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Luther L, Raugh IM, Grant PM, Beck AT, Strauss GP. The Role of Defeatist Performance Beliefs in State Fluctuations of Negative Symptoms in Schizophrenia Measured in Daily Life via Ecological Momentary Assessment. Schizophr Bull 2024:sbae128. [PMID: 39066666 DOI: 10.1093/schbul/sbae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND HYPOTHESIS The Cognitive Model of Negative Symptoms is a prominent model that posits that defeatist performance beliefs (DPB) are a key psychological mechanism underlying negative symptoms in those with schizophrenia (SZ). However, the ecological validity of the model has not been established, and temporally specific evaluations of the model's hypotheses have not been conducted. This study tested the model's key hypotheses in real-world environments using ecological momentary assessment (EMA). STUDY DESIGN Fifty-two outpatients with SZ and 55 healthy controls (CN) completed 6 days of EMA. Multilevel models examined concurrent and time-lagged associations between DPB and negative symptoms in daily life. STUDY RESULTS SZ displayed greater DPB in daily life than CN. Furthermore, greater DPB were associated with greater concurrently assessed negative symptoms (anhedonia, avolition, and asociality) in daily life. Time-lagged analyses indicated that in both groups, greater DPB at time t led to elevations in negative symptoms (anhedonia, avolition, or asociality) at t + 1 above and beyond the effects of negative symptoms at time t. CONCLUSIONS Results support the ecological validity of the Cognitive Model of Negative Symptoms and identify a temporally specific association between DPB and subsequent negative symptoms that is consistent with the model's hypotheses and a putative mechanistic pathway in Cognitive Behavioral Therapy for negative symptoms. Findings suggest that DPB are a psychological factor contributing to negative symptoms in real-world environments. Implications for measuring DPB in daily life and providing just-in-time mobile health-based interventions to target this mechanism are discussed.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
| | - Paul M Grant
- Center for Recovery-Oriented Cognitive Therapy, Beck Institute, Philadelphia, PA
| | - Aaron T Beck
- Center for Recovery-Oriented Cognitive Therapy, Beck Institute, Philadelphia, PA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
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2
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Stocks JK, Shields AN, DeBoer AB, Cerny BM, Ogram Buckley CM, Ovsiew GP, Jennette KJ, Resch ZJ, Basurto KS, Song W, Pliskin NH, Soble JR. The impact of visual memory impairment on Victoria Symptom Validity Test performance: A known-groups analysis. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:329-338. [PMID: 34985401 DOI: 10.1080/23279095.2021.2021911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We assessed the effect of visual learning and recall impairment on Victoria Symptom Validity Test (VSVT) accuracy and response latency for Easy, Difficult, and Total Items. METHOD A sample of 163 adult patients administered the VSVT and Brief Visuospatial Memory Test-Revised were classified as valid (114/163) or invalid (49/163) groups via independent criterion performance validity tests (PVTs). Classification accuracies for all VSVT indices were examined for the overall sample, and separately for subgroups based on visual memory functioning. RESULTS In the overall sample, all indices produced acceptable classification accuracy (areas under the curve [AUCs] ≥ 0.79). When stratified by visual learning/recall impairment, accuracy indices yielded acceptable classification for both the unimpaired (AUCs ≥0.79) and impaired subsamples (AUCs ≥0.75). Latency indices had acceptable classification accuracy for the unimpaired subsample (AUCs ≥0.74), but accuracy and sensitivity dropped for the impaired sample (AUCs ≥0.67). CONCLUSIONS VSVT accuracy and response latency yielded acceptable classification accuracies in the overall sample, and this effect was maintained in those with and without visual learning/recall impairment for the accuracy indices. Findings indicate that the VSVT is a psychometrically robust PVT with largely invariant cut-scores, even in the presence of bona fide visual learning/recall impairment.
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Affiliation(s)
- Jane K Stocks
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison N Shields
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Adam B DeBoer
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Wheaton College, Wheaton, IL, USA
| | - Brian M Cerny
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | | | - Gabriel P Ovsiew
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Kyle J Jennette
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Zachary J Resch
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Karen S Basurto
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Woojin Song
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Neil H Pliskin
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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3
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Akgül Ö, Fide E, Özel F, Alptekin K, Bora E, Akdede BB, Yener G. Enhanced Punishment Responses in Patients With Schizophrenia: An Event-Related Potential Study. Clin EEG Neurosci 2024; 55:219-229. [PMID: 37563908 DOI: 10.1177/15500594231190966] [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: 08/12/2023]
Abstract
It is well known that abnormal reward processing is a characteristic feature of various psychopathologies including schizophrenia. Reduced reward anticipation has been suggested as a core symptom of schizophrenia. The Monetary Incentive Delay Task (MID) is frequently used to detect reward anticipation. The present study aims to evaluate the amplitude and latency of event-related potential (ERP) P300 in patients with schizophrenia (SCH) compared to healthy controls during the MID task. Twenty patients with SCH and 21 demographically matched healthy controls (HC) were included in the study. ERP P300 amplitude and latency values were compared between groups using an MID task in which reward and loss cues were presented. Relations between P300 and clinical facets were investigated in the patient group. SCH group had enhanced mean P300 amplitudes and delayed peak latency in the punishment condition compared with HC. These higher responses were also associated with negative symptoms. SCH group showed altered reward processing as being more sensitive to loss of reward conditions as firstly evidenced by electrophysiological methods, possibly due to abnormality in various systems including social withdrawal, social defeat, and behavioral inhibition system.
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Affiliation(s)
- Özge Akgül
- Faculty of Arts and Sciences, Department of Psychology, Izmir Democracy University, Izmir, Turkey
| | - Ezgi Fide
- Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | - Fatih Özel
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Köksal Alptekin
- Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
- Faculty of Medicine, Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey
| | - Emre Bora
- Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
- Faculty of Medicine, Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey
| | - Berna Binnur Akdede
- Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
- Faculty of Medicine, Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey
| | - Görsev Yener
- Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, Izmir, Turkey
- Faculty of Medicine, Department of Neurology, Izmir University of Economics, Izmir, Turkey
- Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
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4
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Akgül Ö, Fide E, Özel F, Alptekin K, Bora E, Akdede BB, Yener G. Reduced Reward Processing in Schizophrenia: A Comprehensive EEG Event-Related Oscillation Study. Brain Topogr 2024; 37:126-137. [PMID: 38078985 DOI: 10.1007/s10548-023-01021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/03/2023] [Indexed: 01/07/2024]
Abstract
It is well known that abnormal reward processing is a characteristic feature of various psychopathologies including schizophrenia (SZ). Reduced reward anticipation has been suggested as a core symptom of SZ. The present study aims to evaluate the event-related oscillations (EROs) delta, theta, alpha, beta, and gamma in patients with SZ during the Monetary Incentive Delay (MID) task, which elicits the neural activity of reward processing. Twenty-one patients with SZ and twenty-two demographically matched healthy controls were included in the study. EROs were compared between groups and correlation analyses were conducted to determine a possible relationship between clinical scores and ERO values. Compared with healthy controls, the SZ group had reduced (1) delta and theta amplitudes in the reward condition (2) total beta and non-incentive cue-related beta amplitudes, and (3) incentive cue-related frontal gamma amplitudes. These reductions can be interpreted as impaired dopaminergic neurotransmission and disrupted cognitive functioning in the reward processing of SZ. In contrast, SZ patients showed higher incentive cue-related theta and occipital gamma amplitudes compared to controls. These increments may reflect negative symptoms in SZ. Moreover, theta amplitudes showed a negative correlation with Calgary Depression Scale for Schizophrenia scores and a positive correlation with attentional impulsivity. This is the first study showing the impairments of SZ patients in EROs from delta to gamma frequency bands compared with healthy controls during reward anticipation. Being the first comprehensive study, our results can be interpreted as providing evidence for disrupted brain dynamics in the reward processing of SZ studied by EROs. It may become possible to help patients' wellness by improving our understanding of reward processing in schizophrenia and developing innovative rehabilitation treatments based on these findings.
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Affiliation(s)
- Özge Akgül
- Department of Psychology, Faculty of Arts and Sciences, İzmir Democracy University, Izmir, Turkey
| | - Ezgi Fide
- Department of Neurosciences, Dokuz Eylul University, Izmir, Turkey
| | - Fatih Özel
- Department of Organismal Biology, Uppsala University, Uppsala, Sweden
| | - Köksal Alptekin
- Department of Neurosciences, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Emre Bora
- Department of Neurosciences, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Berna Binnur Akdede
- Department of Neurosciences, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Görsev Yener
- Department of Neurosciences, Dokuz Eylul University, Izmir, Turkey.
- Department of Neurology, Faculty of Medicine, İzmir University of Economics, Izmir, Turkey.
- Izmir International Biomedicine and Genome Institute, Izmir, Turkey.
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Legemaat AM, Haagedoorn MAS, Burger H, Denys D, Bockting CL, Geurtsen GJ. Is suboptimal effort an issue? A systematic review on neuropsychological performance validity in major depressive disorder. J Affect Disord 2023; 323:731-740. [PMID: 36528136 DOI: 10.1016/j.jad.2022.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 11/25/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Major Depressive Disorder (MDD), emotion- and motivation related symptoms may affect effort during neuropsychological testing. Performance Validity Tests (PVT's) are therefore essential, but are rarely mentioned in research on cognitive functioning in MDD. We aimed to assess the proportion of MDD patients with demonstrated valid performance and determine cognitive functioning in patients with valid performance. This is the first systematic review on neuropsychological performance validity in MDD. METHODS Databases PubMed, PsycINFO, Embase, and Cochrane Library were searched for studies reporting on PVT results of adult MDD patients. We meta-analyzed the proportion of MDD patients with PVT scores indicative of valid performance. RESULTS Seven studies with a total of 409 MDD patients fulfilled inclusion criteria. Six studies reported the exact proportion of patients with PVT scores indicative of valid performance, which ranged from 60 to 100 % with a proportion estimate of 94 %. Four studies reported on cognitive functioning in MDD patients with valid performance. Two out of these studies found memory impairment in a minority of MDD patients and two out of these studies found no cognitive impairment. LIMITATIONS Small number of studies and small sample sizes. CONCLUSIONS A surprisingly small number of studies reported on PVT in MDD. About 94 % of MDD patients in studies using PVT's had valid neuropsychological test performance. Concessive information regarding cognitive functioning in MDD patients with valid performance was lacking. Neuropsychological performance validity should be taken into account since this may alter conclusions regarding cognitive functioning.
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Affiliation(s)
- Amanda M Legemaat
- Department of Psychiatry Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Marcella A S Haagedoorn
- Department of Geriatric Psychiatry, Mental Health Care North-Holland North, Maelsonstraat 1, 1624 NP Hoorn, the Netherlands
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Claudi L Bockting
- Department of Psychiatry Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, Oude Turfmarkt 147, 1012 GC Amsterdam, the Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam Neuroscience & Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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6
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Zhang J, Wang R, Xue Y. Deconstructing Mechanisms of Abnormal Categorical Perception of Emotional Facial Expressions in Schizophrenia Patients. Psychiatry Investig 2022; 19:991-999. [PMID: 36588433 PMCID: PMC9806511 DOI: 10.30773/pi.2022.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/25/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The current study aims to find out the potential reasons why most schizophrenia patients have a relatively low sensitivity to the classification of emotional facial expressions. METHODS By using an emotional categorical perception task, eighty-three schizophrenia patients and seventy-one healthy adults are provided with morphed emotional continuums with two emotional facial expressions (a positive emotional valence: happy; a negative emotional valence: sad). RESULTS Through comparing the difference between schizophrenia patients and healthy adults in the processes of estimating facial expressions with ambiguous emotions, we find that the pattern of emotional categorical perception for schizophrenia patients is significantly different from that of healthy controls when they process signals on the local facial areas. Compared to healthy people, schizophrenia patients have a significantly separate classification pattern in processing emotional signals between the eyes and mouth regions. It indicates that compared to healthy adults, schizophrenia patients have larger conflicts in integrating emotional signals from different facial areas. To overcome conflicts, more cognitive resources are required. Unfortunately, the lack of cognitive resources leads to the failure of integration, which further increases the difficulty of estimating facial expressions with ambiguous emotions, and finally leads to the relatively low sensitivity of emotional facial expressions classification. CONCLUSION To sum up, the deficit of abnormal perceptions of emotional facial expressions in schizophrenia patients results from an integrated deficit of signals on facial areas.
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Affiliation(s)
- Jian Zhang
- School of Psychology, Guizhou Normal University, Guiyang, China
| | - Ruomin Wang
- Department of Economics, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Yunzhen Xue
- Department of Humanities and Social Science, Shanxi Medical University, Taiyuan, China
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7
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Lee BG, Kent JA, Marcopulos BA, Arredondo BC, Wilson M. Rey-Osterrieth complex figure normative data for the psychiatric population. Clin Neuropsychol 2022; 36:1653-1678. [PMID: 33706660 DOI: 10.1080/13854046.2021.1897163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Appropriate normative data are crucial for competent neuropsychological assessment. Although individuals with psychiatric illness often perform more poorly than healthy adults on neuropsychological testing, data that reflect the psychiatric population are often lacking. We present a normative dataset and calculation tools for the Rey-Osterrieth Complex Figure Test (RCFT) derived from the psychiatric inpatient population. Method: A sample of 301 psychiatric inpatients completed the RCFT and the Test of Memory Malingering (TOMM) between 1999 and 2018. Participants were 59.5% male, 82.1% Caucasian, 13.3% black, and 4.6% identified as another racial demographic, largely consistent with recent Substance Abuse and Mental Health Services Administration (2018) data for inpatients in U.S. psychiatric facilities. Scores for RCFT Copy, Short-Delay Free Recall, Long-Delay Free Recall, Total Recognition, and Percent Retained were modeled via multiple regression with age and education as predictors. Base rates were computed for subscores comprising Total Recognition to aid clinical decision making. Results: Age and education served as significant individual predictors for all models except one model predicting percent retained across delay that included only age. Regression equations and regression standard errors were used to produce a score calculator using a commonly available spreadsheet software package. Healthy adult norms under-estimated performance in our sample, underscoring the importance of these normative data. Conclusions: These normative data for the RCFT represent a large cohort of psychiatric inpatients. For clinical practice and research, both the data and the tools provided are likely to be of particular usefulness among individuals with serious mental illness.
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Affiliation(s)
- Bern G Lee
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Behavioral Medicine, Neuropsychology Laboratory, Western State Hospital, Staunton, VA, USA
| | - Julie-Ann Kent
- Department of Behavioral Medicine, Neuropsychology Laboratory, Western State Hospital, Staunton, VA, USA
| | - Bernice A Marcopulos
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Graduate Psychology, James Madison University, Harrisonburg, VA, USA
| | | | - Monique Wilson
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Behavioral Medicine, Neuropsychology Laboratory, Western State Hospital, Staunton, VA, USA
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8
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Devoe DJ, Cadenhead KS, Cornblatt B, Granholm E, Addington J. Negative symptoms: associations with defeatist beliefs, self-efficacy, and maladaptive schemas in youth and young adults at-risk for psychosis. Behav Cogn Psychother 2021; 50:1-14. [PMID: 34784991 DOI: 10.1017/s1352465821000461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Investigations into possible mechanisms that may contribute to the development, maintenance, and exacerbation of negative symptoms are needed. Defeatist beliefs, self-efficacy, and early maladaptive schemas have been shown to contribute to negative symptoms in schizophrenia. Likewise, negative symptoms occur in those at clinical high-risk (CHR) for psychosis. AIMS The aim of this study was to determine if negative symptoms were associated with defeatist beliefs, self-efficacy, and early maladaptive schemas in CHR participants of a group therapy intervention study. METHOD All CHR participants (n = 203; 99 males, 104 females) were recruited as part of a three-site randomized control trial: Recovery through Group Study (ReGroup). Negative symptoms, defeatist beliefs, self-efficacy and early maladaptive schemas were assessed by trained clinical raters. Mediation analyses were conducted to examine the relationship between defeatist beliefs, self-efficacy, functioning, and negative symptoms. RESULTS The majority of CHR youth (72.9%) had at least one negative symptom of moderate to above moderate severity at baseline. In multiple mediation analyses, both asocial beliefs and social self-efficacy mediated the effects of social functioning on negative symptoms. Finally, defeatist performance attitudes significantly mediated the effects of role functioning on negative symptoms. CONCLUSIONS These results highlight the importance of considering beliefs and attitudes in relation to functioning and severity of negative symptoms. Psychosocial interventions may wish to target beliefs and attitudes in effort to reduce negative symptoms and improve functioning in CHR youth.
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Affiliation(s)
- Daniel J Devoe
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - K S Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Barbara Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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9
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Clay KB, Raugh IM, Bartolomeo LA, Strauss GP. Defeatist performance beliefs in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Early Interv Psychiatry 2021; 15:865-873. [PMID: 32743974 DOI: 10.1111/eip.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high-risk (CHR) for psychosis. METHODS Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition. RESULTS Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's < .01). In SZ, higher DPBs were associated with greater negative symptoms (r's = .31-.37, p's < .01), poorer social functioning and impaired social cognition (r = -.40, P < .001). In CHR, greater DPBs were associated with poorer social functioning (r = -.52, P < .05) and impairments in the neurocognitive domains of reasoning (r = -.48, P < .05) and processing speed (r = -.41, P < .05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples. CONCLUSIONS Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness.
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Affiliation(s)
- Kendall B Clay
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Lisa A Bartolomeo
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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10
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Anxiety and executive functions relationships in schizophrenia: A meta-analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110643] [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: 11/19/2022]
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11
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Grossman MJ, Bowie CR. Money talks: The influence of extrinsic motivators on social cognition in early episode psychosis. Schizophr Res 2021; 233:52-59. [PMID: 34225027 DOI: 10.1016/j.schres.2021.06.017] [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] [Received: 10/25/2020] [Revised: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
Amotivation is a central feature of psychosis that can lead to underperformance on a variety of tasks, including neurocognitive testing; however, there is some evidence that neurocognitive impairments resulting from low effort can be ameliorated with the use of monetary reinforcement. While cross-sectional data has also shown that amotivation is associated with social cognitive performance, limited research has examined the directionality of this relationship, and whether monetary reinforcement can similarly reduce these impairments. In the present study, 35 patients with early psychosis and 35 community controls were randomized to either a reward condition in which they received monetary reinforcement for every correct response on a theory of mind (ToM) task, or a non-reward condition in which no feedback was provided. A significant group by condition interaction emerged after adjusting for premorbid intelligence and global neurocognition, F(1, 63) = 7.76, p = .007. Post-hoc analyses revealed that performance on the ToM task was similar across conditions for controls, whereas early psychosis patients in the reward condition had clinically and statistically significant differences in ToM performance compared to patients in the non-reward condition. These results suggest that social cognitive task performance may underrepresent actual ability in the early stages of psychosis. Future research is needed to discriminate the relative effects of monetary reinforcement, corrective feedback, and/or a combination of these factors to better understand performance differences between conditions, which appeared to be unique to early psychosis patients.
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Affiliation(s)
- Michael J Grossman
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON K7L 3N6, Canada; Heads Up! Early Psychosis Intervention Program, Hotel Dieu Hospital, Kingston, ON K7L 5G2, Canada
| | - Christopher R Bowie
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON K7L 3N6, Canada; Heads Up! Early Psychosis Intervention Program, Hotel Dieu Hospital, Kingston, ON K7L 5G2, Canada.
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12
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Le TP, Moscardini E, Cowan T, Elvevåg B, Holmlund TB, Foltz PW, Tucker RP, Schwartz EK, Cohen AS. Predicting self-injurious thoughts in daily life using ambulatory assessment of state cognition. J Psychiatr Res 2021; 138:335-341. [PMID: 33895607 DOI: 10.1016/j.jpsychires.2021.04.013] [Citation(s) in RCA: 3] [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] [Received: 06/11/2020] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 01/22/2023]
Abstract
Self-injurious thoughts (SITs) fluctuate considerably from moment to moment. As such, "static" and temporally stable predictors (e.g., demographic variables, prior history) are suboptimal in predicting imminent SITs. This concern is particularly true for "online" cognitive abilities, which are important for understanding SITs, but are typically measured using tests selected for temporal stability. Advances in ambulatory assessments (i.e., real-time assessment in a naturalistic environment) allow for measuring cognition with improved temporal resolution. The present study measured relationships between "state" cognitive performance, measured using an ambulatory-based Trail Making Test, and SITs. Self-reported state hope and social connectedness was also measured. Data were collected using a specially designed mobile application (administered 4x/week up to 28 days) in substance use inpatients (N = 99). Consistent with prior literature, state hope and social connectedness was significantly associated with state SITs. Importantly, poorer state cognitive performance also significantly predicted state SITs, independent of hallmark static and state self-report risk variables. These findings highlight the potential importance of "online" cognition to predict SITs. Ambulatory recording reflects an efficient, sensitive, and ecological valid methodology for evaluating subjective and objectives predictors of imminent SITs.
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Affiliation(s)
- Thanh P Le
- Department of Psychology, Louisiana State University, USA.
| | | | - Tovah Cowan
- Department of Psychology, Louisiana State University, USA
| | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Norway; The Norwegian Centre for eHealth Research, University Hospital of North Norway, Norway
| | - Terje B Holmlund
- Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Norway
| | - Peter W Foltz
- Institue of Cognitive Science, University of Colorado Boulder, USA
| | | | | | - Alex S Cohen
- Department of Psychology, Louisiana State University, USA
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Victoria Symptom Validity Test: A Systematic Review and Cross-Validation Study. Neuropsychol Rev 2021; 31:331-348. [PMID: 33433828 DOI: 10.1007/s11065-021-09477-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/03/2021] [Indexed: 12/12/2022]
Abstract
The Victoria Symptom Validity Test (VSVT) is a performance validity test (PVT) with over two decades of empirical backing, although methodological limitations within the extant literature restrict its clinical and research generalizability. Chief among these constraints includes limited consensus on the most accurate index within the VSVT and the most appropriate cut-scores within each VSVT validity index. The current systematic review synthesizes existing VSVT validation studies and provides additional cross-validation in an independent sample using a known-groups design. We completed a systematic search of the literature, identifying 17 peer-reviewed studies for synthesis (7 simulation designs, 7 differential prevalence designs, and 3 known-groups designs). The independent cross-validation sample consisted of 200 mixed clinical neuropsychiatric patients referred for outpatient neuropsychological evaluation. Across all indices, Total item accuracy produced the strongest psychometric properties at an optimal cut-score of ≤ 40 (62% sensitivity/88% specificity). However, ROC curve analyses for all VSVT indices yielded statistically significant areas under the curve (AUCs; .73-81), suggestive of moderate classification accuracy. Cut-scores derived using the independent cross-validation sample converged with some previous findings supporting cut-scores of ≤ 22 for Easy item accuracy and ≤ 40 for Total item accuracy, although divergent findings were noted for Difficult item accuracy. Overall, VSVT validity indicators have adequate diagnostic accuracy across populations, with the current study providing additional support for its use as a psychometrically sound PVT in clinical settings. However, caution is recommended among patients with certain verified clinical conditions (e.g., dementia) and those with pronounced working memory deficits due to concerns for increased risk of false positives.
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14
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Devoe DJ, Lu L, Cannon TD, Cadenhead KS, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Woods SW, Walker EF, Mathalon DH, Bearden CE, Addington J. Persistent negative symptoms in youth at clinical high risk for psychosis: A longitudinal study. Schizophr Res 2021; 227:28-37. [PMID: 32362460 PMCID: PMC7606256 DOI: 10.1016/j.schres.2020.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/29/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Severity of negative symptoms has been associated with poor functioning, cognitive deficits, and defeatist beliefs in schizophrenia patients. However, one area that remains understudied is persistent negative symptoms (PNS). Negative symptoms, including PNS, have been observed in those at clinical high-risk (CHR) for psychosis. The aim of this study was to determine if PNS were associated with functioning, neurocognition, and defeatist beliefs in a CHR sample. METHOD CHR participants (n = 764) were recruited for the North American Prodrome Longitudinal Study. Negative symptoms were rated on the Scale of Psychosis-risk Symptoms. Generalized linear mixed models for repeated measures were used to examine changes over time between and within groups (PNS vs non-PNS). RESULTS The PNS group (n = 67) had significant deficits in functioning at baseline, 6, 12, 18, and 24-months compared to the non-PNS group (n = 673). Functioning improved over time in the non-PNS group, while functioning in the PNS group remained relatively stable and poor over a two-year period. A consistent trend emerged demonstrating higher defeatist beliefs in the PNS group; however, this result was lost when controlling for persistent depressive symptoms. There were no significant differences between the groups on neurocognition, social cognition, and transition to psychosis. CONCLUSIONS PNS exist in youth at CHR for psychosis, resulting in significant and persistent functional impairment, which remains when controlling for persistent depressive symptoms. PNS remain even in CHR youth who do not transition to psychosis. Thus, PNS may represent an unmet therapeutic need in CHR populations for which there are currently no effective treatments.
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Affiliation(s)
- D J Devoe
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - L Lu
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - T D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States
| | - K S Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - B A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Queens, NY, United States
| | - T H McGlashan
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - D O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - L J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States
| | - M T Tsuang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Institute of Genomic Medicine, University of California, La Jolla, CA, United States
| | - S W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - E F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - D H Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, United States; Psychiatry Service, San Francisco, CA, United States
| | - C E Bearden
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States; Department Biobehavioral Sciences and Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - J Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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15
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Lutz O, Lizano P, Mothi SS, Zeng V, Hegde RR, Hoang DT, Henson P, Brady R, Tamminga CA, Pearlson G, Clementz BA, Sweeney JA, Keshavan MS. Do neurobiological differences exist between paranoid and non-paranoid schizophrenia? Findings from the bipolar schizophrenia network on intermediate phenotypes study. Schizophr Res 2020; 223:96-104. [PMID: 32507376 DOI: 10.1016/j.schres.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/23/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
Subtypes of schizophrenia, constructed using clinical phenomenology to resolve illness heterogeneity, have faced criticism due to overlapping symptomatology and longitudinal instability; they were therefore dropped from the Diagnostic Statistical Manual-5. Cognitive and imaging findings comparing paranoid (P-SZ) and non-paranoid (disorganized, residual and undifferentiated; NP-SZ) schizophrenia have been limited due to small sample sizes. We assessed P-SZ and NP-SZ using symptomatology, cognition and brain structure and predicted that there would be few neurobiological differences. P-SZ (n = 237), NP-SZ (n = 127) and controls (n = 430) were included from a multi-site study. In a subset of this sample, structural imaging measures (P-SZ, n = 133; NP-SZ, n = 67; controls, n = 310) were calculated using Freesurfer 6.0. Group contrasts were run using analysis of covariance, controlling for age, sex, race and site, p-values were corrected using False Discovery Rate (FDR) and were repeated excluding the residual subtype. Compared to NP-SZ (with and without the residual subtype), P-SZ displayed fewer negative symptoms, faster speed of processing, larger bilateral hippocampus, right amygdala and their subfield volumes. Additionally, NP-SZ (with residual subtype) displayed fewer depressive symptoms and higher left transverse temporal cortical thickness (CT) but NP-SZ without residual subtype showed lower GAF scores and worse digit sequencing compared to P-SZ. No differences in positive symptoms and functioning (global or social) were detected. Subtle but significant differences were seen in cognition, symptoms, CT and subcortical volumes between P-SZ and NP-SZ. While the magnitude of these differences is not large enough to justify them as distinct categories, the paranoid- nonparanoid distinction in schizophrenia merits further investigation.
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Affiliation(s)
- Olivia Lutz
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Suraj Sarvode Mothi
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Victor Zeng
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Rachal R Hegde
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Dung T Hoang
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Philip Henson
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Roscoe Brady
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Godfrey Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Brett A Clementz
- Department of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, United States of America
| | - John A Sweeney
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH, United States of America
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
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16
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A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders. Neuropsychol Rev 2020; 30:407-424. [PMID: 32766940 DOI: 10.1007/s11065-020-09448-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
Abstract
Psychotic disorders are characterized by a generalized neurocognitive deficit (i.e., performance 1.5 SD below controls across neuropsychological domains with no specific profile of differential deficits). A motivational account of the generalized neurocognitive deficit has been proposed, which attributes poor neuropsychological testing performance to low effort. However, findings are inconsistent regarding effort test failure rate in individuals with psychotic disorders across studies (0-72%), and moderators are unclear, making it difficult to know whether the motivational explanation is viable. To address these issues, a meta-analysis was performed on data from 2205 individuals with psychotic disorders across 19 studies with 24 independent effects. Effort failure rate was examined along with moderators of effort test type, forensic status, IQ, positive symptoms, negative symptoms, diagnosis, age, gender, education, and antipsychotic use. The pooled weighted effort test failure rate was 18% across studies and there was a moderate pooled association between effort failure rate and global neurocognitive performance (r = .57). IQ and education significantly moderated failure rate. Collectively, these findings suggest that a nontrivial proportion of individuals with a psychotic disorder fail effort testing, and failure rate is associated with global neuropsychological impairment. However, given that effort tests are not immune to the effects of IQ in psychotic disorders, these results cannot attest to the viability of the motivational account of the generalized neurocognitive deficit. Furthermore, the significant moderating effect of IQ and education on effort test performance suggests that effort tests have questionable validity in this population and should be interpreted with caution.
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17
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Luther L, Suor JH, Rosen C, Jobe TH, Faull RN, Harrow M. Clarifying the direction of impact of negative symptoms and neurocognition on prospective work functioning in psychosis: A 20-year longitudinal study. Schizophr Res 2020; 220:232-239. [PMID: 32201031 PMCID: PMC8523216 DOI: 10.1016/j.schres.2020.03.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/16/2022]
Abstract
Both neurocognition and negative symptoms have demonstrated strong links to functional outcomes, such as work functioning, among those with severe mental illness (SMI). Prior models have suggested that reduced neurocognition 1) precedes or predicts greater negative symptoms and 2) indirectly influences functional outcomes via its impact on negative symptoms. The current study sought to also test a divergent model: whether greater negative symptoms predict reduced neurocognition and indirectly influence work functioning through their impact on neurocognition. Both models were tested using cross-sectional and prospective data spanning 20-years in a sample of 277 people with a SMI with psychotic features. Results showed that both models were supported in cross-sectional analyses. However, in prospective models predicting work functioning, only the models examining the indirect influence of negative symptoms on work functioning (7.5 to up to 20-years later) through neurocognition demonstrated significant mediation (i.e., a significant indirect effect); further, higher negative symptoms significantly predicted lower prospective neurocognition, while lower neurocognition did not significantly predict greater prospective negative symptoms. Although cross-sectional data were consistent with prior models, our prospective models offered greater support for a putative causal pathway running from negative symptoms to neurocognition-rather than the reverse-to work functioning. Findings have implications for mechanisms contributing to longitudinal work functioning and suggest that targeting negative symptoms prior to neurocognition could be more beneficial for long-term work outcomes.
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Affiliation(s)
- Lauren Luther
- Massachusetts General Hospital, Department of Psychiatry, 149 13th Street, Charlestown, MA 02129, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; University of Illinois at Chicago, Department of Psychiatry, 1601 West Taylor, Chicago, IL 60612, USA.
| | - Jennifer H. Suor
- University of Illinois at Chicago, Department of Psychiatry; 1601 West Taylor, Chicago, IL 60612, U.S.A
| | - Cherise Rosen
- University of Illinois at Chicago, Department of Psychiatry, 1601 West Taylor, Chicago, IL 60612, USA.
| | - Thomas H. Jobe
- University of Illinois at Chicago, Department of Psychiatry; 1601 West Taylor, Chicago, IL 60612, U.S.A
| | - Robert N. Faull
- University of Illinois at Chicago, Department of Psychiatry; 1601 West Taylor, Chicago, IL 60612, U.S.A
| | - Martin Harrow
- University of Illinois at Chicago, Department of Psychiatry, 1601 West Taylor, Chicago, IL 60612, USA.
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18
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Chang CC, Kao YC, Chao CY, Tzeng NS, Chang HA. Examining bi-anodal transcranial direct current stimulation (tDCS) over bilateral dorsolateral prefrontal cortex coupled with bilateral extracephalic references as a treatment for negative symptoms in non-acute schizophrenia patients: A randomized, double-blind, sham-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109715. [PMID: 31362034 DOI: 10.1016/j.pnpbp.2019.109715] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 12/11/2022]
Abstract
No studies have examined the efficacy of bi-anodal transcranial direct current stimulation (tDCS) over bilateral dorsolateral prefrontal cortex (DLPFC) coupled with bilateral extracephalic references in treating negative symptoms of non-acute schizophrenia patients. This study aimed to investigate the therapeutic effects of the new approach of tDCS on negative symptoms, other schizophrenia symptoms, cognitive deficits and psychosocial functioning in a double-blind, randomized, sham-controlled trial. Patients with non-acute schizophrenia (N = 60) in randomized order received sham treatment or bilaterally provided tDCS (2 mA, twice-daily sessions for five consecutive days) with the anode over the DLPFC and the reference (cathode) over the ipsilateral forearm. The negative symptoms as measured by a dimensional approach of Positive and Negative Syndrome Scale (PANSS) were rapidly reduced by bimodal tDCS relative to sham stimulation (F = 24.86, Cohen's d = 0.661, p = 6.11 × 10-6). The beneficial effect on negative symptoms lasted for up to 3 months. The authors also observed improvement with tDCS of psychosocial functioning as measured by the global score of Personal and Social Performance scale (PSP) and psychopathological symptoms especially for disorganization and cognitive symptoms as measured by the PANSS. No effects were observed on other schizophrenia symptom dimensions and the performance on a series of neurocognitive tests. Our results show promise for bi-anodal tDCS over bilateral DLPFC using bilateral extracephalic references in treating negative symptoms and other selected manifestations of schizophrenia. Further studies with electrophysiological or imaging evaluation help unravel the exact mechanism of action of this novel stimulation parameter of tDCS in schizophrenia patients. (ClinicalTrials.gov ID:NCT03701100).
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Affiliation(s)
- Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Che-Yi Chao
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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19
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Siddiqui I, Saperia S, Fervaha G, Da Silva S, Jeffay E, Zakzanis KK, Agid O, Remington G, Foussias G. Goal-directed planning and action impairments in schizophrenia evaluated in a virtual environment. Schizophr Res 2019; 206:400-406. [PMID: 30471980 DOI: 10.1016/j.schres.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/07/2018] [Accepted: 10/18/2018] [Indexed: 11/24/2022]
Abstract
Planning and executing goal-directed behaviours are critical final steps in translating motivation into action. Amotivation is a key feature of schizophrenia, but its impact on goal-directed functioning has not been extensively studied in an objective and ecologically valid manner. To address this, we investigated goal-directed planning and action in schizophrenia using a virtual reality task, the Multitasking in the City Test (MCT). The MCT was administered to 49 outpatients with schizophrenia and 55 healthy controls, and required participants to complete a series of errands in a virtual city. Ability to complete the task as directed was assessed by a performance score based on errands completed and errors committed. Task efficiency was evaluated by the total distance travelled, and an index of path efficiency comparing an optimal route with the traversed route. Schizophrenia participants had lower performance scores, travelled farther, and had reduced path efficiency compared to healthy controls. Greater distance travelled and lower path efficiency in schizophrenia were related to amotivation. Path efficiency in schizophrenia was also related to neurocognition, including planning ability; notably, this relationship appeared to be independent of the relationship with amotivation. Individuals with schizophrenia demonstrated impaired goal-directed planning and action in the context of a simulated everyday errands task, both in terms of reduced capacity to complete errands and reduced efficiency in doing so. The latter may manifest as diminished real-world motivated and functional behaviour in patients with schizophrenia and indicates a specific deficit in the execution of planned behaviour.
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Affiliation(s)
- Ishraq Siddiqui
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
| | - Sarah Saperia
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Susana Da Silva
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Eliyas Jeffay
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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20
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A quantitative approach to neuropsychiatry: The why and the how. Neurosci Biobehav Rev 2019; 97:3-9. [DOI: 10.1016/j.neubiorev.2017.12.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 01/13/2023]
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21
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Richter J, Hesse K, Schreiber L, Burmeister CP, Eberle MC, Eckstein KN, Zimmermann L, Wildgruber D, Klingberg S. Evidence for two distinct domains of negative symptoms: Confirming the factorial structure of the CAINS. Psychiatry Res 2019; 271:693-701. [PMID: 30791343 DOI: 10.1016/j.psychres.2018.12.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 01/04/2023]
Abstract
Negative symptoms are an important predictor of course of illness as well as social and occupational functioning. Clinically effective interventions are scarce. For negative symptoms to become a reliable primary endpoint in treatment studies, clear operationalization and construct validation is needed. Recent factor analyses mostly find two main factors for negative symptoms: diminished expression und amotivation/anhedonia. The Clinical Assessment Interview for Negative Symptoms (CAINS) consists of the subscales "motivation and pleasure" and "expression". We assessed three samples of subjects with schizophrenia (n = 105) for different aspects of the scale's reliability and validity. A confirmatory factor analysis (CFA) of the CAINS confirmed its two-factorial structure. The subscales had distinct correlational profiles: "Motivation and pleasure" was strongly associated with functional outcome and depression and further with neurocognition, positive symptoms and social cognition. "Expression" seems independent of sources of secondary negative symptoms and neurocognition. We found good internal consistency and interrater agreement. Test-retest reliability (two-week interval) was moderate for the CAINS and its "expression" subscale and low for the "motivation and pleasure" subscale. Our findings indicate that the CAINS differentiates reliably between the two main domains of negative symptoms with some questions remaining concerning the validity of the "motivation and pleasure" subscale.
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Affiliation(s)
- Janina Richter
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Lisa Schreiber
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Carolin P Burmeister
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Mark-Christian Eberle
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Kathrin N Eckstein
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Lina Zimmermann
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstrasse 14, 72076 Tuebingen, Germany.
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22
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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23
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Siddiqui I, Remington G, Fervaha G, Fletcher PJ, Voineskos AN, Saperia S, Zakzanis KK, Foussias G. Objective investigation of activity preference in schizophrenia: A pilot study. Psychiatry Res 2018; 267:551-559. [PMID: 29980136 DOI: 10.1016/j.psychres.2018.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/23/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
Amotivation and reduced goal-directed activity engagement are prominent features of schizophrenia. Previous investigations of patients' activities have relied on accounts of daily living activities, rather than objective measures. This study used wireless motion capture to objectively evaluate activity preference when individuals are provided an explicit choice between an active versus passive engagement option. Twenty outpatients with schizophrenia and twenty matched healthy controls completed the Activity Preference Task, in which participants play a motion-based game (active) or watch a film (passive), and were administered clinical and cognitive assessments. Schizophrenia participants' duration, intensity, and persistence of active engagement were associated with apathy and community functioning. No group differences emerged from comparisons of task measures; however, exploratory cluster analysis identified a distinct subgroup of schizophrenia patients with reduced engagement and increased apathy compared to other patients and controls. The Task provides a means of quantifying activity engagement, which may be particularly valuable given the lack of objective measures for intrinsically motivated behaviours. Our initial findings suggest that schizophrenia patients as a group are equally inclined as healthy individuals towards actively engaging activities when presented an explicit choice, but such provision may be insufficient for initiation and maintenance of functional behaviours among amotivated patients.
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Affiliation(s)
- Ishraq Siddiqui
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada..
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Paul J Fletcher
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada; Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychology, University of Toronto, Sidney Smith Hall, 100 St. George St., Toronto, Ontario M5S 3G3, Canada
| | - Aristotle N Voineskos
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Sarah Saperia
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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Ferré S, Bonaventura J, Zhu W, Hatcher-Solis C, Taura J, Quiroz C, Cai NS, Moreno E, Casadó-Anguera V, Kravitz AV, Thompson KR, Tomasi DG, Navarro G, Cordomí A, Pardo L, Lluís C, Dessauer CW, Volkow ND, Casadó V, Ciruela F, Logothetis DE, Zwilling D. Essential Control of the Function of the Striatopallidal Neuron by Pre-coupled Complexes of Adenosine A 2A-Dopamine D 2 Receptor Heterotetramers and Adenylyl Cyclase. Front Pharmacol 2018; 9:243. [PMID: 29686613 PMCID: PMC5900444 DOI: 10.3389/fphar.2018.00243] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/05/2018] [Indexed: 01/10/2023] Open
Abstract
The central adenosine system and adenosine receptors play a fundamental role in the modulation of dopaminergic neurotransmission. This is mostly achieved by the strategic co-localization of different adenosine and dopamine receptor subtypes in the two populations of striatal efferent neurons, striatonigral and striatopallidal, that give rise to the direct and indirect striatal efferent pathways, respectively. With optogenetic techniques it has been possible to dissect a differential role of the direct and indirect pathways in mediating "Go" responses upon exposure to reward-related stimuli and "NoGo" responses upon exposure to non-rewarded or aversive-related stimuli, respectively, which depends on their different connecting output structures and their differential expression of dopamine and adenosine receptor subtypes. The striatopallidal neuron selectively expresses dopamine D2 receptors (D2R) and adenosine A2A receptors (A2AR), and numerous experiments using multiple genetic and pharmacological in vitro, in situ and in vivo approaches, demonstrate they can form A2AR-D2R heteromers. It was initially assumed that different pharmacological interactions between dopamine and adenosine receptor ligands indicated the existence of different subpopulations of A2AR and D2R in the striatopallidal neuron. However, as elaborated in the present essay, most evidence now indicates that all interactions can be explained with a predominant population of striatal A2AR-D2R heteromers forming complexes with adenylyl cyclase subtype 5 (AC5). The A2AR-D2R heteromer has a tetrameric structure, with two homodimers, which allows not only multiple allosteric interactions between different orthosteric ligands, agonists, and antagonists, but also the canonical Gs-Gi antagonistic interaction at the level of AC5. We present a model of the function of the A2AR-D2R heterotetramer-AC5 complex, which acts as an integrative device of adenosine and dopamine signals that determine the excitability and gene expression of the striatopallidal neurons. The model can explain most behavioral effects of A2AR and D2R ligands, including the psychostimulant effects of caffeine. The model is also discussed in the context of different functional striatal compartments, mainly the dorsal and the ventral striatum. The current accumulated knowledge of the biochemical properties of the A2AR-D2R heterotetramer-AC5 complex offers new therapeutic possibilities for Parkinson's disease, schizophrenia, SUD and other neuropsychiatric disorders with dysfunction of dorsal or ventral striatopallidal neurons.
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Affiliation(s)
- Sergi Ferré
- Integrative Neurobiology Section, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Jordi Bonaventura
- Integrative Neurobiology Section, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Wendy Zhu
- Circuit Therapeutics, Inc., Menlo Park, CA, United States
| | - Candice Hatcher-Solis
- Integrative Neurobiology Section, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Jaume Taura
- Unitat de Farmacologia, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina i Ciències de la Salut, IDIBELL, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - César Quiroz
- Integrative Neurobiology Section, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Ning-Sheng Cai
- Integrative Neurobiology Section, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Estefanía Moreno
- Center for Biomedical Research in Neurodegenerative Diseases Network, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona, University of Barcelona, Barcelona, Spain
| | - Verónica Casadó-Anguera
- Center for Biomedical Research in Neurodegenerative Diseases Network, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alexxai V Kravitz
- Eating and Addiction Section, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
| | | | - Dardo G Tomasi
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, National Institutes of Health, Rockville, MD, United States
| | - Gemma Navarro
- Department of Biochemistry and Physiology, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Arnau Cordomí
- Laboratory of Computational Medicine, School of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
| | - Leonardo Pardo
- Laboratory of Computational Medicine, School of Medicine, Autonomous University of Barcelona, Bellaterra, Spain
| | - Carme Lluís
- Center for Biomedical Research in Neurodegenerative Diseases Network, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona, University of Barcelona, Barcelona, Spain
| | - Carmen W Dessauer
- Department of Integrative Biology and Pharmacology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nora D Volkow
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Intramural Research Program, National Institutes of Health, Rockville, MD, United States
| | - Vicent Casadó
- Center for Biomedical Research in Neurodegenerative Diseases Network, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francisco Ciruela
- Unitat de Farmacologia, Departament de Patologia i Terapèutica Experimental, Facultat de Medicina i Ciències de la Salut, IDIBELL, Universitat de Barcelona, Barcelona, Spain.,Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Diomedes E Logothetis
- Department of Pharmaceutical Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
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25
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Moritz S, Klein JP, Desler T, Lill H, Gallinat J, Schneider BC. Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills? Psychol Med 2017; 47:2602-2612. [PMID: 28485257 DOI: 10.1017/s0033291717000939] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Most original studies and all meta-analyses conducted to date converge on the conclusion that patients with schizophrenia display rather generalized neurocognitive deficits. For the present study, we reopen this seemingly closed chapter and examine whether important influences, such as lack of motivation and negative attitudes towards cognitive assessment, result in poorer secondary neuropsychological performance. METHOD A sample of 50 patients with an established diagnosis of schizophrenia were tested for routine neurocognitive assessment and compared to 60 nonclinical volunteers. Before and after the assessment, subjective momentary influences were examined (e.g. motivation, concerns about assessment, fear about poor outcome) for their impact on performance using a new questionnaire called the Momentary Influences, Attitudes and Motivation Impact (MIAMI) on Cognitive Performance Scale. RESULTS As expected, patients performed significantly worse than controls on all neurocognitive domains tested (large effect size, on average). However, patients also displayed more subjective momentary impairment, as well as more fears about the outcome and less motivation than controls. Mediation analyses indicated that these influences contributed to (secondary) poorer neurocognitive performance. Differences in neurocognitive scores shrank to a medium effect size, on average, when MIAMI scores were accounted for. CONCLUSIONS The data argue that performance on measures of neurocognition in schizophrenia are to a considerable extent due to secondary factors. Poor motivation, fears and momentary impairments distinguished patients from controls and these variables heavily impacted performance. Before concluding that neurocognitive deficits in psychiatric patients are present, clinicians should take these confounding influences into account. Although patients with schizophrenia achieved, on average, worse test scores than controls, a large subgroup displayed spared performance.
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Affiliation(s)
- S Moritz
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - J P Klein
- Department of Psychiatry and Psychotherapy,Lübeck University,Ratzeburger Allee 160, 23538 Lübeck,Germany
| | - T Desler
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - H Lill
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - J Gallinat
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
| | - B C Schneider
- Department of Psychiatry and Psychotherapy,University Medical Center Hamburg-Eppendorf,Martinistraße 52, 20246, Hamburg,Germany
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26
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Mucci A, Merlotti E, Üçok A, Aleman A, Galderisi S. Primary and persistent negative symptoms: Concepts, assessments and neurobiological bases. Schizophr Res 2017; 186:19-28. [PMID: 27242069 DOI: 10.1016/j.schres.2016.05.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 02/01/2023]
Abstract
Primary and persistent negative symptoms (PPNS) represent an unmet need in the care of people with schizophrenia. They have an unfavourable impact on real-life functioning and do not respond to available treatments. Underlying etiopathogenetic mechanisms of PPNS are still unknown. The presence of primary and enduring negative symptoms characterizes deficit schizophrenia (DS), proposed as a separate disease entity with respect to non-deficit schizophrenia (NDS). More recently, to reduce the heterogeneity of negative symptoms by using criteria easily applicable in the context of clinical trials, the concept of persistent negative symptoms (PNS) was developed. Both PNS and DS constructs include enduring negative symptoms (at least 6months for PNS and 12months for DS) that do not respond to available treatments. PNS exclude secondary negative symptoms based on a cross-sectional evaluation of severity thresholds on commonly used rating scales for positive symptoms, depression and extrapyramidal side effects; the DS diagnosis, instead, excludes all potential sources of secondary negative symptoms based on a clinical longitudinal assessment. In this paper we review the evolution of concepts and assessment modalities relevant to PPNS, data on prevalence of DS and PNS, as well as studies on clinical, neuropsychological, brain imaging electrophysiological and psychosocial functioning aspects of DS and PNS.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy.
| | | | - Alp Üçok
- Department of Psychiatry, Psychotic Disorders Research Program, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and Department of Psychology, Groningen, The Netherlands
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Barnes SA, Der-Avakian A, Young JW. Preclinical Models to Investigate Mechanisms of Negative Symptoms in Schizophrenia. Schizophr Bull 2017; 43:706-711. [PMID: 28586462 PMCID: PMC5472160 DOI: 10.1093/schbul/sbx065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Samuel A Barnes
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Andre Der-Avakian
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Jared W Young
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA
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28
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Abstract
In the DSM5, negative symptoms are 1 of the 5 core dimensions of psychopathology evaluated for schizophrenia. However, negative symptoms are not pathognomonic-they are also part of the diagnostic criteria for other schizophrenia-spectrum disorders, disorders that sometimes have comorbid psychosis, diagnoses not in the schizophrenia-spectrum, and the general "nonclinical" population. Although etiological models of negative symptoms have been developed for chronic schizophrenia, there has been little attention given to whether these models have transdiagnostic applicability. In the current review, we examine areas of commonality and divergence in the clinical presentation and etiology of negative symptoms across diagnostic categories. It was concluded that negative symptoms are relatively frequent across diagnostic categories, but individual disorders may differ in whether their negative symptoms are persistent/transient or primary/secondary. Evidence for separate dimensions of volitional and expressive symptoms exists, and there may be multiple mechanistic pathways to the same symptom phenomenon among DSM-5 disorders within and outside the schizophrenia-spectrum (ie, equifinality). Evidence for a novel transdiagnostic etiological model is presented based on the Research Domain Criteria (RDoC) constructs, which proposes the existence of 2 such pathways-a hedonic pathway and a cognitive pathway-that can both lead to expressive or volitional symptoms. To facilitate treatment breakthroughs, future transdiagnostic studies on negative symptoms are warranted that explore mechanisms underlying volitional and expressive pathology.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
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29
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Thomas EC, Luther L, Zullo L, Beck AT, Grant PM. From neurocognition to community participation in serious mental illness: the intermediary role of dysfunctional attitudes and motivation. Psychol Med 2017; 47:822-836. [PMID: 27884217 DOI: 10.1017/s0033291716003019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Evidence for a relationship between neurocognition and functional outcome in important areas of community living is robust in serious mental illness research. Dysfunctional attitudes (defeatist performance beliefs and asocial beliefs) have been identified as intervening variables in this causal chain. This study seeks to expand upon previous research by longitudinally testing the link between neurocognition and community participation (i.e. time in community-based activity) through dysfunctional attitudes and motivation. METHOD Adult outpatients with serious mental illness (N = 175) participated, completing follow-up assessments approximately 6 months after initial assessment. Path analysis tested relationships between baseline neurocognition, emotion perception, functional skills, dysfunctional attitudes, motivation, and outcome (i.e. community participation) at baseline and follow-up. RESULTS Path models demonstrated two pathways to community participation. The first linked neurocognition and community participation through functional skills, defeatist performance beliefs, and motivation. A second pathway linked asocial beliefs and community participation, via a direct path passing through motivation. Model fit was excellent for models predicting overall community participation at baseline and, importantly, at follow-up. CONCLUSIONS The existence of multiple pathways to community participation in a longitudinal model supports the utility of multi-modal interventions for serious mental illness (i.e. treatment packages that build upon individuals' strengths while addressing the array of obstacles to recovery) that feature dysfunctional attitudes and motivation as treatment targets.
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Affiliation(s)
- E C Thomas
- Department of Rehabilitation Sciences,College of Public Health,Temple University,Philadelphia,PA,USA
| | - L Luther
- Department of Psychology,School of Science,Indiana University-Purdue University Indianapolis,Indianapolis,IN,USA
| | - L Zullo
- Department of Psychology,University of Texas Southwestern Medical Center,Dallas,TX,USA
| | - A T Beck
- Department of Psychiatry,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA,USA
| | - P M Grant
- Department of Psychiatry,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA,USA
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30
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Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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31
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Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. WORLD PSYCHIATRY : OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA) 2017. [PMID: 28127915 DOI: 10.1002/wps.20385.] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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32
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Subramaniam K, Ranasinghe KG, Mathalon D, Nagarajan S, Vinogradov S. Neural mechanisms of mood-induced modulation of reality monitoring in schizophrenia. Cortex 2017; 91:271-286. [PMID: 28162778 DOI: 10.1016/j.cortex.2017.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/26/2016] [Accepted: 01/05/2017] [Indexed: 11/19/2022]
Abstract
Reality monitoring is the ability to accurately distinguish the source of self-generated information from externally-presented information. Although people with schizophrenia (SZ) show impaired reality monitoring, nothing is known about how mood state influences this higher-order cognitive process. Accordingly, we induced positive, neutral and negative mood states to test how different mood states modulate subsequent reality monitoring performance. Our findings indicate that mood affected reality monitoring performance in HC and SZ participants in both similar and dissociable ways. Only a positive mood facilitated task performance in Healthy Control (HC) subjects, whereas a negative mood facilitated task performance in SZ subjects. Yet, when both HC and SZ participants were in a positive mood, they recruited medial prefrontal cortex (mPFC) to bias better subsequent self-generated item identification, despite the fact that mPFC signal was reduced in SZ participants. Additionally, in SZ subjects, negative mood states also modulated left and right dorsal mPFC signal to bias better externally-presented item identification. Together our findings reveal that although the mPFC is hypoactive in SZ participants, mPFC signal plays a functional role in mood-cognition interactions during both positive and negative mood states to facilitate subsequent reality monitoring decision-making.
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Affiliation(s)
- Karuna Subramaniam
- Department of Psychiatry, University of California, San Francisco, CA, USA.
| | | | - Daniel Mathalon
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Srikantan Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Sophia Vinogradov
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Anda L, Brønnick KS, Johnsen E, Kroken RA, Jørgensen H, Løberg EM. The Course of Neurocognitive Changes in Acute Psychosis: Relation to Symptomatic Improvement. PLoS One 2016; 11:e0167390. [PMID: 27977720 PMCID: PMC5157988 DOI: 10.1371/journal.pone.0167390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cognitive impairment is a core aspect of psychosis, but the course of cognitive functioning during acute psychosis remains poorly understood, as does the association between symptom change and neurocognitive change. Some studies have found cognitive improvement to be related to improvement in negative symptoms, but few have examined cognitive changes in the early acute phase, when clinical improvement mainly happens. This study's aim was to investigate the relation between cognitive and symptomatic change in clinically heterogeneous patients during the early acute phase of psychosis. METHOD Participants (n = 84), including both first-episode and previously ill patients, were recruited from consecutive admissions to the acute psychiatric emergency ward of Haukeland University Hospital, Bergen, Norway, as part of the Bergen Psychosis Project (BPP). The RBANS neurocognitive test battery was administered on admission and again at discharge from the acute ward (mean time 4.1 weeks, SD 1.86 weeks). Symptomatic change was measured by PANSS. RESULTS The proportion of subjects with cognitive impairment (t < 35) was 28.6% in the acute phase and 13.1% at follow-up. A sequential multiple linear regression model with RBANS change as the dependent variable found PANSS negative symptoms change to significantly predict total RBANS performance improvement (beta = -.307, p = .016). There was no significant difference between subjects with schizophrenia and those with other psychotic disorders in terms of cognitive change. CONCLUSION The proportion of subjects with mild to moderate impairment in cognitive test performance is reduced across the acute phase of psychosis, with improvement related to amelioration of negative symptoms.
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Affiliation(s)
- Liss Anda
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Kolbjørn S. Brønnick
- TIPS, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Institute of Health, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo Jørgensen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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Bayan SM, Nitch S, Kinney D, Kaminetskaya M. Exploratory analysis of CVLT-II forced-choice recognition and RBANS EI base rates for forensically-committed, psychotic-disordered inpatients: Implications on clinical decision-making. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:71-81. [PMID: 27827539 DOI: 10.1080/23279095.2016.1247092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Within the inpatient forensic setting, requests for a neuropsychological evaluation are common to determine cognitive strengths and weaknesses. However, variable effort proves to be a prominent issue in this setting. Thus, assessment of effort becomes an essential component of a neuropsychological evaluation. The California Verbal Learning Test, 2nd Edition (CVLT-II) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) are widely utilized cognitive measures in the inpatient setting. The purpose of this study is to establish the local base rates and predictive abilities of the CVLT-II Forced-Choice Recognition (FCR) measure and RBANS Effort Index (EI). Participants included 56 and 595 forensically-committed, psychotic-disordered inpatients who completed the CVLT-II FCR and RBANS EI, respectively. Results indicated that the estimated local base rate for a positive CVLT-II FCR score was 8%, which resulted in 97% negative predictive power and 50% positive predictive power. The estimated local base rate for a positive RBANS EI score was 16%, which resulted in 91.7% negative predictive power and 57.1% positive predictive power. Given their low sensitivity and predictive power, the results suggest that much more confidence can be placed in negative FCR and EI results as opposed to positive findings.
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Affiliation(s)
- Stacey M Bayan
- a Department of State Hospitals-Patton, Psychology , San Bernardino , California , USA
| | - Steve Nitch
- a Department of State Hospitals-Patton, Psychology , San Bernardino , California , USA
| | - Dominique Kinney
- a Department of State Hospitals-Patton, Psychology , San Bernardino , California , USA
| | - Marina Kaminetskaya
- a Department of State Hospitals-Patton, Psychology , San Bernardino , California , USA
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Campellone TR, Sanchez AH, Kring AM. Defeatist Performance Beliefs, Negative Symptoms, and Functional Outcome in Schizophrenia: A Meta-analytic Review. Schizophr Bull 2016; 42:1343-1352. [PMID: 26980144 PMCID: PMC5049520 DOI: 10.1093/schbul/sbw026] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Negative symptoms are a strong predictor of poor functional outcome in people with schizophrenia. Unfortunately there are few effective interventions for either negative symptoms or functional outcome, despite the identification of potential mechanisms. Recent research, however, has elucidated a new potential mechanism for negative symptoms and poor functional outcome: defeatist performance beliefs (DPB), or negative thoughts about one's ability to successfully perform goal-directed behavior that can prevent behavior initiation and engagement. We conducted 2 meta-analyses examining the relationship between DPB and both negative symptoms (n = 10 studies) and functional outcome (n = 8 studies) in people with schizophrenia. We found a small effect size for the relationship between DPB and negative symptoms, regardless of how negative symptoms were measured. We also found a small effect size for the relationship between DPB and functional outcome, which was significantly moderated by the method of assessing DPB and moderated by the sex composition of the study at a trend level. These findings highlight the potential of targeting DPB in psychosocial interventions for both negative symptoms and functional outcome.
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Affiliation(s)
- Timothy R. Campellone
- First authorship is shared between these 2 authors.,*To whom correspondence should be addressed; Department of Psychology, University of California, Berkeley, 3210 Tolman Hall, Berkeley, CA 94720-1690, US; tel: 510-643-4098, fax: 510-642-5293, e-mail:
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Strauss GP, Gold JM. A Psychometric Comparison of the Clinical Assessment Interview for Negative Symptoms and the Brief Negative Symptom Scale. Schizophr Bull 2016; 42:1384-1394. [PMID: 27174556 PMCID: PMC5049528 DOI: 10.1093/schbul/sbw046] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 2005, the National Institute of Mental Health held a consensus development conference on negative symptoms of schizophrenia. Among the important conclusions of this meeting were that there are at least 5 commonly accepted domains of negative symptoms (blunted affect, alogia, avolition, anhedonia, asociality) and that new rating scales were needed to adequately assess these constructs. Two next-generation negative symptom scales resulted from this meeting: the Brief Negative Symptom Scale (BNSS) and Clinical Assessment Interview for Negative Symptoms (CAINS). Both measures are becoming widely used and studies have demonstrated good psychometric properties for each scale. The current study provides the first direct psychometric comparison of these scales. Participants included 65 outpatients diagnosed with schizophrenia or schizoaffective disorder who completed clinical interviews, questionnaires, and neuropsychological testing. Separate raters completed the BNSS and CAINS within the same week. Results indicated that both measures had good internal consistency, convergent validity, and discriminant validity. High correspondence was observed between CAINS and BNSS blunted affect and alogia items. Moderate convergence occurred for avolition and asociality items, and low convergence was seen among anhedonia items. Findings suggest that both scales have good psychometric properties, but that there are important distinctions among the items related to motivation and pleasure.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY;
| | - James M Gold
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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Granholm E, Ruiz I, Gallegos-Rodriguez Y, Holden J, Link PC. Pupillary Responses as a Biomarker of Diminished Effort Associated With Defeatist Attitudes and Negative Symptoms in Schizophrenia. Biol Psychiatry 2016; 80:581-8. [PMID: 26475673 PMCID: PMC4792801 DOI: 10.1016/j.biopsych.2015.08.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 08/07/2015] [Accepted: 08/25/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The hypothesis that defeatist performance attitudes are associated with decreased goal-directed task effort and negative symptoms in consumers with schizophrenia was investigated by using pupillary responses as a biomarker of task effort. Pupillary dilation during cognitive tasks provides a biomarker of effort devoted to the task, with greater dilation indicating greater effort. METHODS Defeatist attitudes were assessed in 149 consumers with schizophrenia or schizoaffective disorder and 50 healthy control subjects, and consumers were divided into three groups (tertile split) with respect to severity of defeatist attitudes. Pupillary dilation responses were recorded during a digit-span task with three-, six-, and nine-digit spans. RESULTS Effort allocation (pupillary responses) to the task increased as the processing load increased from low (three-digit) to moderate (six-digit) demands in healthy control subjects and consumers with schizophrenia with mild and moderate severity of defeatist attitudes. In contrast, consumers with severe defeatist attitudes did not increase their effort when processing demands increased from low to moderate loads. These consumers showed significantly less effort in the six-digit condition relative to consumers with mild defeatist attitudes. Moreover, consumers with severe defeatist attitudes showed significantly greater severity of negative symptoms relative to consumers with mild defeatist attitudes and negative symptoms were significantly correlated with defeatist attitudes. CONCLUSIONS These results suggest a relationship between defeatist performance attitudes, goal-directed task effort indexed by pupillary responses, and negative symptoms in schizophrenia. The findings have implications for using cognitive therapy to reduce defeatist attitudes that may contribute to diminished effort and negative symptoms in schizophrenia.
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Affiliation(s)
- Eric Granholm
- Veterans Affairs San Diego Healthcare System (EG, IR, YG-R, JH, PCL), San Diego; Department of Psychiatry (EG), University of California, San Diego, La Jolla, California.
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Abstract
Cognitive control is subjectively costly, suggesting that engagement is modulated in relationship to incentive state. Dopamine appears to play key roles. In particular, dopamine may mediate cognitive effort by two broad classes of functions: (1) modulating the functional parameters of working memory circuits subserving effortful cognition, and (2) mediating value-learning and decision-making about effortful cognitive action. Here, we tie together these two lines of research, proposing how dopamine serves "double duty", translating incentive information into cognitive motivation.
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Affiliation(s)
- Andrew Westbrook
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA.
| | - Todd S Braver
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA; Department of Radiology, Washington University in St. Louis, St. Louis, MO 63110, USA
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Nguyen A, Frobert L, McCluskey I, Golay P, Bonsack C, Favrod J. Development of the Positive Emotions Program for Schizophrenia: An Intervention to Improve Pleasure and Motivation in Schizophrenia. Front Psychiatry 2016; 7:13. [PMID: 26924992 PMCID: PMC4756115 DOI: 10.3389/fpsyt.2016.00013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/25/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The efficacy of drug-based treatments and psychological interventions on the primary negative symptoms of schizophrenia remains limited. Recent literature has distinguished negative symptoms associated with a diminished capacity to experience, from those associated with a limited capacity for expression. The positive emotions program for schizophrenia (PEPS) is a new method that specifically aims to reduce the syndrome of a diminished capacity to experience. METHODS The intervention's vital ingredients were identified through a literature review of emotion in schizophrenia and positive psychology. The program has been beta-tested on various groups of health-care professionals. RESULTS A detailed description of the final version of PEPS is presented here. The French version of the program is freely downloadable. CONCLUSION PEPS is a specific, short, easy to use, group-based intervention to improve pleasure, and motivation in schizophrenia. It was built considering a recovery-oriented approach to schizophrenia.
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Affiliation(s)
- Alexandra Nguyen
- School of Nursing Science La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Laurent Frobert
- School of Nursing Science La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Iannis McCluskey
- School of Nursing Science La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland
| | - Philippe Golay
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland
| | - Charles Bonsack
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland
| | - Jérôme Favrod
- School of Nursing Science La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland
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Strauss GP, Whearty KM, Frost KH, Carpenter WT. An Affective Neuroscience Model of Impaired Approach Motivation in Schizophrenia. NEBRASKA SYMPOSIUM ON MOTIVATION. NEBRASKA SYMPOSIUM ON MOTIVATION 2016; 63:159-203. [PMID: 27627827 DOI: 10.1007/978-3-319-30596-7_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Favrod J, Nguyen A, Fankhauser C, Ismailaj A, Hasler JD, Ringuet A, Rexhaj S, Bonsack C. Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy. BMC Psychiatry 2015; 15:231. [PMID: 26419356 PMCID: PMC4588492 DOI: 10.1186/s12888-015-0610-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/17/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments. METHODS This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)--an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions. RESULTS Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention. DISCUSSION Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives. CONCLUSIONS PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study. TRIAL REGISTRATION NUMBER ISRCTN registry ISRCTN74048461, registered 18 may 2015.
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Affiliation(s)
- Jérôme Favrod
- School of nursing sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Avenue Vinet 30, 1004, Lausanne, Switzerland. .,Community psychiatry service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland.
| | - Alexandra Nguyen
- School of nursing sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Avenue Vinet 30, 1004, Lausanne, Switzerland.
| | - Caroline Fankhauser
- School of nursing sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Avenue Vinet 30, 1004, Lausanne, Switzerland.
| | | | | | | | - Shyhrete Rexhaj
- School of nursing sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Avenue Vinet 30, 1004, Lausanne, Switzerland. .,Community psychiatry service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland. .,Institut Universitaire de Formation et de Recherche en Soins Infirmiers, University of Lausanne, Lausanne, Switzerland.
| | - Charles Bonsack
- Community psychiatry service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland.
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Horan WP, Reddy LF, Barch DM, Buchanan RW, Dunayevich E, Gold JM, Marder SR, Wynn JK, Young JW, Green MF. Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 2—External Validity and Correlates. Schizophr Bull 2015; 41. [PMID: 26209546 PMCID: PMC4535650 DOI: 10.1093/schbul/sbv090] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture.
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Affiliation(s)
- William P. Horan
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA;,UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - L. Felice Reddy
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA;,UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Deanna M. Barch
- Departments of Psychology, Psychiatry and Radiology, Washington University, St. Louis, MO
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | | | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Steven R. Marder
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA;,UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Jonathan K. Wynn
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA;,UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Jared W. Young
- Department of Psychiatry, University of California San Diego, San Deigo, CA;,Research Service, VA San Diego Healthcare System, San Diego, CA
| | - Michael F. Green
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA;,UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA
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Whearty KM, Allen DN, Lee BG, Strauss GP. The evaluation of insufficient cognitive effort in schizophrenia in light of low IQ scores. J Psychiatr Res 2015; 68:397-404. [PMID: 26026486 DOI: 10.1016/j.jpsychires.2015.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/13/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
Low IQ has recently been shown to predict neuropsychological effort test failure in healthy and neurological populations. Although low IQ is common in schizophrenia (SZ), its effect on effort test performance remains unclear in this population. The current study examined the role of IQ in effort test performance in a sample of 60 outpatients with SZ and 30 demographically matched healthy controls (CN). Participants were administered a battery of neuropsychological tests, and insufficient effort was calculated using two embedded effort indices: the Reliable Digit Span Effort Index and the Finger Tapping Effort Index. Results indicated that 16.1% of SZ patients and 0% CN failed both effort measures and that 32.1% of SZ and 3.3% of CN failed one measure. In SZ, IQ in the <70 or 70-79 range was associated with the highest rates of falling below the effort cut-off scores; however, patients with IQs in the low-average or higher range (>80) did not fall below effort cut-offs. Findings suggest that low IQ is a significant predictor of insufficient effort during neuropsychological test performance in schizophrenia, calling into question the validity of neuropsychological effort testing in SZ patients with low IQ.
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Affiliation(s)
- Kayla M Whearty
- State University of New York at Binghamton, Department of Psychology, USA
| | - Daniel N Allen
- University of Nevada Las Vegas, Department of Psychology, USA
| | - Bern G Lee
- University of Nevada Las Vegas, Department of Psychology, USA
| | - Gregory P Strauss
- State University of New York at Binghamton, Department of Psychology, USA.
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Subramaniam K, Hooker CI, Biagianti B, Fisher M, Nagarajan S, Vinogradov S. Neural signal during immediate reward anticipation in schizophrenia: Relationship to real-world motivation and function. NEUROIMAGE-CLINICAL 2015; 9:153-63. [PMID: 26413478 PMCID: PMC4556736 DOI: 10.1016/j.nicl.2015.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 10/26/2022]
Abstract
Amotivation in schizophrenia is a central predictor of poor functioning, and is thought to occur due to deficits in anticipating future rewards, suggesting that impairments in anticipating pleasure can contribute to functional disability in schizophrenia. In healthy comparison (HC) participants, reward anticipation is associated with activity in frontal-striatal networks. By contrast, schizophrenia (SZ) participants show hypoactivation within these frontal-striatal networks during this motivated anticipatory brain state. Here, we examined neural activation in SZ and HC participants during the anticipatory phase of stimuli that predicted immediate upcoming reward and punishment, and during the feedback/outcome phase, in relation to trait measures of hedonic pleasure and real-world functional capacity. SZ patients showed hypoactivation in ventral striatum during reward anticipation. Additionally, we found distinct differences between HC and SZ groups in their association between reward-related immediate anticipatory neural activity and their reported experience of pleasure. HC participants recruited reward-related regions in striatum that significantly correlated with subjective consummatory pleasure, while SZ patients revealed activation in attention-related regions, such as the IPL, which correlated with consummatory pleasure and functional capacity. These findings may suggest that SZ patients activate compensatory attention processes during anticipation of immediate upcoming rewards, which likely contribute to their functional capacity in daily life.
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Affiliation(s)
- Karuna Subramaniam
- San Francisco Department of Veterans Affairs Medical Center, Department of Psychiatry, University of California, San Francisco, CA 94121, USA
| | | | - Bruno Biagianti
- San Francisco Department of Veterans Affairs Medical Center, Department of Psychiatry, University of California, San Francisco, CA 94121, USA
| | - Melissa Fisher
- San Francisco Department of Veterans Affairs Medical Center, Department of Psychiatry, University of California, San Francisco, CA 94121, USA
| | - Srikantan Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94123, USA
| | - Sophia Vinogradov
- San Francisco Department of Veterans Affairs Medical Center, Department of Psychiatry, University of California, San Francisco, CA 94121, USA
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Foussias G, Siddiqui I, Fervaha G, Mann S, McDonald K, Agid O, Zakzanis KK, Remington G. Motivated to do well: an examination of the relationships between motivation, effort, and cognitive performance in schizophrenia. Schizophr Res 2015; 166:276-82. [PMID: 26008882 DOI: 10.1016/j.schres.2015.05.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Abstract
The uncertain relationship between negative symptoms, and specifically motivational deficits, with cognitive dysfunction in schizophrenia is in need of further elucidation as it pertains to the interpretation of cognitive test results. Findings to date have suggested a possible mediating role of motivational deficits on cognitive test measures, although findings from formal examinations of effort using performance validity measures have been inconsistent. The aim of this study was to examine the relationships between motivation, effort exerted during cognitive testing, and cognitive performance in schizophrenia. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were evaluated for psychopathology, severity of motivational deficits, effort exerted during cognitive testing, and cognitive performance. Motivation and degree of effort exerted during cognitive testing were significantly related to cognitive performance, specifically verbal fluency, verbal and working memory, attention and processing speed, and reasoning and problem solving. Further, effort accounted for 15% of the variance in cognitive performance, and partially mediated the relationship between motivation and cognitive performance. Examining cognitive performance profiles for individuals exerting normal or reduced effort revealed significant differences in global cognition, as well as attention/processing speed and reasoning and problem solving. These findings suggest that cognitive domains may be differentially affected by impairments in motivation and effort, and highlight the importance of understanding the interplay between motivation and cognitive performance deficits, which may guide the appropriate selection of symptom targets for promoting recovery in patients.
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Affiliation(s)
- G Foussias
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada.
| | - I Siddiqui
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - G Fervaha
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - S Mann
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - K McDonald
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - O Agid
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - K K Zakzanis
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario M1C 1A4, Canada
| | - G Remington
- Campbell Family Research Institute and Schizophrenia Division, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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Abstract
Social cognition, referring to one's ability to perceive and process social cues, is an important domain in schizophrenia. Numerous studies have demonstrated that patients with schizophrenia have poorer performance on tests assessing social cognition relative to healthy comparison participants. However, whether variables such as motivation are related to performance on these tests in patients with schizophrenia is unclear. One thousand three-hundred and seventy-eight patients with schizophrenia completed the Facial Emotion Discrimination Task as a measure of emotional processing, a key facet of social cognition. Level of motivation was also evaluated in these patients using a derived measure from the Quality of Life Scale. The relationship between motivation and task performance was examined using bivariate correlations and logistic regression modeling, controlling for the impact of age and overall severity of psychopathology, the latter evaluated using the Positive and Negative Syndrome Scale. Motivation was positively related to performance on the social cognition test, and this relationship remained significant after controlling for potential confounding variables such as age and illness severity. Social cognition was also related to functioning, and the relationship was mediated by level of motivation. The present study found a significant relationship between motivation and performance on a test of social cognition in a large sample of patients with schizophrenia. These findings suggest that amotivation undermines task performance, or alternatively that poor social cognitive ability impedes motivation. Future studies evaluating social cognition in patients with schizophrenia should concurrently assess for variables such as effort and motivation.
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47
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Glassmire DM, Toofanian Ross P, Kinney DI, Nitch SR. Derivation and Cross-Validation of Cutoff Scores for Patients With Schizophrenia Spectrum Disorders on WAIS-IV Digit Span–Based Performance Validity Measures. Assessment 2015; 23:292-306. [DOI: 10.1177/1073191115587551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two studies were conducted to identify and cross-validate cutoff scores on the Wechsler Adult Intelligence Scale–Fourth Edition Digit Span–based embedded performance validity (PV) measures for individuals with schizophrenia spectrum disorders. In Study 1, normative scores were identified on Digit Span–embedded PV measures among a sample of patients ( n = 84) with schizophrenia spectrum diagnoses who had no known incentive to perform poorly and who put forth valid effort on external PV tests. Previously identified cutoff scores resulted in unacceptable false positive rates and lower cutoff scores were adopted to maintain specificity levels ≥90%. In Study 2, the revised cutoff scores were cross-validated within a sample of schizophrenia spectrum patients ( n = 96) committed as incompetent to stand trial. Performance on Digit Span PV measures was significantly related to Full Scale IQ in both studies, indicating the need to consider the intellectual functioning of examinees with psychotic spectrum disorders when interpreting scores on Digit Span PV measures.
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48
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Morra LF, Gold JM, Sullivan SK, Strauss GP. Predictors of neuropsychological effort test performance in schizophrenia. Schizophr Res 2015; 162:205-10. [PMID: 25583248 PMCID: PMC4339544 DOI: 10.1016/j.schres.2014.12.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/28/2022]
Abstract
There is some evidence that insufficient effort may be common in schizophrenia, posing significant threats to the validity of neuropsychological test results. Low effort may account for a significant proportion of variance in neuropsychological test scores and the generalized cognitive deficit that characterizes the disorder. The current study evaluated clinical predictors of insufficient effort in schizophrenia using an embedded effort measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI). Participants were 330 patients meeting DSM-IV-TR criteria for schizophrenia, schizoaffective disorder, or another psychotic disorder who received a battery of neuropsychological tests, including: Wechsler Test of Adult Reading (WTAR), Wechsler Abbreviated Scale of Intelligence (WASI), and RBANS. Clinical assessments designed to measure functional outcome and symptoms were also obtained. Results indicated that 9.4% of patients failed the EI. Patients who failed had lower full-scale, verbal, and performance IQ, as well as poorer performance on RBANS domains not included in the EI (immediate memory, language, and visuospatial/construction). Patients who failed the EI also displayed poorer community-based vocational outcome, greater likelihood of having "deficit schizophrenia" (i.e., primary and enduring negative symptoms), and increased severity of positive symptoms. Regression analyses revealed that insufficient effort was most significantly predicted by a combination of low IQ, negative symptoms, and positive symptoms. Findings suggest that although insufficient effort may be relatively uncommon in schizophrenia, it is associated with important clinical outcomes. The RBANS EI may be a useful tool in evaluating insufficient effort in schizophrenia.
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Affiliation(s)
- Lindsay F. Morra
- State University of New York at Binghamton, Department of Psychology
| | - James M. Gold
- University of Maryland School of Medicine, Department of Psychiatry and Maryland Psychiatric Research Center
| | - Sara K. Sullivan
- State University of New York at Binghamton, Department of Psychology
| | - Gregory P. Strauss
- State University of New York at Binghamton, Department of Psychology,Correspondence concerning this article should be addressed to Gregory P. Strauss, Ph.D., . Phone: +1-607-777-5408. Fax: +1-607-777-4890. State University of New York at Binghamton, Department of Psychology, PO Box 6000, Binghamton, New York, USA, 13902-6000
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