(s)
- Janina Richter
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Mark-Christian Eberle
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Kathrin N Eckstein
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Lina Zimmermann
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Lisa Schreiber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Carolin P Burmeister
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany.
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Li Y, Li WX, Zou YM, Yang ZY, Xie DJ, Yang Y, Lui SSY, Strauss GP, Cheung EFC, Chan RCK. Revisiting the persistent negative symptoms proxy score using the Clinical Assessment Interview for Negative Symptoms. Schizophr Res 2018; 202:248-253. [PMID: 29996973 DOI: 10.1016/j.schres.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/18/2018] [Accepted: 07/01/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study aimed to validate a severity cut-off of negative symptoms for persistent negative symptoms (PNS) identification using the Clinical Assessment Interview for Negative Symptoms (CAINS). METHOD A total of 206 patients with schizophrenia were recruited and divided into the PNS group (n = 57) and the Non-PNS group (n = 149) using PNS criteria based on the SANS and the SAPS. To determine the appropriate cut-offs on the CAINS in identifying PNS, Receiver Operating Characteristic (ROC) curve analysis was conducted in the PNS and Non-PNS groups. RESULTS Our results showed that the cutoffs for identifying PNS on the CAINS total score, the Motivation and Pleasure (MAP) subscale score and the Expression (EXP) subscale score were 25, 17, and 5 respectively. Area Under the Curve (AUC) analysis indicated excellent discrimination of the PNS group from the Non-PNS group using the cut-off for the CAINS total score. However, discrimination was somewhat better for the MAP subscale score than the EXP subscale score. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the MAP subscale were 81.54% and 97.16%. CONCLUSION We found that the cut-off scores derived from the CAINS to identify PNS are comparable to existing scales. The CAINS offers an alternative means in identifying PNS patients in clinical trials that overcomes methodological and conceptual limitations of older scales.
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Affiliation(s)
- Ying Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; Haidian District Mental Health Prevent-Treatment Hospital, Beijing, China
| | - Wen-Xiu Li
- Haidian District Mental Health Prevent-Treatment Hospital, Beijing, China
| | - Ying-Min Zou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhuo-Ya Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dong-Jie Xie
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yin Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Simon S Y Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, United States of America
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Faerden A, Lyngstad SH, Simonsen C, Ringen PA, Papsuev O, Dieset I, Andreassen OA, Agartz I, Marder SR, Melle I. Reliability and validity of the self-report version of the apathy evaluation scale in first-episode Psychosis: Concordance with the clinical version at baseline and 12 months follow-up. Psychiatry Res 2018; 267:140-147. [PMID: 29906681 DOI: 10.1016/j.psychres.2018.05.065] [Citation(s) in RCA: 12] [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: 06/07/2017] [Revised: 05/04/2018] [Accepted: 05/25/2018] [Indexed: 11/15/2022]
Abstract
Negative symptoms have traditionally been assessed based on clinicians' observations. The subjective experience of negative symptoms in people with psychosis may bring new insight. The Apathy Evaluation Scale (AES) is commonly used to study apathy in psychosis and has corresponding self-rated (AES-S) and clinician-rated (AES-C) versions. The aim of the present study was to determine the validity and reliability of the AES-S by investigating its concordance with the AES-C. Eighty-four first-episode (FEP) patients completed the shortened 12-item AES-S and AES-C at baseline (T1) and 12 months (T2). Concordance was studied by degree of correlation, comparison of mean scores, and change and difference between diagnostic groups. The Positive and Negative Symptom Scale (PANSS) was used to study convergent and discriminative properties. High concordance was found between AES-S and AES-C at both T1 and T2 regarding mean values, change from T1 to T2, and the proportion with high levels of apathy. Both versions indicated high levels of apathy in FEP, while associations with PANSS negative symptoms were weaker for AES-S than AES-C. Controlling for depression did not significantly alter results. We concluded that self-rated apathy in FEP patients is in concordance with clinician ratings, but in need of further study.
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Affiliation(s)
- Ann Faerden
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway.
| | - Siv Hege Lyngstad
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Carmen Simonsen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Petter Andreas Ringen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Oleg Papsuev
- Outpatient Psychiatry and Organization of Psychiatric Care Department, Moscow Research Institute of Psychiatry, Russia
| | - Ingrid Dieset
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway
| | - Ole A Andreassen
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
| | - Ingrid Agartz
- NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway; Diakonhjemmet Hospital, Oslo 0319, Norway
| | - Stephen R Marder
- Semel Institute for Neuroscience, University of California in Los Angeles, USA
| | - Ingrid Melle
- Clinic of mental health and addiction, Oslo University Hospital, Ulleval, Oslo 0407, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo 0318, Norway
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de Medeiros HLV, Vasconcelos SC, Elkis H, Martins DR, de Alexandria Leite RM, de Albuquerque ACL, Freitas RR, Scardoelli MA, Di Sarno E, Napolitano I, Oliveira GM, Vizzotto A, da Silva AMP, da Costa Lima MD. The Brief Negative Symptom Scale: Validation in a multicenter Brazilian study. Compr Psychiatry 2018; 85:42-47. [PMID: 29966891 DOI: 10.1016/j.comppsych.2018.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Negative symptoms are a core feature of schizophrenia. The Brief Negative Symptom Scale (BNSS) is a scale developed to measure negative symptoms in schizophrenia. METHODS The present study aimed to examine the construct validity of BNSS, by using convergent and divergent validities as well as factor analysis, in a Brazilian sample of 111 outpatients diagnosed with schizophrenia by DSM-5. Patients were evaluated by the Brazilian version of the BNSS and positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS). RESULTS Assessment of patients by both instruments revealed an excellent internal consistency (Cronbach's alpha = 0.938) or inter-rater reliability (ICC = 0.92), as well as a strong correlation between BNSS and Marder negative PANSS (r = 0.866) and a weak correlation of the instrument with the positive PANSS (r = 0.292), thus characterizing convergent and discriminant validities, respectively. The exploratory factor analysis identified two distinct factors, namely, motivation/pleasure and emotional expressivity, accounting for 68.63% of the total variance. CONCLUSION The study shows that the Brazilian version of the BNSS has adequate psychometric properties and is a reliable instrument for the assessment of negative symptoms in schizophrenia, either for clinical practice or research.
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Affiliation(s)
| | | | - Helio Elkis
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
| | - Diana Rocha Martins
- Federal University of Paraíba, Jardim Universitário STr, João Pessoa, PB, Brazil
| | | | | | | | | | - Elaine Di Sarno
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
| | - Isabel Napolitano
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
| | | | - Adriana Vizzotto
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
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Galderisi S, Mucci A, Buchanan RW, Arango C. Negative symptoms of schizophrenia: new developments and unanswered research questions. Lancet Psychiatry 2018; 5:664-677. [PMID: 29602739 DOI: 10.1016/s2215-0366(18)30050-6] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/03/2017] [Accepted: 12/13/2017] [Indexed: 01/05/2023]
Abstract
Negative symptoms of schizophrenia are associated with poor functional outcome and place a substantial burden on people with this disorder, their families, and health-care systems. We summarise the evolution of the conceptualisation of negative symptoms, the most important findings, and the remaining open questions. Several studies have shown that negative symptoms might be primary to schizophrenia or secondary to other factors, and that they cluster in the domains of avolition-apathy and expressive deficit. Failure to take this heterogeneity into account might hinder progress in research on neurobiological substrates and discoveries of treatments for primary or enduring negative symptoms. Improvement in recognition and routine assessment of negative symptoms is instrumental for correct management of secondary negative symptoms that are amenable to treatment. If substantial progress is to be made in the understanding and treatment of negative symptoms, then advances in concepts and assessment should be integrated into the design of future studies of these symptoms.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación en Red de Salud Mental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Effort-based decision-making paradigms as objective measures of apathy in schizophrenia? Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Krynicki CR, Upthegrove R, Deakin JFW, Barnes TRE. The relationship between negative symptoms and depression in schizophrenia: a systematic review. Acta Psychiatr Scand 2018. [PMID: 29532909 DOI: 10.1111/acps.12873] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To provide an update on the evidence base for the nature of the relationship between negative symptoms and depressive features in people with schizophrenia, and propose new models that reflect their complex relationship. METHOD A systematic review following PRISMA guidelines. A total of 2210 articles were identified from EMBASE, PsychInfo and MEDLINE, and further two articles were hand-searched from references. Twenty-seven met inclusion criteria and were included in the review. RESULTS In schizophrenia, primary evidence suggests symptoms of low mood, suicidal ideation and pessimism have more specificity for depression whereas alogia and blunted affect may have more specificity as negative symptoms. Anhedonia, anergia and avolition may be common to both. CONCLUSION It may be possible to further distinguish depressive features from negative symptoms in schizophrenia when detailed phenomenology is considered. However, in a proposed dimensional model, these two domains continue to share certain phenomena, highlighting their close relationship.
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Affiliation(s)
- C R Krynicki
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - R Upthegrove
- Institute for Mental Health, School of Psychology and Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - J F W Deakin
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, UK
| | - T R E Barnes
- Centre for Psychiatry, Imperial College, London, UK
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