Toward an understanding of anticipatory pleasure deficits in schizophrenia: Memory, prospection, and emotion experience

Social anhedonia in the daily lives of people with schizophrenia: Examination of anticipated and consummatory pleasure

Social anhedonia is a hallmark symptom of schizophrenia. Discrepancies in anticipated versus consummatory pleasure for non-social stimuli are well-documented. Thus, a similar emotional paradox may underlie social anhedonia. If so, our understanding of social anhedonia-including how to treat it in schizophrenia-could be enhanced. This project used a 5-day experience sampling method (ESM) to measure discrepancies between anticipated and consummatory pleasure for real-world social activities in people with schizophrenia and healthy controls (n = 30/group). ESM results were compared to laboratory assessments of negative symptoms and neurocognition. The schizophrenia group exhibited similar levels of anticipated and consummatory social pleasure as controls throughout daily life, and both groups were accurate in their short-term predictions of pleasure. Clinical interviews revealed those with schizophrenia showed significant deficits in long-term social pleasure prediction (i.e., a 1-week timeframe). Thus, people with schizophrenia may exhibit differences in ability to predict pleasure in the short-term versus the long-term. Negative symptoms and neurocognition were related to anticipated, but not consummatory, social pleasure, suggesting anhedonia is driven by deficits in thinking about pleasure, rather than inability to experience pleasure. Clinical implications include focusing on building upon short-term ability to predict pleasure in therapy to increase social motivation in schizophrenia.

The Future-oriented Repetitive Thought (FoRT) scale: Validation in Chinese samples and application in the schizophrenia spectrum

BACKGROUND

Repetitive thoughts are usually associated with psychopathology. The Future-oriented Repetitive Thought (FoRT) Scale is a measure designed to capture frequency of repetitive thought about positive and negative future events. However, the validity of the scale in Chinese population and its application in the schizophrenia spectrum have not been examined.

METHODS

The current study aimed to examine the psychometric properties of the Chinese version of the FoRT scale and to apply it to the schizophrenia spectrum. In Study 1, three samples (total N = 1875) of university students were recruited for exploratory factor analysis, confirmatory factor analysis, and validity test, respectively. In Study 2, we identified subsamples with high schizotypal traits (N = 89) and low schizotypal traits (N = 89), and recruited 36 inpatients with schizophrenia and 41 matched healthy controls.

RESULTS

The three-factor (pessimistic repetitive future thinking, repetitive thinking about future goals, and positive indulging about the future) structure of the FoRT scale with one item deleted, fitted the Chinese samples. And the scale could distinguish patients with schizophrenia and individuals with high schizotypal traits from controls.

CONCLUSION

These findings support that the Chinese version of the FoRT scale is a valid tool and provide evidence for the potential applications in the schizophrenia spectrum.

Prospection deficits in patients with first-episode schizophrenia: a cross-sectional comparative study

Prospection refers to the ability to simulate and pre-experience future events. Schizophrenia patients have difficulty in anticipating pleasure in future events, but previous studies examined prospection deficits in chronic schizophrenia patients. This study aimed to investigate prospection deficits in first-episode schizophrenia patients. Thirty first-episode schizophrenia patients and 31 healthy controls completed the Affective Prospection Task, which utilized pictorial cues to involve positive, neutral and negative prospection. Participants' ratings regarding the phenomenal characteristics of their prospected events were collected, and their prospected narratives were coded using a valid scoring manual. We also assessed intelligence, working memory and logical memory. The results showed, in all participants, valence of the cues significantly influenced participants' sense of pre-experience, temporal distance, emotion experience, vividness and participation of the prospected events, as well as the richness of sensory details. The two groups did not differ in self-report phenomenal characteristics of their prospected events. For coded characteristics, schizophrenia patients' prospected narratives were less rich in thought/emotion than controls, even after controlling for intelligence and memory deficits. We extended empirical evidence for prospection deficits from chronic schizophrenia samples to first-episode schizophrenia patients.

"Goals in Focus"-a targeted CBT approach for motivational negative symptoms of psychosis: study protocol for a randomized-controlled feasibility trial

BACKGROUND

The reduction of goal-directed behavior is the main characteristic in motivational negative symptoms of psychosis as it accounts for the long-term decline in psychological well-being and psychosocial functioning. However, the available treatment options are largely unspecific and show only small effects on motivational negative symptoms. Interventions that directly target the relevant psychological mechanisms are likely to be more effective. For "Goals in Focus", we translated findings from basic clinical research on mechanisms underlying motivational negative symptoms into a tailored and comprehensive novel psychological outpatient treatment program. With this study, we will test the feasibility of the therapy manual and the trial procedures. We also aim to examine first estimates of the effect size that can be expected from "Goals in Focus" to inform the sample size calculation of a subsequent fully powered trial.

METHODS

Thirty participants diagnosed with a schizophrenia spectrum disorder and at least moderate motivational negative symptoms will be randomly assigned to either 24 sessions of "Goals in Focus" over the course of 6 months (n = 15) or to a 6-month wait-list control group (n = 15). Single-blind assessments will be conducted at baseline (t₀) and 6 months after baseline completion (t₁). Feasibility outcomes include patient recruitment, retention, and attendance rates. Acceptability will be rated by trial therapists and by participants at end of treatment. Primary outcome for effect size estimation is the motivational negative symptom subscale sum score of the Brief Negative Symptom Scale at t₁ corrected for baseline values. Secondary outcomes include psychosocial functioning, psychological well-being, depressive symptoms, expressive negative symptoms, negative symptom factor scores, and goal pursuit in everyday life.

DISCUSSION

The feasibility and acceptability data will be used to improve trial procedures and the "Goals in Focus" intervention where necessary. The treatment effect on the primary outcome will provide the basis for the sample size calculation for a fully powered RCT.

TRIAL REGISTRATION

1) ClinicalTrials.gov, NCT05252039 . Registered on 23 February 2022. 2) Deutsches Register Klinischer Studien, DRKS00018083 . Registered on 28 August 2019.

Community-based multi-site randomized controlled trial of behavioral activation for patients with negative symptoms of schizophrenia

BACKGROUND

Negative symptoms are closely related to the poor prognosis of schizophrenia, for which there is no effective treatment to date. Behavioral activation (BA), which is an effective treatment for depression, is a behavioral approach that targets low levels of response-contingent positive reinforcement. This study aimed to explore BA as an effective intervention for relieving the negative symptoms of schizophrenia.

METHODS

This was a randomized single-blind controlled trial. Eighty-four patients with schizophrenia were enrolled in community mental health settings. Excluding 14 patients who opted out of the study, 70 were randomly assigned to receive BA in addition to treatment-as-usual (BA + TAU) or treatment-as-usual (TAU) only. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS) and Brief Negative Symptom Scale (BNSS) at baseline, post-treatment, and 6-months follow-up.

RESULTS

Significant differences between the BA + TAU and TAU only groups were observed in the measures of negative symptoms post-treatment. The total score of CAINS was significantly decreased after BA treatment (η² = 0.13). The tendency of the BA + TAU treatment effect was also observed for the BNSS total score and PANSS negative symptom subscale (η² = 0.10 and η² = 0.11, respectively). However, the difference between the two groups was not sustained at the six-month follow-up.

CONCLUSIONS

Our findings suggest that BA could be a promising time-limited and structured psychosocial intervention for schizophrenia-associated negative symptoms with the merit of easy dissemination. Further studies are needed to examine the factors involved in sustaining improvement.

The development of the Negative Bias in Prospection Scale: A novel assessment of dysfunctional prospection in depression

"Prospection" refers to the ability to mentally simulate one's future episodes. Negative bias in prospection, which includes both reduced positivity and enhanced negativity, is considered to be closely related to the development and maintenance of depression. However, there is a relative paucity of measures that adequately assess negative bias in prospection in depressed people. The current study developed and initially validated the Negative Bias in Prospection Scale (NBPS) using a nonclinical sample (n = 959). The validity and reliability of the NBPS were investigated in several ways. Results suggested the 14 NBPS items loaded onto three factors, namely the "Increased negativity," the "Reduced positivity," and the "Overgeneralization." The NBPS demonstrated decent internal consistency and test-retest reliability. Further, the NBPS was strongly associated with severity of depressive symptoms. Moreover, the NBPS was correlated in a theoretically meaningful way with other measures of future-oriented cognitions or negative biases. In conclusion, the NBPS has promising preliminary psychometric properties. It will be an efficient tool for exploring dysfunctional prospection in depression and provides a novel measure for mechanism of change in prospection-based interventions.

Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies

People with severe mental illness such as schizophrenia experience high physical comorbidity, leading to a 15-20-year mortality gap compared with the general population. Lifestyle behaviours such as physical activity (PA) play important roles in the quest to bridge this gap. Interventions to increase PA engagement in this population have potential to be efficacious; however, their effectiveness can be hindered by low participant engagement, including low adherence and high drop-out, and by implementation of interventions that are not designed to compensate for the cognitive and motivational impairments characteristic for this group. Moreover, and importantly, the negative symptoms of schizophrenia are associated with neurobiological changes in the brain, which-based on principles of biopsychology-can contribute to poor motivation and impaired decision-making processes and behavioural maintenance. To increase PA levels in people with schizophrenia, better understanding of these neurological changes that impact PA engagement is needed. This has the potential to inform the design of interventions that, through enhancement of motivation, could effectively increase PA levels in this specific population. Incorporating strategies that address the dopamine dysregulation associated with schizophrenia, such as boosting the role of reward and self-determined motivation, may improve long-term PA maintenance, leading to habitual PA. Consideration of motivation and behavioural maintenance is also needed to impart health benefits such as prevention of chronic disease, which is associated with currently low PA levels in this high metabolic risk population. Taking a biopsychological perspective, we outline the neural pathways involved in motivation that are impacted by schizophrenia and propose strategies for promoting motivation for and PA engagement from adoption to habit formation.

Enhancing future-directed thinking in people with first-episode psychosis using a guided imagery intervention

BACKGROUND AND OBJECTIVES

Future-directed thinking (FDT) is associated with goal directed behaviour and may differ in people with psychosis compared to non-clinical controls. This study investigated whether guided imagery could enhance positive FDT in people with psychosis.

METHOD

Participants were 44 people experiencing a first episode of psychosis. They were assessed for negative and positive symptoms, FDT on the Future Thinking Task (FTT), depression, anxiety, autobiographical memory, verbal fluency and spontaneous use of imagery. They were randomised to either a positive or neutral imagery condition, before being retested on the FTT. Outcomes on the FTT were number of events generated, anticipated likelihood, anticipated affect and a composite score.

RESULTS

Participants in the positive imagery condition generated significantly more positive events on the FTT compared with those in the neutral (F (1, 42) = 19.916, p < .001, η_p² = 0.322). In both imagery conditions, likelihood ratings of positive events increased post-intervention. Positive and negative events were both perceived as less likely to occur the further into the future they were, and positive events were anticipated to be more positive and negative events more negative, the further into the future they were.

LIMITATIONS

The participants in this study experienced relatively low levels of symptoms, and therefore caution should be used when applying these results to people with greater symptomatology.

CONCLUSIONS

Positive guided imagery shows promise for enhancing positive FDT in people with first-episode psychosis. This intervention may offer a simple and effective method of enhancing engagement with the future, with potential implications for goal-directed behaviour.

Functional disconnection between subsystems of the default mode network in schizophrenia

BACKGROUND

A dysfunctional default mode network (DMN) has been reported in patients with schizophrenia. However, the stability of the deficits has not been determined across different stages of the disorder.

METHODS

We examined the functional connectivity of the DMN subsystems of 125 patients with first-episode schizophrenia (FES) or recurrent schizophrenia (RES), compared to that of 82 healthy controls. We tested the robustness of the findings in an independent cohort of 158 patients and 39 healthy controls. We performed resting-state functional connectivity analysis, and examined the strength of the connections within and between the three subsystems of the DMN (core, dorsal medial prefrontal cortex [dMPFC], and medial temporal lobe [MTL]). We also analyzed the connectivity correlations to symptoms and illness duration.

RESULTS

We found reduced connectivity strength between the core and MTL subsystems in schizophrenia patients compared to controls, with no differences between the FES and RES patient groups; these findings were validated in the second sample. Schizophrenia patients also showed a significant reduction in connectivity within the MTL and between the dMPFC-MTL subsystems, similarly between FES and RES groups. The connectivity strength within the core subsystem was negatively correlated with clinical symptoms in schizophrenia. There was no significant correlation between the DMN subsystem connectivity and illness duration.

CONCLUSIONS

DMN subsystem connectivity deficits are present in schizophrenia, and the homochronicity of their appearance indicates the trait-like nature of these alterations. The DMN deficit may be useful for early diagnosis, and MTL dysfunction may be a crucial mechanism underlying schizophrenia.

Psychological Dimensions Relevant to Motivation and Pleasure in Schizophrenia

Motivation and pleasure deficits are common in schizophrenia, strongly linked with poorer functioning, and may reflect underlying alterations in brain functions governing reward processing and goal pursuit. While there is extensive research examining cognitive and reward mechanisms related to these deficits in schizophrenia, less attention has been paid to psychological characteristics that contribute to resilience against, or risk for, motivation and pleasure impairment. For example, psychological tendencies involving positive future expectancies (e.g., optimism) and effective affect management (e.g., reappraisal, mindfulness) are associated with aspects of reward anticipation and evaluation that optimally guide goal-directed behavior. Conversely, maladaptive thinking patterns (e.g., defeatist performance beliefs, asocial beliefs) and tendencies that amplify negative cognitions (e.g., rumination), may divert cognitive resources away from goal pursuit or reduce willingness to exert effort. Additionally, aspects of sociality, including the propensity to experience social connection as positive reinforcement may be particularly relevant for pursuing social goals. In the current review, we discuss the roles of several psychological characteristics with respect to motivation and pleasure in schizophrenia. We argue that individual variation in these psychological dimensions is relevant to the study of motivation and reward processing in schizophrenia, including interactions between these psychological dimensions and more well-characterized cognitive and reward processing contributors to motivation. We close by emphasizing the value of considering a broad set of modulating factors when studying motivation and pleasure functions in schizophrenia.

From Memories of Past Experiences to Present Motivation? A Meta-analysis on the Association Between Episodic Memory and Negative Symptoms in People With Psychosis

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.

Reduced specificity and increased overgenerality of autobiographical memory persist as cognitive vulnerabilities in remitted major depression: A meta-analysis

Difficulty in accessing specific memories, referred to as reduced memory specificity or overgeneral memory (OGM), has been established as a marker of clinical depression. However, it is not clear if this deficit persists following the remission of depressive episodes. The current study involved a systematic review and meta-analysis of empirical studies with the aim of establishing whether remitted depression was associated with retrieving fewer specific and more overgeneral autobiographical memories. Seventeen studies were identified as eligible. The results indicated that people with remitted depression recalled fewer specific memories (k = 15; g = -0.314, 95% CI [-0.543; -0.085], z = -2.69, p = .007) and more categoric memories (k = 9; g = 0.254, 95% CI [0.007; 0.501], z = 2.02, p = .043) compared to people who had never been depressed. Given these deficits have elsewhere been shown to be prognostic of future depressive symptoms, these findings suggest that reduced memory specificity/overgeneral memory persists following remission and may be a risk factor for future episodes of depression in those that are in remission. The findings are discussed in terms of how this knowledge might influence clinical understanding of relapse prevention and maintenance of remission in those with a history of depression.

Altered activation and functional connectivity in individuals with social anhedonia when envisioning positive future episodes

BACKGROUND

Anticipatory pleasure deficits are closely correlated with negative symptoms in schizophrenia, and may be found in both clinical and subclinical populations along the psychosis continuum. Prospection, which is an important component of anticipatory pleasure, is impaired in individuals with social anhedonia (SocAnh). In this study, we examined the neural correlates of envisioning positive future events in individuals with SocAnh.

METHODS

Forty-nine individuals with SocAnh and 33 matched controls were recruited to undergo functional MRI scanning, during which they were instructed to simulate positive or neutral future episodes according to cue words. Two stages of prospection were distinguished: construction and elaboration.

RESULTS

Reduced activation at the caudate and the precuneus when prospecting positive (v. neutral) future events was observed in individuals with SocAnh. Furthermore, compared with controls, increased functional connectivity between the caudate and the inferior occipital gyrus during positive (v. neutral) prospection was found in individuals with SocAnh. Both groups exhibited a similar pattern of brain activation for the construction v. elaboration contrast, regardless of the emotional context.

CONCLUSIONS

Our results provide further evidence on the neural mechanism of anticipatory pleasure deficits in subclinical individuals with SocAnh and suggest that altered cortico-striatal circuit may play a role in anticipatory pleasure deficits in these individuals.

The current state of memory Specificity Training (MeST) for emotional disorders

Memory Specificity Training (MeST) is an intervention developed from basic science that has found clinical utility. MeST uses cued recall exercises to target the difficulty that some people with emotional disorders have in recalling personally experienced events. MeST is simple enough to be delivered alongside traditional interventions or online by artificial intelligence. Currently, research indicates MeST's effects are immediate but short-lived, and there is limited research indicating its superiority over established interventions. Future investigations must establish the dosage and specific components of MeST that are necessary for clinically significant effects. Further, it must establish the secondary processes (e.g., problem-solving) that mediate between MeST-driven improvements in memory and symptoms. Similar interventions that build upon the idea of training autobiographical memory specificity are also emerging and warrant further investigation.

Cognitive mechanisms of episodic simulation in psychiatric populations

Episodic simulation is the construction of a mental representation of a specific autobiographical future event. Episodic simulation has increasingly been studied in psychiatric populations. Here we 1) review evidence indicating that episodic simulation is compromised in patients with depression, anxiety, schizophrenia, bipolar disorder, and PTSD; and 2) consider several potential cognitive mechanisms of episodic simulation in psychiatric populations: episodic retrieval, scene construction, mental imagery, components of the CaRFAX model (i.e., capture and rumination, functional avoidance, and executive functioning), and narrative style. We evaluate evidence regarding these mechanisms across psychiatric populations, and identify areas of future research. Understanding the factors that contribute to episodic simulation impairment in psychiatric populations may lead to targeted and effective treatment approaches.

Remembering the past to live better in the future: A feasibility randomised controlled trial of memory specificity training for motivation in psychosis

BACKGROUND AND OBJECTIVES

People with a diagnosis of psychosis often experience low motivation and reduced activity levels. Autobiographical memory deficits have been identified in people with psychosis and this may limit the role of memory retrieval in supporting motivation. This pilot study adapted a recently developed protocol, Memflex, which aims to enhance autobiographical memory and has shown promise in depression. Our brief intervention targets experiential negative symptoms of psychosis using supported autobiographical memory retrieval.

METHOD

A sample of 31 participants with psychosis were recruited from inpatient and community settings and randomised in a 2:1 ratio to either a basic recall control or an enhanced recall intervention group. Participants were asked to generate positive autobiographical memories linked to activities they wish to repeat in the future. The enhanced recall condition received additional prompts from the Memflex protocol, and the basic recall condition received no additional support.

RESULTS

The intervention delivered was acceptable (rated >80%) and feasible (94% adherence) to those who took part. Participants were able to generate positive autobiographical memories linked to their goals and experienced appropriate emotions linked to these. The controlled preliminary effect sizes (0.2-0.34) showed encouraging signals for self-efficacy, motivation and a reduction in negative mood.

LIMITATIONS

As this was a pilot study with a small sample size between-group tests of statistical significance were not conducted, and therefore findings should be interpreted with caution.

CONCLUSIONS

These findings suggest that guided autobiographical memory retrieval may be an effective way tool for targeting motivation in people with psychosis.

Lexical analysis of emotional responses to "real-world" experiences in individuals with schizophrenia

Abnormalities in emotion perception, expression, and experience are considered a core component of schizophrenia. Previous laboratory studies have demonstrated that while individuals with schizophrenia report levels of positive emotions comparable to healthy individuals in response to positive stimuli, they also report co-occurring negative emotions in response to such stimuli. However, it is unknown whether this response pattern extends to "real world" naturalistic environments. To examine this question, we employed an experience sampling method (ESM) approach using mobile electronic devices to collect information up to 10 times/day over a two-day period from 53 individuals with schizophrenia and 19 non-clinical controls. As part of each experience sample, participants completed brief open-ended responses and answered questions about their emotional responses to three recent events (neutral, positive, and negative). Additionally, participants completed diagnostic and clinical measures. Lexical analyses were used to analyze ESM-based word production and characterize emotion word use. Compared to non-clinical controls, individuals with schizophrenia reported similar levels of positive emotion, but significantly higher negative emotion, which was associated with increased negative symptoms. The schizophrenia group used more anxiety words in response to negative and neutral events, and more anger words in response to positive events. Increased use of anger words was linked with elevations in positive symptoms as well as symptoms of depression, while use of sadness words was linked with anhedonia. Our findings support the co-activation of negative emotion hypothesis documented in laboratory settings and provide evidence of its ecological validity. Implications for functioning and future directions are discussed.

Neural correlates of prospection impairments in schizophrenia: Evidence from voxel-based morphometry analysis

Prospection, which has a close relationship with motivation and goal-directed behavior, could be a potential target for alleviating negative symptoms. The present study aimed to examine the structural neural correlates of prospection impairments and the involvement of working memory in prospection in schizophrenia patients. Thirty-seven patients with schizophrenia and 28 healthy controls were recruited and all of them completed a prospection task. Working memory was assessed with the Letter Number Span test. In addition, all participants underwent a structural MRI scan. Voxel-based morphometry (VBM) analysis was used to measure grey matter (GM) volume. We found that in schizophrenia patients, GM loss in the right lateral prefrontal cortex (PFC) and the right ventral medial PFC was correlated with decreased internal details in the prospection task. Moreover, GM volume of the right lateral PFC was found to mediate the relationship between working memory and internal details in these patients. In conclusion, GM loss in the PFC is associated with prospection impairments in schizophrenia patients. Working memory deficits may partially account for prospection impairments in schizophrenia patients.

Functional connectivity of the default mode network is associated with prospection in schizophrenia patients and individuals with social anhedonia

BACKGROUND

Prospection, which is closely related to negative symptoms in patients with schizophrenia, is mainly associated with the Default Mode Network (DMN). Although abnormalities of the DMN have been reported in schizophrenia patients and at-risk individuals, little is known about the relationship between functional connectivity of the DMN and prospection in these clinical and subclinical populations.

METHOD

Study 1 recruited 40 schizophrenia patients and 29 healthy controls, while 31 individuals with social anhedonia (SocAhn) and 28 controls participated in Study 2. Participants in both studies were asked to complete a prospection task and underwent resting-state functional MRI scans. Eleven regions of interest (ROIs) in the DMN were defined. Functional connectivity between each ROI and whole brain voxels were calculated and compared between groups (schizophrenia vs. control and SocAhn vs. control). Correlation analysis was conducted between altered functional connectivity and prospection variables in the schizophrenia and SocAhn groups.

RESULTS

Schizophrenia patients showed both hyper-connectivity and hypo-connectivity at the medial temporal lobe (MTL) subsystem of the DMN. Decreased connectivity between the ventral medial prefrontal cortex (vMPFC) and the right superior temporal gyrus (rSTG) was correlated with poor thought/emotion details in prospection. In individuals with SocAhn, decreased connectivity between the retrosplenial cortex (Rsp), a region of the MTL subsystem, and the right fusiform gyrus, was found and this was correlated with their prospection performance.

CONCLUSION

Altered functional connectivity of the key nodes of the MTL subsystem was found in both patients with schizophrenia and individuals with SocAhn. Moreover, hypo-connectivity of the vMPFC was found to be correlated with prospection impairments in schizophrenia patients.

Nonsocial and social cognition in schizophrenia: current evidence and future directions

Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.

Toward an Understanding of Incongruent Affect in People With Schizophrenia

Previous studies have found that people with schizophrenia report more negative affect (NA) in response to positive and neutral stimuli (incongruent NA) than people without schizophrenia, perhaps related to heightened overall NA. We sought to decrease NA and increase positive affect (PA) using the Broad-Minded Affective Coping (BMAC) procedure in people with (n = 29) and without (n = 26) schizophrenia. We also investigated whether decreased NA would contribute to a decrease in incongruent NA in people with schizophrenia. The BMAC procedure increased PA but did not decrease NA in participants, nor did it influence reports of incongruent NA (in response to positive and neutral films) in people with schizophrenia. Baseline NA in people with schizophrenia was correlated with incongruent NA and symptom severity. Results indicate that people with schizophrenia report heightened NA that does not readily diminish in the face of heightened PA.

Anticipatory pleasure for future experiences in schizophrenia spectrum disorders and major depression: A systematic review and meta-analysis

OBJECTIVES

Deficits in anticipating pleasure may be an important dimension of anhedonia and functioning in psychiatric disorders, particularly schizophrenia and depression; however, inconsistent findings have limited the conclusions that can be drawn. We conducted the first systemic review and meta-analysis of the extant literature for research comparing psychiatric groups to healthy control groups on anticipatory pleasure.

METHODS

Academic Search Complete, Science Direct, and CINAHL databases were systematically searched up to 9 June 2018 for relevant peer-reviewed articles, book chapters, and dissertations. Reference lists were also hand searched. A total of 36 studies were included in the review.

RESULTS

A moderate-sized deficit was observed in schizophrenia spectrum disorders (k = 32, 1,851 patients and 1,449 controls, g = -0.42 [95% CI = -0.53 to -0.31], p < .001), and a large deficit in major depression (k = 415 patients and 506 controls, g = -0.87 [95% CI = -1.23 to -0.51], p < .001), with this effect being significantly larger for depression (p < .05). Meta-regression showed that heterogeneity was partially explained in schizophrenia spectrum by longer duration of illness and lower cognitive functioning predicting larger deficits. In depression, some evidence was found that ruling out a history of psychiatric illness in controls may be related to larger effects. There was evidence for small study bias inflating estimates in schizophrenia spectrum disorders.

CONCLUSIONS

Deficits in anticipatory pleasure are manifest in these disorders, and significantly more so in major depression. These findings indicate a possible therapeutic target to link cognitive, affective, and behavioural factors that precipitate and maintain disorder.

PRACTITIONER POINTS

Anticipatory pleasure is impaired in schizophrenia spectrum and major depression. A particular focus on enhancing anticipatory pleasure may improve motivation for rewarding behaviour and psychosocial functioning. The review contained only a small number of studies for major depression. Given the heterogeneity in effects, there are likely to be more moderators of anticipatory pleasure that require examination.

Profiling of experiential pleasure, emotional regulation and emotion expression in patients with schizophrenia

BACKGROUND

Emotion deficits may be the basis of negative symptoms in schizophrenia patients and they are prevalent in these patients. However, inconsistent findings about emotion deficits in schizophrenia suggest that there may be subtypes.

AIM

The present study aimed to examine and profile experiential pleasure, emotional regulation and expression in patients with schizophrenia.

METHODS

A set of checklists specifically capturing experiential pleasure, emotional regulation, emotion expression, depressive symptoms and anhedonia were administered to 146 in-patients with schizophrenia and 73 demographically-matched healthy controls. Psychiatric symptoms and negative symptoms were also evaluated by a trained psychiatrist for patients with schizophrenia.

RESULTS

Two-stage cluster analysis and discriminant function analysis were used to analyze the profile of these measures in patients with schizophrenia. We found a three-cluster solution. Cluster 1 (n=41) was characterized by a deficit in experiential pleasure and emotional regulation, Cluster 2 (n=47) was characterized by a general deficit in experiential pleasure, emotional regulation and emotion expression, and Cluster 3 (n=57) was characterized by a deficit in emotion expression. Results of a discriminant function analysis indicated that the three groups were reasonably discrete.

CONCLUSION

The present findings suggest that schizophrenia patients can be classified into three subtypes based on experiential pleasure, emotional regulation and emotion expression, which are characterized by distinct clinical representations.

Preliminary study of visual perspective in mental time travel in schizophrenia

This study explored specificity and visual perspective of mental time travel in schizophrenia. Fifteen patients with schizophrenia and 18 controls were recruited. Participants were asked to recall or imagine specific events according to cue words. Results showed that schizophrenia patients generated fewer specific events than controls, the recalled events were more specific than imagined events. Schizophrenia adopted less field perspective and more observer perspective than controls. These results suggested that patients with schizophrenia were impaired in mental time travel both in specificity and visual perspective. Further studies are needed to identify the underlying mechanisms.

Anticipatory Emotion in Schizophrenia

While people with schizophrenia report experiencing as much emotion in the presence of emotionally evocative stimuli as do people without schizophrenia, evidence suggests that they have deficits in the anticipation of positive emotion. However, little is known about the anticipation of negative emotion in schizophrenia, thus leaving open whether anticipation deficits are more general. We sought to assess anticipation of positive and negative stimuli across multiple methods of measurement. We measured reported experience and emotion modulated startle response in people with (n = 27) and without (n = 27) schizophrenia as they anticipated and subsequently viewed evocative pictures. People with schizophrenia showed an overall dampened response during the anticipation of positive and negative stimuli, suggesting a more general deficit in anticipatory emotional responses. Moreover, anticipatory responses were related to symptoms and functioning in people with schizophrenia. Together, these findings point to important new directions for understanding emotion deficits in schizophrenia.

Categorizing and assessing negative symptoms

PURPOSE OF REVIEW

To provide a review on studies published in the last year relevant to the categorization and assessment of negative symptoms.

RECENT FINDINGS

Recent research supported the validity of the 'deficit/non-deficit schizophrenia' categorization. Few studies confirmed the validity of the category 'persistent negative symptoms', whereas no recent study explored the validity of the category 'predominant negative symptoms'. The two-factor structure of the negative dimension is supported by studies reporting different correlates for the two subdomains: diminished expression and avolition/apathy. The need to further split avolition/apathy in two distinct components, that is anhedonia and amotivation, is confirmed in recent papers. Additional approaches to the assessment of negative symptoms have been proposed, including the self-assessment of negative symptoms, and the evaluation of negative symptoms in daily life and their assessment by means of computerized analyses.

SUMMARY

Negative symptoms represent an unmet need in the care of schizophrenia, as they are associated to poor response to available treatments and to poor functional outcome. Their accurate categorization and assessment represent a major challenge for research on neurobiological substrates and new treatment strategies.

A Review of Anticipatory Pleasure in Schizophrenia

PURPOSE OF REVIEW

Anhedonia, traditionally defined as a diminished capacity to experience pleasure, has long been considered a core symptom of schizophrenia. However, recent research calls into question whether individuals with schizophrenia are truly anhedonic, suggesting intact subjective and neurophysiological response to rewarding stimuli in-the-moment. Despite a presumably intact capacity to experience pleasure, people with schizophrenia still engage in fewer reward-seeking behaviors. This discrepancy has been explained as a dissociation between "liking" and "wanting", with dopaminergic and prefrontal influences on incentive salience leading hedonic responses to not effectively translate into motivated behavior. In the current review, the literature on a key aspect of the wanting deficit is reviewed, anticipatory pleasure.

RECENT FINDINGS

Results provide consistent evidence for impairment in some aspects of anticipatory pleasure (e.g., prospection, associative learning between reward predictive cues and outcomes), and inconsistent evidence for others (e.g., anticipatory affect and affective forecasting).

SUMMARY

Mechanisms underlying anticipatory pleasure abnormalities in schizophrenia are discussed and a new model of anticipatory pleasure deficits is proposed. Findings suggest that anticipatory pleasure may be a critical component of impairments in wanting that impact motivated behavior in schizophrenia.