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James SH, Ahmed AO, Harvey PD, Saoud JB, Davidson M, Kuchibhatla R, Luthringer R, Strauss GP. Network intervention analysis indicates that roluperidone achieves its effect on negative symptoms of schizophrenia by targeting avolition. Eur Neuropsychopharmacol 2024; 87:18-23. [PMID: 39024856 DOI: 10.1016/j.euroneuro.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
Roluperidone, a 5-HT2A, sigma2, and ɑ1A-adrenergic receptor antagonist, has proven efficacious for treating negative symptoms of schizophrenia in phase 2b and phase 3 clinical trials. Using network analysis, we demonstrated that the improvements observed in the phase 2b trial resulted from targeting avolition which was highly central and spurred a cascading effect of global negative symptom reductions when successfully treated. The current study aims to replicate these network findings using the phase 3 roluperidone clinical trial data. Participants included 496 schizophrenia patients with moderate to severe negative symptoms who were randomized to either roluperidone 32 mg/day (n =167), 64 mg/day (n = 162), or placebo (n = 167). Negative symptoms were assessed at baseline and weeks 2,4,8, and 12. Network intervention analysis (NIA) evaluated treatment-induced symptom changes over time to identify direct and indirect treatment effects. This analytic approach extends prior work by determining whether the symptoms with highest centrality have causal effects on the entire negative symptom construct and directly lead to symptom improvement. NIA indicated that the efficacious 64 mg/day dose of roluperidone had a direct effect on avolition, suggesting that changes in avolition propels treatment effects across the entire negative symptom constellation. These phase 3 findings replicated the phase 2b findings, indicating that from a network perspective, roluperidone achieves its effect by influencing the extent to which avolition drives other negative symptoms. These findings are relevant for understanding negative symptoms and how to treat them in neuropsychiatric disorders.
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Affiliation(s)
- Sydney H James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Anthony O Ahmed
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Health System, Miami, FL, USA
| | - Jay B Saoud
- Pharmaceutical Product Development Associates, LLC, Groton, MA, USA
| | - Michael Davidson
- Minerva Neurosciences, Inc., Burlington, MA, USA; Department of Basic and Clinical Sciences, Psychiatry, University of Nicosia Medical School, 2414, Nicosia, Cyprus
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Savage CLG, Orth RD, Bennett ME, Blanchard JJ. Interpersonal consequences of paranoid ideation, negative symptoms and sleep problems in a transdiagnostic sample of individuals with psychosis. J Psychiatr Res 2024; 177:194-202. [PMID: 39029161 PMCID: PMC11371495 DOI: 10.1016/j.jpsychires.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/19/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Abstract
Paranoid ideation is a transdiagnostic construct that is associated with social impairment and often occurs in psychotic spectrum disorders. Little research has examined how paranoid ideation is related to social behaviors that underlie social impairment and may ultimately lead to social rejection. It is important to consider that negative symptoms and sleep problems also contribute to social impairment. No research has assessed the unique and combined influence of paranoid ideation, negative symptoms, and sleep problems on social impairment. Therefore, the current study examined how paranoid ideation, negative symptoms, and sleep problems contribute to poorer social skills and social rejection in a transdiagnostic sample of persons with psychosis and community members (N = 112). Assessments included diagnostic and symptom interviews, questionnaires, behavioral ratings of social skill and facial displays of affect, and naive observer reactions utilizing thin-slice methodology. Greater paranoid ideation, negative symptoms, and sleep problems were each related to poorer social skill and more negative reactions from observers. When considered in path analyses, negative symptoms were associated with observer reports of less willingness to interact with participants through poorer social skill. These findings demonstrate the symptom correlates of social rejection and how interpersonal behavior may contribute to social exclusion.
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Affiliation(s)
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, MD, USA
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DeBats CC, Abel DB, Sullivan MM, Koesterer SC, Linton IS, Mickens JL, Russell MT, Hammer LA, Minor KS. Social Activity in Schizotypy: Measuring Frequency and Enjoyment of Social Events. Behav Sci (Basel) 2024; 14:474. [PMID: 38920806 PMCID: PMC11201023 DOI: 10.3390/bs14060474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Improving social functioning deficits-a core characteristic of schizophrenia-spectrum disorders-is often listed by patients as a key recovery goal. Evidence suggests that social deficits also extend to people with schizotypy, a group at heightened risk for psychotic and other psychopathological disorders. One challenge of social functioning research in schizotypy is understanding whether social deficits arise from receiving less pleasure from social activities or from participating less in high-pleasure activities. However, limited information exists on what constitutes highly pleasurable, common social activities. In this study, 357 college students rated the frequency and enjoyment of 38 social activities. Our aims were to categorize activities based on their frequency and enjoyment, and whether these correlated with validated social functioning and schizotypy measures. We found that social activities could be characterized based on their frequency and enjoyment and created a frequency-enjoyment matrix that could be useful for future studies. Activities were correlated with social functioning, generally reaching a small effect size level, with increasing frequency and enjoyment showing associations with greater social functioning. Further, negative and disorganized-but not positive-traits were associated with less engagement and pleasure. Although follow-up studies in community samples are needed, our findings have the potential to help researchers and clinicians better understand which activities participants are more likely to engage in and derive pleasure from. The findings may also illustrate the extent to which social deficits may be due to less engagement or less pleasure from social activities, as well as which aspects of schizophrenia-spectrum disorders are associated with these facets of social functioning.
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Affiliation(s)
- Candice C. DeBats
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Danielle B. Abel
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
- West Haven VA Medical Center, West Haven, CT 06516, USA
| | - Morgan M. Sullivan
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
- Department of Psychology, University of Indianapolis, Indianapolis, IN 46227, USA
| | - Sophia C. Koesterer
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
- Department of Psychology, University of Iowa, Iowa City, IA 52242, USA
| | - Imani S. Linton
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Jessica L. Mickens
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Madisen T. Russell
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
| | - Lillian A. Hammer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA;
| | - Kyle S. Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA; (C.C.D.); (D.B.A.); (M.M.S.); (S.C.K.); (I.S.L.); (J.L.M.); (M.T.R.)
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Cernvall M, Bengtsson J, Bodén R. The Swedish version of the Motivation and Pleasure Scale self-report (MAP-SR): psychometric properties in patients with schizophrenia or depression. Nord J Psychiatry 2024; 78:339-346. [PMID: 38436927 DOI: 10.1080/08039488.2024.2324060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Negative symptoms are commonly regarded as a symptom dimension belonging to schizophrenia spectrum disorders but are also present in depression. The recently developed Clinical Assessment Interview for Negative Symptoms (CAINS) has shown to be reliable and valid. A corresponding self-report questionnaire has also been developed, named the Motivation and Pleasure Scale - Self Report (MAP-SR). The purpose was to evaluate the psychometric properties of the Swedish version of the MAP-SR in patients with either schizophrenia or depression. MATERIALS AND METHODS The MAP-SR was translated to Swedish. Participants were 33 patients with schizophrenia spectrum disorders and 52 patients with a depressive disorder and they completed the MAP-SR, the CAINS and other measures assessing adjacent psychopathology, functioning and cognition. RESULTS The internal consistency for the MAP-SR was adequate in both groups (schizophrenia spectrum α = .93, depressive disorder α = .82). Furthermore, the MAP-SR had a large correlation to the motivation and pleasure subscale of the CAINS in patients with schizophrenia disorders (r = -0.75, p < .001), however among patients with depression this correlation was medium-to-large (r = -0.48, p < 0.001). CONCLUSIONS Findings suggest that the Swedish version of the MAP-SR shows promise as a useful measure of motivation and pleasure, especially in patients with schizophrenia spectrum disorders. Furthermore, results also suggest that the MAP-SR does not assess negative symptoms specifically, but that there is an overlap between depressive and negative symptoms.
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Affiliation(s)
- Martin Cernvall
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Johan Bengtsson
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
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Chui MKK, Schneider K, Miclau K, LaHue SC, Furman D, Leutwyler H, Newman JC. Associations of Systemic Inflammation and Senescent Cell Biomarkers with Clinical Outcomes in Older Adults with Schizophrenia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.06.24303857. [PMID: 38496401 PMCID: PMC10942530 DOI: 10.1101/2024.03.06.24303857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Individuals with schizophrenia suffer from higher morbidity and mortality throughout life partly due to acceleration of aging-related diseases and conditions. Systemic inflammation is a hallmark of aging and is also observed in schizophrenia. An improved understanding of how inflammation and accelerated aging contribute to long-term health outcomes in schizophrenia could provide more effective treatments to preserve long-term cognitive and physical function. In this pilot cross-sectional study, 24 older adults (≥55 years old) with schizophrenia were assessed on symptoms (Positive and Negative Syndrome Scale), neurocognition (Matrics Consensus Cognitive Battery), mobility (Timed Get Up and Go), and general health (SF-12). Serum levels of 112 different cytokines were measured, from which we derived estimated senescence-associated secretory phenotype (SASP) scores for each participant. Two-tailed Pearson's bivariate correlations were computed to test the associations between schizophrenia clinical outcomes with individual cytokines, and SASP. Higher levels of eotaxin, IL-1α, IL-1β, and IFNα are associated with both worse PANSS negative and depressive symptoms scores. IL-1α and IL-1β negatively associated with general physical health whereas eotaxin negatively associated with mobility and global cognition. Overall, we found that specific inflammatory cytokines, but not composite measurements of SASP, are associated with clinical outcomes in older adults with schizophrenia.
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Affiliation(s)
- M K Kirsten Chui
- Buck Institute for Research on Aging, Novato CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | | | - Katherine Miclau
- School of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Sara C LaHue
- Buck Institute for Research on Aging, Novato CA, USA
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
| | - David Furman
- Buck Artificial Intelligence Platform, the Buck Institute for Research on Aging, Novato, CA, USA
- Stanford 1000 Immunomes Project, Stanford University School of Medicine, Stanford, CA, USA
- Instituto de Investigaciones en Medicina Traslacional (IIMT), Universidad Austral, CONICET, Pilar, Argentina
| | - Heather Leutwyler
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco CA, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco CA, USA
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VAYISOĞLU S, KARAHAN S, GÜREL ŞC, YAĞCIOĞLU AEANIL. Validity and Reliability Study of Turkish Version of Clinical Assessment Interview for Negative Symptoms (CAINS). Noro Psikiyatr Ars 2024; 61:59-65. [PMID: 38496217 PMCID: PMC10943947 DOI: 10.29399/npa.28438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/27/2023] [Indexed: 03/19/2024] Open
Abstract
Introduction This study aims to translate and investigate the validity and reliability of the Turkish version of the Clinical Assessment Interview for Negative Symptoms (CAINS), which has additional features compared to other scales in assessing negative symptoms in patients with schizophrenia. Methods The Turkish version of CAINS was constructed upon an initial translation to Turkish, and an English back translation of the scale was later conducted. The patients diagnosed with schizophrenia (n=79) according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria were administered the Turkish version of CAINS, the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), the Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression Scale (CGI), the Global Assessment of Functioning Scale (GAF) and the Simpson-Angus Extrapyramidal Side Effects Assessment Scale (SAS). In addition, two interviewers assessed the video recordings of 11 patients for reliability analysis. Results Inter-rater reliability was found to be high (intraclass correlation coefficient (ICC): 0.831). Exploratory and confirmatory factor analyses indicated that Cronbach's alpha was 0.956 for the full scale, and the two-dimensional structure explained the scale better. In convergent validity analyses, CAINS overall scores correlated significantly with the SANS total score (r=0,932) and PANSS negative score (r=0,902). In discriminant validity analyses, CAINS overall scores markedly correlated with the SAPS total (r=0,615), PANSS positive (r=0,497) and PANSS general psychopathology (r=0,737) scores. Additionally, when CGI and GAF scores were considered covariant, the significant correlation of CAINS total scores with the SANS total and PANSS negative scores continued; however, the correlation with PANSS positive score was prominently reduced, and the correlation with PANSS general psychopathology disappeared. Conclusion The Turkish version of the CAINS appears to be a valid and reliable tool with strong psychometric properties in a sample consisting of patients with schizophrenia.
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Affiliation(s)
- Sefa VAYISOĞLU
- Bodrum State Hospital, Department of Mental Health and Diseases, Bodrum, Turkey
| | - Sevilay KARAHAN
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Şeref Can GÜREL
- Hacettepe University Faculty of Medicine, Department of Mental Health and Diseases, Ankara, Turkey
| | - Ayşe Elif ANIL YAĞCIOĞLU
- Hacettepe University Faculty of Medicine, Department of Mental Health and Diseases, Ankara, Turkey
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Kong L, Zhang Y, Wu XM, Wang XX, Wu HS, Li SB, Chu MY, Wang Y, Lui SSY, Lv QY, Yi ZH, Chan RCK. The network characteristics in schizophrenia with prominent negative symptoms: a multimodal fusion study. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:10. [PMID: 38233433 PMCID: PMC10851703 DOI: 10.1038/s41537-023-00408-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/26/2023] [Indexed: 01/19/2024]
Abstract
Previous studies on putative neural mechanisms of negative symptoms in schizophrenia mainly used single modal imaging data, and seldom utilized schizophrenia patients with prominent negative symptoms (PNS).This study adopted the multimodal fusion method and recruited a homogeneous sample with PNS. We aimed to identify negative symptoms-related structural and functional neural correlates of schizophrenia. Structural magnetic resonance imaging (sMRI) and resting-state functional MRI (rs-fMRI) were performed in 31 schizophrenia patients with PNS and 33 demographically matched healthy controls.Compared to healthy controls, schizophrenia patients with PNS exhibited significantly altered functional activations in the default mode network (DMN) and had structural gray matter volume (GMV) alterations in the cerebello-thalamo-cortical network. Correlational analyses showed that negative symptoms severity was significantly correlated with the cerebello-thalamo-cortical structural network, but not with the DMN network in schizophrenia patients with PNS.Our findings highlight the important role of the cerebello-thalamo-cortical structural network underpinning the neuropathology of negative symptoms in schizophrenia. Future research should recruit a large sample and schizophrenia patients without PNS, and apply adjustments for multiple comparison, to verify our preliminary findings.
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Affiliation(s)
- Li Kong
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Yao Zhang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China
| | - Xu-Ming Wu
- Nantong Fourth People's Hospital, Nantong, China
| | - Xiao-Xiao Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China
| | - Hai-Su Wu
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuai-Biao Li
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min-Yi Chu
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qin-Yu Lv
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China
| | - Zheng-Hui Yi
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China.
- Institute of Mental Health, Fudan University, Shanghai, China.
| | - Raymond C K Chan
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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Barch DM, Culbreth AJ, Ben Zeev D, Campbell A, Nepal S, Moran EK. Dissociation of Cognitive Effort-Based Decision Making and Its Associations With Symptoms, Cognition, and Everyday Life Function Across Schizophrenia, Bipolar Disorder, and Depression. Biol Psychiatry 2023; 94:501-510. [PMID: 37080416 PMCID: PMC10755814 DOI: 10.1016/j.biopsych.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Anhedonia and amotivation are symptoms of many different mental health disorders that are frequently associated with functional disability, but it is not clear whether the same processes contribute to motivational impairments across disorders. This study focused on one possible factor, the willingness to exert cognitive effort, referred to as cognitive effort-cost decision making. METHODS We examined performance on the deck choice task as a measure of cognitive effort-cost decision making, in which people choose to complete an easy task for a small monetary reward or a harder task for larger rewards, in 5 groups: healthy control (n = 80), schizophrenia/schizoaffective disorder (n = 50), bipolar disorder with psychosis (n = 58), current major depression (n = 60), and past major depression (n = 51). We examined cognitive effort-cost decision making in relation to clinician and self-reported motivation symptoms, working memory and cognitive control performance, and life function measured by ecological momentary assessment and passive sensing. RESULTS We found a significant diagnostic group × reward interaction (F8,588 = 4.37, p < .001, ηp2 = 0.056). Compared with the healthy control group, the schizophrenia/schizoaffective and bipolar disorder groups, but not the current or past major depressive disorder groups, showed a reduced willingness to exert effort at the higher reward values. In the schizophrenia/schizoaffective and bipolar disorder groups, but not the major depressive disorder groups, reduced willingness to exert cognitive effort for higher rewards was associated with greater clinician-rated motivation impairments, worse working memory and cognitive control performance, and less engagement in goal-directed activities measured by ecological momentary assessment. CONCLUSIONS These findings suggest that the mechanisms contributing to motivational impairments differ among individuals with psychosis spectrum disorders versus depression.
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Affiliation(s)
- Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Adam J Culbreth
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, Baltimore, Maryland
| | - Dror Ben Zeev
- Department of Psychiatry, University of Washington, Seattle, Washington
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
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Strauss GP, Walker EF, Pelletier-Baldelli A, Carter NT, Ellman LM, Schiffman J, Luther L, James SH, Berglund AM, Gupta T, Ristanovic I, Mittal VA. Development and Validation of the Negative Symptom Inventory-Psychosis Risk. Schizophr Bull 2023; 49:1205-1216. [PMID: 37186040 PMCID: PMC10483448 DOI: 10.1093/schbul/sbad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND HYPOTHESES Early identification and prevention of psychosis is limited by the availability of tools designed to assess negative symptoms in those at clinical high-risk for psychosis (CHR). To address this critical need, a multi-site study was established to develop and validate a clinical rating scale designed specifically for individuals at CHR: The Negative Symptom Inventory-Psychosis Risk (NSI-PR). STUDY DESIGN The measure was developed according to guidelines recommended by the NIMH Consensus Conference on Negative Symptoms using a transparent, iterative, and data-driven process. A 16-item version of the NSI-PR was designed to have an overly inclusive set of items and lengthier interview to support the ultimate intention of creating a new briefer measure. Psychometric properties of the 16-item NSI-PR were evaluated in a sample of 218 CHR participants. STUDY RESULTS Item-level analyses indicated that men had higher scores than women. Reliability analyses supported internal consistency, inter-rater agreement, and temporal stability. Associations with measures of negative symptoms and functioning supported convergent validity. Small correlations with positive, disorganized, and general symptoms supported discriminant validity. Structural analyses indicated a 5-factor structure (anhedonia, avolition, asociality, alogia, and blunted affect). Item response theory identified items for removal and indicated that the anchor range could be reduced. Factor loadings, item-level correlations, item-total correlations, and skew further supported removal of certain items. CONCLUSIONS These findings support the psychometric properties of the NSI-PR and guided the creation of a new 11-item NSI-PR that will be validated in the next phase of this multi-site scale development project.
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Affiliation(s)
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | | | - Nathan T Carter
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Lauren M Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California- Irvine, Irvine, CA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Sydney H James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Segura AG, Mezquida G, Martínez-Pinteño A, Gassó P, Rodriguez N, Moreno-Izco L, Amoretti S, Bioque M, Lobo A, González-Pinto A, García-Alcon A, Roldán-Bejarano A, Vieta E, de la Serna E, Toll A, Cuesta MJ, Mas S, Bernardo M. Link between cognitive polygenic risk scores and clinical progression after a first-psychotic episode. Psychol Med 2023; 53:4634-4647. [PMID: 35678455 PMCID: PMC10388335 DOI: 10.1017/s0033291722001544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical intervention in early stages of psychotic disorders is crucial for the prevention of severe symptomatology trajectories and poor outcomes. Genetic variability is studied as a promising modulator of prognosis, thus novel approaches considering the polygenic nature of these complex phenotypes are required to unravel the mechanisms underlying the early progression of the disorder. METHODS The sample comprised of 233 first-episode psychosis (FEP) subjects with clinical and cognitive data assessed periodically for a 2-year period and 150 matched controls. Polygenic risk scores (PRSs) for schizophrenia, bipolar disorder, depression, education attainment and cognitive performance were used to assess the genetic risk of FEP and to characterize their association with premorbid, baseline and progression of clinical and cognitive status. RESULTS Schizophrenia, bipolar disorder and cognitive performance PRSs were associated with an increased risk of FEP [false discovery rate (FDR) ⩽ 0.027]. In FEP patients, increased cognitive PRSs were found for FEP patients with more cognitive reserve (FDR ⩽ 0.037). PRSs reflecting a genetic liability for improved cognition were associated with a better course of symptoms, functionality and working memory (FDR ⩽ 0.039). Moreover, the PRS of depression was associated with a worse trajectory of the executive function and the general cognitive status (FDR ⩽ 0.001). CONCLUSIONS Our study provides novel evidence of the polygenic bases of psychosis and its clinical manifestation in its first stage. The consistent effect of cognitive PRSs on the early clinical progression suggests that the mechanisms underlying the psychotic episode and its severity could be partially independent.
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Affiliation(s)
- Alex G. Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Gisela Mezquida
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Albert Martínez-Pinteño
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Patricia Gassó
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Natalia Rodriguez
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Silvia Amoretti
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitario de Alava, Vitoria-Gasteiz, Spain
- Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Spain
- University of the Basque Country, Vizcaya, Spain
| | - Alicia García-Alcon
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Alexandra Roldán-Bejarano
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Psychiatry Department, Institut d'Investigació Biomèdica-SantPau (IIB-SANTPAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Alba Toll
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institute of Neuropsychiatry and Addiction, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Manuel J. Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Sergi Mas
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPs), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - PEPs Group
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
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11
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Hogoboom A, Rouch M, Lauerman D, Pauselli L, Compton MT. Initial evidence of vowel space reduction in a subset of individuals with schizophrenia. Schizophr Res 2023; 255:158-164. [PMID: 36989674 PMCID: PMC11371129 DOI: 10.1016/j.schres.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Acoustic phonetic measures have been found to correlate with negative symptoms of schizophrenia, thus offering a path toward quantitative measurement of such symptoms. These acoustic properties include F1 and F2 measurements (affected by tongue height and tongue forward/back position, respectively), which determine a general "vowel space." Among patients and controls, we consider two phonetic measures of vowel space: average Euclidean distance from a participant's mean F1 and mean F2, and density of vowels around one standard deviation of mean F1 and of F2. METHODS Structured and spontaneous speech of 148 participants (70 patients and 78 controls) was recorded and measured acoustically. We examined correlations between the phonetic measures of vowel space and ratings of aprosody obtained using two clinical research measures, the Scale for the Assessment of Negative Symptoms (SANS) and the Clinical Assessment Interview for Negative Symptoms (CAINS). RESULTS Vowel space measurements were significantly associated with patient/control status, attributed to a cluster of 13 patients whose phonetic values correspond to reduced vowel space as assessed by both phoenetic measures. No correlation was found between phonetic measures and relevant items and averages of ratings on the SANS and CAINS. Reduced vowel space appears to affect only a subset of patients with schizophrenia, potentially those on higher antipsychotic dosages. CONCLUSIONS Acoustic phonetic measures may be more sensitive measures of constricted vowel space than clinical research rating scales of aprosody or monotone speech. Replications are needed before further interpretation of this novel finding, including potential medication effects.
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Affiliation(s)
- Anya Hogoboom
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Megan Rouch
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Diana Lauerman
- William & Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, Morningside/West Hospitals, Department of Psychiatry, New York, NY, USA
| | - Michael T Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
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12
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Raudeberg R, Karr JE, Iverson GL, Hammar Å. Examining the repeatable battery for the assessment of neuropsychological status validity indices in people with schizophrenia spectrum disorders. Clin Neuropsychol 2023; 37:101-118. [PMID: 33522847 DOI: 10.1080/13854046.2021.1876169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: We examined the frequency of possible invalid test scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in patients with schizophrenia spectrum disorders, and whether there was an association between scores on the embedded RBANS performance validity tests (PVTs) and self-reported symptoms of apathy as measured by the Initiate Scale of the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Methods: Participants included 250 patients (M = 24.4 years-old, SD = 5.7) with schizophrenia spectrum disorders. Base rates of RBANS Effort Index (EI), Effort Scale (ES), and Performance Validity Index (PVI) test scores were computed. Spearman correlations were used to examine the associations between the RBANS PVTs, the RBANS Index scores, and the BRIEF-A Initiate Scale. Regression analyses were used to investigate how well the RBANS PVTs predicted scores on the BRIEF-A Initiate Scale. Results: The frequency of invalid scores on the EI (>3) and the PVI (<42) in participants with schizophrenia spectrum disorders was 6%. The frequency of invalid ES scores (<12) was 28% in the patients compared to 15% in the U.S. standardization sample. There was a small significant correlation between the EI and the BRIEF-A Initiate Scale (rho=.158, p<.05). Conclusions: The rates of invalid scores were similar to previously published studies. Invalid scores on the BRIEF-A were uncommon. Apathy measured with the BRIEF-A Initiate Scale was not associated with performance on the RBANS validity measures or with measures of cognition.
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Affiliation(s)
- Rune Raudeberg
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital and Spaulding Research Institute; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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13
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Sabe M, Chen C, Perez N, Solmi M, Mucci A, Galderisi S, Strauss GP, Kaiser S. Thirty years of research on negative symptoms of schizophrenia: A scientometric analysis of hotspots, bursts, and research trends. Neurosci Biobehav Rev 2023; 144:104979. [PMID: 36463972 DOI: 10.1016/j.neubiorev.2022.104979] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/19/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Research on negative symptoms of schizophrenia has received renewed interest since the 1980s. A scientometric analysis that objectively maps scientific knowledge, with changes in recent trends, is currently lacking. We searched the Web of Science Core Collection (WOSCC) on December 17, 2021 using relevant keywords. R-bibliometrix and CiteSpace were used to perform the analysis. We retrieved 27,568 references published between 1966 and 2022. An exponential rise in scientific interest was observed, with an average annual growth rate in publications of 16.56% from 1990 to 2010. The co-cited reference network that was retrieved presented 24 different clusters with a well-structured network (Q=0.7921; S=0.9016). Two distinct major research trends were identified: research on the conceptualization and treatment of negative symptoms. The latest trends in research on negative symptoms include evidence synthesis, nonpharmacological treatments, and computational psychiatry. Scientometric analyses provide a useful summary of changes in negative symptom research across time by identifying intellectual turning point papers and emerging trends. These results will be informative for systematic reviews, meta-analyses, and generating novel hypotheses.
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Affiliation(s)
- Michel Sabe
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland.
| | - Chaomei Chen
- College of Computing & Informatics, Drexel University, Philadelphia, PA, USA
| | - Natacha Perez
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ontario, Ottawa; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
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14
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Giordano GM, Caporusso E, Pezzella P, Galderisi S. Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia. Expert Rev Neurother 2022; 22:541-555. [PMID: 35758871 DOI: 10.1080/14737175.2022.2092402] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Negative symptoms in schizophrenia are associated with poor response to available treatments, poor quality of life, and functional outcome. Therefore, they represent a substantial burden for people with schizophrenia, their families, and health-care systems. AREAS COVERED In this manuscript, we will provide an update on the conceptualization, assessment, and treatment of this complex psychopathological dimension of schizophrenia. EXPERT OPINION Despite the progress in the conceptualization of negative symptoms and in the development of state-of-the-art assessment instruments made in the last decades, these symptoms are still poorly recognized, and not always assessed in line with current conceptualization. Every effort should be made to disseminate the current knowledge on negative symptoms, on their assessment instruments and available treatments whose efficacy is supported by research evidence. Longitudinal studies should be promoted to evaluate the natural course of negative symptoms, improve our ability to identify the different sources of secondary negative symptoms, provide effective interventions, and target primary and persistent negative symptoms with innovative treatment strategies. Further research is needed to identify pathophysiological mechanisms of primary negative symptoms and foster the development of new treatments.
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15
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Davidson M, Saoud J, Staner C, Noel N, Werner S, Luthringer E, Walling D, Weiser M, Harvey PD, Strauss GP, Luthringer R. Efficacy and Safety of Roluperidone for the Treatment of Negative Symptoms of Schizophrenia. Schizophr Bull 2022; 48:609-619. [PMID: 35211743 PMCID: PMC9077422 DOI: 10.1093/schbul/sbac013] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is a placebo-controlled multi-national trial of roluperidone, a compound with antagonist properties for 5-HT2A, sigma2, and α1A-adrenergic receptors, targeting negative symptoms in patients with schizophrenia. This trial follows a previous trial that demonstrated roluperidone superiority over placebo in a similar patient population. METHODS Roluperidone 32 mg/day, roluperidone 64 mg/day, or placebo was administered for 12 weeks to 513 patients with schizophrenia with moderate to severe negative symptoms. The primary endpoint was the PANSS-derived Negative Symptom Factor Score (NSFS) and the key secondary endpoint was Personal and Social Performance scale (PSP) total score. RESULTS NSFS scores were lower (improved) for roluperidone 64 mg compared to placebo and marginally missing statistical significance for the intent-to-treat (ITT) analysis data set (P ≤ .064), but reached nominal significance (P ≤ .044) for the modified-ITT (m-ITT) data set. Changes in PSP total score were statistically significantly better on roluperidone 64 mg compared to placebo for both ITT and m-ITT (P ≤ .021 and P ≤ .017, respectively). CONCLUSIONS Results of this trial confirm the potential of roluperidone as a treatment of negative symptoms and improving everyday functioning in patients with schizophrenia. Study registration: Eudra-CT: 2017-003333-29; NCT03397134.
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Affiliation(s)
- Michael Davidson
- Minerva Neurosciences, Watham, MA, USA
- Department Of Psychiatry Nicosia Cyprus, Nicosia University Medical School, Egkomi, Cyprus
| | - Jay Saoud
- Minerva Neurosciences, Watham, MA, USA
| | - Corinne Staner
- PPRS, 4e Av. du Général de Gaulle, Colmar, Grand EST, France
| | - Nadine Noel
- PPRS, 4e Av. du Général de Gaulle, Colmar, Grand EST, France
| | - Sandra Werner
- PPRS, 4e Av. du Général de Gaulle, Colmar, Grand EST, France
| | | | - David Walling
- Collaborative Neuroscience Network, Suite 3, Garden Grove, CA, USA
| | - Mark Weiser
- University of Tel Aviv School of Medicine, Ramat Aviv, Israel
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Strauss GP, Raugh IM, Zhang L, Luther L, Chapman HC, Allen DN, Kirkpatrick B, Cohen AS. Validation of accelerometry as a digital phenotyping measure of negative symptoms in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:37. [PMID: 35853890 PMCID: PMC9261099 DOI: 10.1038/s41537-022-00241-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/24/2022] [Indexed: 05/05/2023]
Abstract
Negative symptoms are commonly assessed via clinical rating scales; however, these measures have several inherent limitations that impact validity and utility for their use in clinical trials. Objective digital phenotyping measures that overcome some of these limitations are now available. The current study evaluated the validity of accelerometry (ACL), a passive digital phenotyping method that involves collecting data on the presence, vigor, and variability of movement. Outpatients with schizophrenia (SZ: n = 50) and demographically matched healthy controls (CN: n = 70) had ACL continuously recorded from a smartphone and smartband for 6 days. Active digital phenotyping assessments, including surveys related to activity context, were also collected via 8 daily surveys throughout the 6 day period. SZ participants had lower scores on phone ACL variables reflecting vigor and variability of movement compared to CN. ACL variables demonstrated convergent validity as indicated by significant correlations with active digital phenotyping self-reports of time spent in goal-directed activities and clinical ratings of negative symptoms. The discriminant validity of ACL was demonstrated by low correlations with clinical rating scale measures of positive, disorganized, and total symptoms. Collectively, findings suggest that ACL is a valid objective measure of negative symptoms that may complement traditional approaches to assessing the construct using clinical rating scales.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Luyu Zhang
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Hannah C Chapman
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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17
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Crespo Cobo Y, Kandel S, Soriano MF, Iglesias-Parro S. Examining Motor Anticipation in Handwriting as an Indicator of Motor Dysfunction in Schizophrenia. Front Psychol 2022; 13:807935. [PMID: 35432092 PMCID: PMC9012163 DOI: 10.3389/fpsyg.2022.807935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022] Open
Abstract
Dysfunction in motor skills can be linked to alterations in motor processing, such as the anticipation of forthcoming graphomotor sequences. We expected that the difficulties in motor processing in schizophrenia would be reflected in a decrease of motor anticipation. In handwriting, motor anticipation concerns the ability to write a letter while processing information on how to produce the following letters. It is essential for fast and smooth handwriting, that is, for the automation of graphomotor gestures. In this study, we examined motor anticipation by comparing the kinematic characteristics of the first l in the bigrams ll and ln written on a digitiser. Previous studies indicated that the downstroke duration of the first l is modulated by the anticipation of the local constraints of the following letter. Twenty-four adult individuals with diagnosis of schizophrenia and 24 healthy adults participated in the study. The classic measures of duration (sec), trajectory (cm), and dysfluency (velocity peaks) were used for the kinematic analysis of the upstroke (US) and downstroke (DS). In the control group, the duration of the downstroke of the l was longer in ln than ll (US: ln = ll; DS: ln > ll) whereas no differences were found for the group with schizophrenia. Likewise, the control group showed a longer DS trajectory for the l of ln than ll in downstrokes, while the group of patients failed to show this effect. These results suggest that the motor alterations in patients with schizophrenia could also affect their ability for motor anticipation.
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Affiliation(s)
- Yasmina Crespo Cobo
- Department of Methodology of Behavioral Sciences, University of Jaén, Jaén, Spain
- *Correspondence: Yasmina Crespo Cobo,
| | - Sonia Kandel
- Département Parole et Cognition, Université Grenoble Alpes, Grenoble, France
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18
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The role of BDNF and NGF plasma levels in first-episode schizophrenia: A longitudinal study. Eur Neuropsychopharmacol 2022; 57:105-117. [PMID: 35219096 DOI: 10.1016/j.euroneuro.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/21/2022]
Abstract
Neurotrophins have been proposed to be involved in biological mechanisms which might underlie different clinical outcomes in schizophrenia. The aims of the present study were to examine the BDNF/NGF plasma levels in a cohort of first-episode schizophrenia (FES) patients in remission as potential biological predictors of relapse; to study the associations between these neurotrophins and the symptomatology severity through different stages after a FES in two independent cohorts. 2EPs-Cohort: 69 first-episode in clinical remission were included. BDNF/NGF plasma levels and symptom severity were measured at enrollment and at 3-year or at the time of the second episode/relapse. FLAMM-PEPs-Cohort: 65 first-episodes were also included. BDNF/NGF and symptom severity were obtained at enrollment and 2-year follow-up. Symptomatology was assessed with the Marder-PANSS-Factor scores. Plasma neurotrophins did not differ significantly over time and neither BDNF/NGF were predictors of relapse. Besides, in remission stages, baseline BDNF levels showed significant correlations with both positive and negative symptoms (p<0.05); NGF, with negative symptomatology (p<0.01). Similarly, in the FLAMM-PEPs-Cohort, baseline BDNF/NGF levels showed significant correlations with negative symptoms (and not positive symptomatology) at follow-up (p<0.05). In both cohorts, lower levels correlated with higher symptom severity. Findings did not support a role for BDNF/NGF plasma levels as biomarkers of relapse in FES patients. Nevertheless, baseline BDNF/NGF may lead to be considered potentially useful biomarkers of long-term severity in schizophrenia and of the underlying illness traits, specially of negative symptomatology severity. More longitudinal studies in FES samples and adding a control group are warranted to replicate these findings.
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19
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Abram SV, Weittenhiller LP, Bertrand CE, McQuaid JR, Mathalon DH, Ford JM, Fryer SL. Psychological Dimensions Relevant to Motivation and Pleasure in Schizophrenia. Front Behav Neurosci 2022; 16:827260. [PMID: 35401135 PMCID: PMC8985863 DOI: 10.3389/fnbeh.2022.827260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Motivation and pleasure deficits are common in schizophrenia, strongly linked with poorer functioning, and may reflect underlying alterations in brain functions governing reward processing and goal pursuit. While there is extensive research examining cognitive and reward mechanisms related to these deficits in schizophrenia, less attention has been paid to psychological characteristics that contribute to resilience against, or risk for, motivation and pleasure impairment. For example, psychological tendencies involving positive future expectancies (e.g., optimism) and effective affect management (e.g., reappraisal, mindfulness) are associated with aspects of reward anticipation and evaluation that optimally guide goal-directed behavior. Conversely, maladaptive thinking patterns (e.g., defeatist performance beliefs, asocial beliefs) and tendencies that amplify negative cognitions (e.g., rumination), may divert cognitive resources away from goal pursuit or reduce willingness to exert effort. Additionally, aspects of sociality, including the propensity to experience social connection as positive reinforcement may be particularly relevant for pursuing social goals. In the current review, we discuss the roles of several psychological characteristics with respect to motivation and pleasure in schizophrenia. We argue that individual variation in these psychological dimensions is relevant to the study of motivation and reward processing in schizophrenia, including interactions between these psychological dimensions and more well-characterized cognitive and reward processing contributors to motivation. We close by emphasizing the value of considering a broad set of modulating factors when studying motivation and pleasure functions in schizophrenia.
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Affiliation(s)
- Samantha V Abram
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren P Weittenhiller
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Claire E Bertrand
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
| | - John R McQuaid
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel H Mathalon
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Judith M Ford
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Susanna L Fryer
- Mental Health Service, Veterans Affairs San Francisco Healthcare System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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20
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Pillny M, Krkovic K, Buck L, Lincoln TM. From Memories of Past Experiences to Present Motivation? A Meta-analysis on the Association Between Episodic Memory and Negative Symptoms in People With Psychosis. Schizophr Bull 2022; 48:307-324. [PMID: 34635918 PMCID: PMC8886596 DOI: 10.1093/schbul/sbab120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Based on findings from cognitive science, it has been theorized that the reductions in motivation and goal-directed behavior in people with psychosis could stem from impaired episodic memory. In the current meta-analysis, we investigated this putative functional link between episodic memory deficits and negative symptoms. We hypothesized that episodic memory deficits in psychosis would be related to negative symptoms in general but would be more strongly related to amotivation than to reduced expressivity. We included 103 eligible studies (13,622 participants) in the analyses. Results revealed significant, moderate negative associations of episodic memory with negative symptoms in general (k = 103; r = -.23; z = -13.40; P ≤ .001; 95% CI [-.26; -.20]), with amotivation (k = 16; r = -.18; z = -6.6; P ≤ .001; 95% CI [-.23; -.13]) and with reduced expressivity (k = 15; r = -.18; z = -3.30; P ≤.001; 95% CI[-.29; -.07]). These associations were not moderated by sociodemographic characteristics, positive symptoms, depression, antipsychotic medication or type of negative symptom scale. Although these findings provide sound evidence for the association between episodic memory deficits and amotivation, the rather small magnitude and the unspecific pattern of this relationship also indicate that episodic memory deficits are unlikely to be the only factor relevant to amotivation. This implicates that future research should investigate episodic memory in conjunction with other factors that could account for the association of episodic memory deficits and amotivation in psychosis.
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Affiliation(s)
- Matthias Pillny
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Laura Buck
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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Mavituna S, Hahn E, Hahne I, Bergmann N, Pijnenborg M, Ta TMT, Tafelski L, Böge K. Compassion-based approaches: a systematic review of their effectiveness and acceptability in schizophrenia spectrum disorders. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractThe purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.
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García-Fernández L, Romero-Ferreiro V, Sánchez-Pastor L, Dompablo M, Martínez-Gras I, Espejo-Saavedra JM, Rentero D, Aparicio AI, Alvarez-Mon MA, Lahera G, Lee J, Santos JL, Rodriguez-Jimenez R. Impact of Negative Symptoms on Functioning and Quality of Life in First Psychotic Episodes of Schizophrenia. J Clin Med 2022; 11:jcm11040983. [PMID: 35207256 PMCID: PMC8879613 DOI: 10.3390/jcm11040983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Negative symptoms are not considered a unitary construct encompassing two different domains, diminished expression, and avolition-apathy. The aim of this study was to explore the relationships between each domain and psychosocial functioning and quality of life in people with a first psychotic episode of schizophrenia. In total, 61 outpatients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS), The Functioning Assesment Short Test (FAST) and The Quality of Life Scale (QLS). The mean global score for CAINS was 21.5 (SD: 15.6), with a CAINS Avolition-Apathy (MAP) score of 17.0 (SD: 11.8), and CAINS Diminished Expression (EXP) score of 4.5 (SD: 5.0). The mean FAST score was 31.9 (SD: 18.9), and 41.1 (SD: 17.9) for QLS. Linear regression analysis revealed a significant (F(4,53) = 15.65, p < 0.001) relationship between MAP and EXP CAINS’ score and FAST score. CAINS-MAP was more predictive of FAST scores (β = 0.44, p = 0.001) than CAINS-EXP (β = 0.37, p = 0.007). Linear regression analysis for QLS revealed a significant model (F(4,56) = 29.29, p < 0.001). The standardized regression weight for the CAINS-MAP was around three times greater (β = −0.63, p < 0.001) than for CAINS-EXP (β = −0.24, p = 0.024). The two different domains are associated differently with functionality and quality of life.
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Affiliation(s)
- Lorena García-Fernández
- Clinical Medicine Department, Universidad Miguel Hernández, 03550 Alicante, Spain;
- Psychiatry Department, Hospital Universitario de San Juan, 03550 Alicante, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
| | - Verónica Romero-Ferreiro
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
- Quality and Academic Compliance Unit, Universidad Europea de Madrid, 28670 Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas 12), 28041 Madrid, Spain; (L.S.-P.); (I.M.-G.); (J.M.E.-S.)
| | - Luis Sánchez-Pastor
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas 12), 28041 Madrid, Spain; (L.S.-P.); (I.M.-G.); (J.M.E.-S.)
| | - Mónica Dompablo
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas 12), 28041 Madrid, Spain; (L.S.-P.); (I.M.-G.); (J.M.E.-S.)
- Cardenal Cisneros, Centro de Enseñanza Superior Adscrito a la Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Isabel Martínez-Gras
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas 12), 28041 Madrid, Spain; (L.S.-P.); (I.M.-G.); (J.M.E.-S.)
- RETIC (Network of Addictive Conditions), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Juan Manuel Espejo-Saavedra
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas 12), 28041 Madrid, Spain; (L.S.-P.); (I.M.-G.); (J.M.E.-S.)
- Legal Medicine, Psychiatry and Pathology Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - David Rentero
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas 12), 28041 Madrid, Spain; (L.S.-P.); (I.M.-G.); (J.M.E.-S.)
| | - Ana Isabel Aparicio
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
- Psychiatry Department, Hospital Virgen de la Luz, 16002 Cuenca, Spain
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Guillermo Lahera
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore 539747, Singapore;
- North Region & Department of Psychosis, Institute of Mental Health, Singapore 539747, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore
| | - Jose Luis Santos
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
- Psychiatry Department, Hospital Virgen de la Luz, 16002 Cuenca, Spain
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain
| | - Roberto Rodriguez-Jimenez
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain; (V.R.-F.); (M.D.); (D.R.); (A.I.A.); (G.L.); (J.L.S.)
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas 12), 28041 Madrid, Spain; (L.S.-P.); (I.M.-G.); (J.M.E.-S.)
- Legal Medicine, Psychiatry and Pathology Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-91-390-85-36
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Laraki Y, Lebrun C, Merenciano M, Eisenblaetter M, Attal J, Macgregor A, Decombe A, Capdevielle D, Raffard S. Validation of the French Clinical Assessment Interview for Negative Symptoms in a Sample of Stable French Individuals With Schizophrenia. Front Psychiatry 2022; 13:836600. [PMID: 35432043 PMCID: PMC9010618 DOI: 10.3389/fpsyt.2022.836600] [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: 12/15/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Clinical Assessment Interview for Negative Symptoms (CAINS) is an interview-based instrument evaluating the existence and severity of negative symptoms in people diagnosed with schizophrenia or schizoaffective disorder. The aim of this study is to translate and validate a French version of the CAINS in a French sample of outpatients diagnosed with schizophrenia or schizoaffective disorder. METHODS In this study, we included 84 outpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier, France. All participants were assessed for the severity of negative symptoms as well as level of depression. Psychometric properties of the French CAINS were investigated including its factor structure, internal consistency, and interrater and test-retest reliabilities. We also determined the discriminant and convergent validity. RESULTS Exploratory factor analysis and parallel analysis reproduced the two-factor model, and explained 43.55% of the total score variation with good internal consistency (Cronbach α of 0.87). Both interrater and test-retest reliabilities were high for the CAINS and its subscales (intraclass correlation coefficient range, 0.89-0.99). The standard errors of measurement and minimal detectable change were also investigated. Convergent validity of the CAINS was underpinned by correlations obtained with various measures of negative symptoms. Adequate discriminant validity was established by showing that the CAINS did not correlate with positive symptoms. CONCLUSION Overall, our results obtained were similar to those found in the original study of the CAINS. Structural analyses also replicated the two-factor model of the CAINS. Our results indicate that the French CAINS has robust psychometric properties and is a valid tool for evaluating negative symptoms in French-speaking individuals diagnosed with schizophrenia.
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Affiliation(s)
- Yasmine Laraki
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
| | - Cindy Lebrun
- Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
| | - Marine Merenciano
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | | | - Jerôme Attal
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Alexandra Macgregor
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Amandine Decombe
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Raffard
- University Department of Adult Psychiatry, CHU Montpellier, University of Montpellier, Hôpital la Colombière, Montpellier, France.,Université Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
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Rekhi G, Ang MS, Chan YH, Fernandez-Egea E, Kirkpatrick B, Lee J. Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:3-13. [PMID: 35256070 DOI: 10.1016/j.rpsmen.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/11/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS). MATERIAL AND METHODS 274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed - NSR based on the BNSS domains scores (NSRBNSS_DOMAINS) and NSR based on 5 key items of the BNSS (NSRBNSS_5ITEMS). A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria. RESULTS Eighty-nine (32.5%) participants fulfilled NSRBNSS_DOMAINS criterion whereas 70 (25.6%) participants fulfilled NSRBNSS_5ITEMS criterion. The two NSR criteria had substantial agreement (Kappa statistic=0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSRBNSS_DOMAINS and NSRBNSS_5ITEMS were 0.761 (CI: 0.696-0.826, p<0.001) and 0.723 (CI: 0.656-0.790, p<0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters. CONCLUSIONS Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Mei San Ang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Brian Kirkpatrick
- Department of Psychiatry & Behavioral Sciences, University of Nevada, Reno School of Medicine, United States
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore; North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Bengtsson J, Bodén R, Neider D, Cernvall M. A blinded validation of the Swedish version of the Clinical Assessment Interview for Negative Symptoms (CAINS). Nord J Psychiatry 2022; 76:44-51. [PMID: 34126848 DOI: 10.1080/08039488.2021.1933174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed in order to advance the assessment of negative symptoms. The aim of this study was to validate the Swedish version of the CAINS. MATERIALS AND METHODS Thirty-four out-patients with a schizophrenia spectrum disorder were recruited. All patients were videotaped while interviewed with the CAINS and the Brief Psychiatric Rating Scale (BPRS). Another rater watched the video recordings in the reverse order, enabling a blinded design. The patients also filled in self-reported measures of depression, quality of life, and social and vocational functioning. We calculated inter-rater agreement and internal consistency for the CAINS. We also calculated validity measures by correlating the subscales Motivation and Pleasure (CAINS-MAP) and Expression (CAINS-EXP) to subscales of the BPRS. RESULTS The blinded inter-rater agreement for the CAINS total score was high (ICC = 0.92) but slightly lower for the expression subscale (ICC = 0.76). Cronbach's alpha was 0.84 for the total score. Convergent validity with the negative symptoms subscale of BPRS was different for the blinded and the unblinded data, with a CAINS-MAP correlation of 0.10 (p = 0.580) and a CAINS-EXP correlation of 0.48 (p = 0.004) in the blinded data. The unblinded data had a CAINS-MAP correlation of 0.38 (p = 0.026) and a CAINS-EXP correlation of 0.87 (p < 0.001). Self-rated measures of anhedonia correlated to CAINS-MAP with a coefficient of 0.68 (p < 0.001), while the CAINS-EXP only had a correlation of 0.16 (p = 0.366) to these measures. CONCLUSION The Swedish version of the CAINS displays adequate psychometric properties in line with earlier validation studies.
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Affiliation(s)
- Johan Bengtsson
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | | | - Martin Cernvall
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Cuesta MJ, Sánchez-Torres AM, Lorente-Omeñaca R, Moreno-Izco L, Peralta V. Cognitive, community functioning and clinical correlates of the Clinical Assessment Interview for Negative Symptoms (CAINS) in psychotic disorders. Eur Arch Psychiatry Clin Neurosci 2021; 271:1537-1546. [PMID: 32895741 DOI: 10.1007/s00406-020-01188-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022]
Abstract
Negative symptoms are a core dimension of schizophrenia and other psychoses that account for a large degree of the poor functional outcomes related to these disorders. Newer assessment scales for negative symptoms, such as the Clinical Assessment Interview for Negative Symptoms (CAINS), provide evidence for separate dimensions of motivational and pleasure (MAP) and expression (EXP) dimensions. This study was aimed at extending the analysis of the clinical, functional and cognitive correlates of CAINS dimensions in a sample of patients with psychotic disorders (n = 98) and 50 healthy controls.A psychopathological evaluation was conducted by using the Comprehensive Assessment of Symptoms and History (CASH). To assess the extrapyramidal signs, the UKU scale was used. Community functioning was evaluated by means of real-world and functional attainment measures. Additionally, a full neuropsychological test battery was administered. Pearson correlation and hierarchical multiple linear regression analyses were performed to identify the influencing and predictive factors associated with the CAINS dimensions.The MAP and EXP dimensions showed strong associations with the Scale for the Assessment of Negative Symptoms (SANS) items and were not significantly associated with extra-pyramidal or cognitive deficits. The MAP and EXP CAINS dimensions revealed good predictive validity for real-world functioning and functional attainment measures.These findings suggest that the CAINS scale endorses good convergent validity for the assessment of negative symptoms and is very useful in the prediction of psychosocial functioning. In addition, the CAINS dimensions might provide advantages over old assessment scales on disentangling the complex associations between negative symptoms and cognitive impairment.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
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Functional connectivity of cerebellar dentate nucleus and cognitive impairments in patients with drug-naive and first-episode schizophrenia. Psychiatry Res 2021; 300:113937. [PMID: 33895443 DOI: 10.1016/j.psychres.2021.113937] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/11/2021] [Indexed: 12/17/2022]
Abstract
Cognitive impairments are the hallmark of schizophrenia and prominent in the early episode stage. However, the underlying pathological mechanisms of cognitive impairments are not fully understood. This study aimed to investigate the abnormal functional connectivity (FC) of the cerebellar dentate nucleus (DN) and its correlation with cognitive impairments in patients with drug-naive and first-episode schizophrenia. Resting-state functional magnetic resonance imaging data were acquired in 47 patients and 43 healthy controls. Cognitive functions were assessed by number sequence span, verbal category fluency, digit-symbol coding tests. The results showed that the patients had deficits in all three cognitive tests compared to the controls. Furthermore, the increased FC of DN with the bilateral postcentral gyrus and decreased FC of DN with the right inferior temporal gyrus and regional cerebellum (e.g., Vermis 4-5 and Crus I) were observed in the patient group compared to the control group. Importantly, these abnormal DN FC significantly correlated with cognitive tests (e.g., number sequence span and digit-symbol coding) and clinical symptoms (e.g., negative symptom) in the patient group. The results suggested that abnormal FC of DN with cortical and subcortical regions was associated with cognitive impairments and symptom severity and might be an underlying neural mechanism in schizophrenia.
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28
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Amoretti S, Verdolini N, Mezquida G, Rabelo-da-Ponte FD, Cuesta MJ, Pina-Camacho L, Gomez-Ramiro M, De-la-Cámara C, González-Pinto A, Díaz-Caneja CM, Corripio I, Vieta E, de la Serna E, Mané A, Solé B, Carvalho AF, Serra M, Bernardo M. Identifying clinical clusters with distinct trajectories in first-episode psychosis through an unsupervised machine learning technique. Eur Neuropsychopharmacol 2021; 47:112-129. [PMID: 33531261 DOI: 10.1016/j.euroneuro.2021.01.095] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 12/22/2022]
Abstract
The extreme variability in symptom presentation reveals that individuals diagnosed with a first-episode psychosis (FEP) may encompass different sub-populations with potentially different illness courses and, hence, different treatment needs. Previous studies have shown that sociodemographic and family environment factors are associated with more unfavorable symptom trajectories. The aim of this study was to examine the dimensional structure of symptoms and to identify individuals' trajectories at early stage of illness and potential risk factors associated with poor outcomes at follow-up in non-affective FEP. One hundred and forty-four non-affective FEP patients were assessed at baseline and at 2-year follow-up. A Principal component analysis has been conducted to identify dimensions, then an unsupervised machine learning technique (fuzzy clustering) was performed to identify clinical subgroups of patients. Six symptom factors were extracted (positive, negative, depressive, anxiety, disorganization and somatic/cognitive). Three distinct clinical clusters were determined at baseline: mild; negative and moderate; and positive and severe symptoms, and five at follow-up: minimal; mild; moderate; negative and depressive; and severe symptoms. Receiving a low-dose antipsychotic, having a more severe depressive symptomatology and a positive family history for psychiatric disorders were risk factors for poor recovery, whilst having a high cognitive reserve and better premorbid adjustment may confer a better prognosis. The current study provided a better understanding of the heterogeneous profile of FEP. Early identification of patients who could likely present poor outcomes may be an initial step for the development of targeted interventions to improve illness trajectories and preserve psychosocial functioning.
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Affiliation(s)
- Silvia Amoretti
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Norma Verdolini
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain
| | | | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Laura Pina-Camacho
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta Gomez-Ramiro
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain
| | - Concepción De-la-Cámara
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Hospital Clínico Universitario and Instituto de Investigación Sanitaria (IIS), Department of Medicine and Psychiatry. Universidad de Zaragoza, Zaragoza, Spain
| | - Ana González-Pinto
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Department of Neurociences, University of the Basque Country, Vitoria, Spain
| | - Covadonga M Díaz-Caneja
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychatry and Mental Health, Hospital General Universitario Gregorio Marañon, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduard Vieta
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain.
| | - Elena de la Serna
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry and Psychology, Clínic Institute of Neurosciences, Hospital Clínic de Barcelona, 2017SGR881, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Anna Mané
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Brisa Solé
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Maria Serra
- Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Neuroscience Institute, University of Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Spain
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Rekhi G, Ang MS, Chan YH, Fernandez-Egea E, Kirkpatrick B, Lee J. Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 15:S1888-9891(21)00060-4. [PMID: 34058418 DOI: 10.1016/j.rpsm.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to propose criteria for negative symptoms remission (NSR) in schizophrenia using the Brief Negative Symptom Scale (BNSS). MATERIAL AND METHODS 274 participants were assessed on the Positive and Negative Syndrome Scale (PANSS), BNSS and Social and Occupational Functioning Assessment Scale (SOFAS). Two criteria for NSR on the BNSS were proposed - NSR based on the BNSS domains scores (NSRBNSS_DOMAINS) and NSR based on 5 key items of the BNSS (NSRBNSS_5ITEMS). A SOFAS score of 61 and above was considered as functional remission (FR). Logistic regressions were run to examine the association between FR and NSR. Receiver operating characteristic (ROC) curve analysis was performed for the NSR criteria on FR. Kappa agreement statistic was used to evaluate the agreement between the two NSR criteria. RESULTS Eighty-nine (32.5%) participants fulfilled NSRBNSS_DOMAINS criterion whereas 70 (25.6%) participants fulfilled NSRBNSS_5ITEMS criterion. The two NSR criteria had substantial agreement (Kappa statistic=0.797) with each other. Sixty-one (25.3%) participants were in FR. FR was significantly associated with NSR, irrespective of the criterion used. To predict FR, the Area Under the Curve for NSRBNSS_DOMAINS and NSRBNSS_5ITEMS were 0.761 (CI: 0.696-0.826, p<0.001) and 0.723 (CI: 0.656-0.790, p<0.001), respectively. Hence, both NSR criteria demonstrated a fair ability to discriminate between functional remitters and non-remitters. CONCLUSIONS Depending on the setting and needs, clinicians and researchers might employ either the full BNSS or an abbreviated 5-item BNSS scale to identify NSR in schizophrenia. More research is needed to further examine the validity of these criteria in schizophrenia.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Mei San Ang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Brian Kirkpatrick
- Department of Psychiatry & Behavioral Sciences, University of Nevada, Reno School of Medicine, United States
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore; North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Rampino A, Falcone RM, Giannuzzi A, Masellis R, Antonucci LA, Torretta S. Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies. Clin Pract Epidemiol Ment Health 2021; 17:31-47. [PMID: 34249137 PMCID: PMC8227533 DOI: 10.2174/1745017902117010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/15/2021] [Accepted: 02/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up. OBJECTIVES We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction. CONCLUSION A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time.An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.
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Affiliation(s)
- Antonio Rampino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Azienda Ospedaliero-Universitaria Policlinico di Bari, 70124 Bari, Italy
| | - Rosa M. Falcone
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Arianna Giannuzzi
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Rita Masellis
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Linda A. Antonucci
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, 70122 Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
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31
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Okada H, Hirano D, Taniguchi T. Single versus dual pathways to functional outcomes in schizophrenia: Role of negative symptoms and cognitive function. Schizophr Res Cogn 2021; 23:100191. [PMID: 33204652 PMCID: PMC7648174 DOI: 10.1016/j.scog.2020.100191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background The functional outcomes for many patients with schizophrenia remain poor, and the specific determinants for and pathways to functional outcomes are not well understood to date. It is unknown whether major determinants of outcomes are achieved via a motivated single pathway or by the motivation and capacity defined in dual pathways. This study investigated whether different aspects of functional outcomes, such as residential, social, and vocational outcomes, are the main determinants of the experience factors for negative symptoms or whether the experience factors and cognitive function are the determinants. Method We enrolled 107 patients with schizophrenia. The Social Functioning Scale domains were used to examine whether a single or dual pathway is appropriate for each domain based on the model fit using structural equation modeling. Results The model goodness of fit criterion showed a dual pathway for residential and vocational outcomes. In contrast, social and recreational outcomes showed a single pathway. Conclusion The major determinants were clearly different for each outcome. Therefore, we emphasize the importance of using different treatment strategies for each outcome. Irrespective of the factors approached, social and recreational outcomes should ultimately focus on motivation. The findings also suggest that interventions should be combined for vulnerable cognitive functions and motivational interventions for residential and vocational outcomes.
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Strauss GP, Bartolomeo LA, Harvey PD. Avolition as the core negative symptom in schizophrenia: relevance to pharmacological treatment development. NPJ SCHIZOPHRENIA 2021; 7:16. [PMID: 33637748 PMCID: PMC7910596 DOI: 10.1038/s41537-021-00145-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
Negative symptoms have long been considered a core component of schizophrenia. Modern conceptualizations of the structure of negative symptoms posit that there are at least two broad dimensions (motivation and pleasure and diminished expression) or perhaps five separable domains (avolition, anhedonia, asociality, blunted affect, alogia). The current review synthesizes a body of emerging research indicating that avolition may have a special place among these dimensions, as it is generally associated with poorer outcomes and may have distinct neurobiological mechanisms. Network analytic findings also indicate that avolition is highly central and interconnected with the other negative symptom domains in schizophrenia, and successfully remediating avolition results in global improvement in the entire constellation of negative symptoms. Avolition may therefore reflect the most critical treatment target within the negative symptom construct. Implications for targeted treatment development and clinical trial design are discussed.
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Affiliation(s)
| | | | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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33
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Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, Giordano GM, Vandevelde A, Nielsen MØ, Glenthøj LB, Sabé M, Pezzella P, Bitter I, Gaebel W. EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e23. [PMID: 33597064 PMCID: PMC8080207 DOI: 10.1192/j.eurpsy.2021.11] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
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Affiliation(s)
- S Galderisi
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - S Dollfus
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - P Pezzella
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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34
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Intermittent theta burst stimulation for negative symptoms of schizophrenia-A double-blind, sham-controlled pilot study. NPJ SCHIZOPHRENIA 2021; 7:10. [PMID: 33580032 PMCID: PMC7880987 DOI: 10.1038/s41537-021-00138-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
Optimal noninvasive brain stimulation parameters for the treatment of negative symptoms of schizophrenia remain unclear. Here, we aimed to investigate the clinical and biological effects of intermittent theta burst transcranial magnetic stimulation (iTBS) in patients with treatment-resistant negative symptoms of schizophrenia (NCT00875498). In a randomized sham-controlled 2-arm study, 22 patients with schizophrenia and treatment-resistant negative symptoms received 20 sessions of either active (n = 12) or sham (n = 10) iTBS. Sessions were delivered twice a day on 10 consecutive working days. Negative symptom severity was assessed 5 times using the Scale for the Assessment of Negative Symptoms (SANS): before iTBS, after iTBS, and 1, 3, and 6 months after iTBS. As a secondary objective, we explored the acute effects of iTBS on functional connectivity of the left dorsolateral prefrontal cortex (DLPFC) using seed-based resting-state functional connectivity MRI (rsFC fMRI) images acquired before and after iTBS. Active iTBS over the left DLPFC significantly decreased negative symptoms severity compared to sham iTBS (F(3,60) = 3.321, p = 0.026). Post hoc analyses revealed that the difference between groups was significant 6 months after the end of stimulation sessions. Neuroimaging revealed an increase in rsFC between the left DLPFC and a brain region encompassing the right lateral occipital cortex and right angular gyrus and a right midbrain region that may encompass dopamine neuron cell bodies. Thus, iTBS over the left DLPFC can alleviate negative symptoms of schizophrenia. The effect might be driven by significant modulation of dopamine transmission.
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35
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Abbas A, Yadav V, Smith E, Ramjas E, Rutter SB, Benavidez C, Koesmahargyo V, Zhang L, Guan L, Rosenfield P, Perez-Rodriguez M, Galatzer-Levy IR. Computer Vision-Based Assessment of Motor Functioning in Schizophrenia: Use of Smartphones for Remote Measurement of Schizophrenia Symptomatology. Digit Biomark 2021; 5:29-36. [PMID: 33615120 DOI: 10.1159/000512383] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Motor abnormalities have been shown to be a distinct component of schizophrenia symptomatology. However, objective and scalable methods for assessment of motor functioning in schizophrenia are lacking. Advancements in machine learning-based digital tools have allowed for automated and remote "digital phenotyping" of disease symptomatology. Here, we assess the performance of a computer vision-based assessment of motor functioning as a characteristic of schizophrenia using video data collected remotely through smartphones. Methods Eighteen patients with schizophrenia and 9 healthy controls were asked to remotely participate in smartphone-based assessments daily for 14 days. Video recorded from the smartphone front-facing camera during these assessments was used to quantify the Euclidean distance of head movement between frames through a pretrained computer vision model. The ability of head movement measurements to distinguish between patients and healthy controls as well as their relationship to schizophrenia symptom severity as measured through traditional clinical scores was assessed. Results The rate of head movement in participants with schizophrenia (1.48 mm/frame) and those without differed significantly (2.50 mm/frame; p = 0.01), and a logistic regression demonstrated that head movement was a significant predictor of schizophrenia diagnosis (p = 0.02). Linear regression between head movement and clinical scores of schizophrenia showed that head movement has a negative relationship with schizophrenia symptom severity (p = 0.04), primarily with negative symptoms of schizophrenia. Conclusions Remote, smartphone-based assessments were able to capture meaningful visual behavior for computer vision-based objective measurement of head movement. The measurements of head movement acquired were able to accurately classify schizophrenia diagnosis and quantify symptom severity in patients with schizophrenia.
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Affiliation(s)
| | | | - Emma Smith
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth Ramjas
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sarah B Rutter
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Li Zhang
- AiCure, LLC, New York, New York, USA
| | - Lei Guan
- AiCure, LLC, New York, New York, USA
| | - Paul Rosenfield
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Isaac R Galatzer-Levy
- AiCure, LLC, New York, New York, USA.,Psychiatry, New York University School of Medicine, New York, New York, USA
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Haguiara B, Koga G, Diniz E, Fonseca L, Higuchi CH, Kagan S, Lacerda A, Correll CU, Gadelha A. What is the Best Latent Structure of Negative Symptoms in Schizophrenia? A Systematic Review. SCHIZOPHRENIA BULLETIN OPEN 2021; 2:sgab013. [PMID: 34901862 PMCID: PMC8650068 DOI: 10.1093/schizbullopen/sgab013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Determining the best latent structure of negative symptoms in schizophrenia could benefit assessment tools, neurobiological research, and targeted interventions. However, no review systematically evaluated studies that assessed and validated latent models of negative symptoms. Objective To identify and evaluate existing latent structure models in the literature of negative symptoms and to determine the best model. Method Systematic search of MEDLINE, EMBASE, and Scopus on July 19, 2020, for confirmatory factor analysis models of negative symptoms in patients with schizophrenia. The available evidence was assessed through 2 sets of criteria: (1) study design quality—based on negative symptoms assessment and modeling strategy and (2) psychometric quality and model fit—based on fit indices and factor definition quality. Results In total, 22 studies (n = 17 086) from 9 countries were included. Studies differed greatly regarding symptom scales, setting, and sample size (range = 86–6889). Dimensional models included 2–6 factors (median = 4). Twelve studies evaluated competing models and adopted appropriate instruments to assess the latent structure of negative symptoms. The 5-factor and hierarchical models outperformed unitary, 2-factor, and 3-factor models on all direct comparisons, and most of the analyses derived from the Brief Negative Symptom Scale. Considering the quality criteria proposed, 5-factor and hierarchical models achieved excellent fit in just one study. Conclusions Our review points out that the 5-factor and hierarchical models represent the best latent structure of negative symptoms, but the immaturity of the relevant current literature may affect the robustness of this conclusion. Future studies should address current limitations regarding psychometric properties and also address biological and clinical validity to refine available models.
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Affiliation(s)
- Bernardo Haguiara
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Gabriela Koga
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Elton Diniz
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Lais Fonseca
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Cinthia H Higuchi
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Simão Kagan
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Acioly Lacerda
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ary Gadelha
- Laboratory of Integrative Neurosciences, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
- Schizophrenia Program, Department of Psychiatry, Escola Paulista de Medicina/Universidade Federal de São Paulo, SP, Brazil
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Yu L, Ni H, Wu Z, Fang X, Chen Y, Wang D, Zhang C. Association of Cognitive Impairment With Anhedonia in Patients With Schizophrenia. Front Psychiatry 2021; 12:762216. [PMID: 34925093 PMCID: PMC8674556 DOI: 10.3389/fpsyt.2021.762216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Anhedonia is considered as one of the five dimensions of negative symptoms and mainly refers to the reduction of the capacity of feeling pleasure. Increasing evidence suggests that anhedonia in schizophrenia may be partly explained by cognitive impairment. However, the associations between specific cognitive impairment and anhedonia are not fully investigated. The purpose of this study was to examine anticipatory anhedonia, consummatory anhedonia, and their cognitive associations in schizophrenia. A total number of 100 patients with schizophrenia and 67 healthy volunteers were recruited. The clinical symptoms of schizophrenia were assessed. Anticipatory pleasure, consummatory pleasure, and cognitive functions of each participant were measured. Multiple linear regression analysis was performed to investigate the influencing factors of anhedonia in schizophrenia. The results showed no significant differences in sex, age, education year, body mass index (BMI), and marital status between the schizophrenia group and healthy control group (all P > 0.05). Both anticipatory and consummatory pleasure in the schizophrenia group were significantly lower than those in the healthy control group (all P < 0.05). Immediate memory, visual spanning, language, attention, and delayed memory were significantly poorer in the schizophrenia group (all P < 0.05). The results showed that language deficit is an independent risk factor for anticipatory anhedonia (B' = 0.265, P = 0.008, 95% CI: 0.038-0.244), while delayed memory deficit is an independent risk factor for consummatory anhedonia (B' = 0.391, P < 0.001, 95% CI:0.085-0.237). To the best of our knowledge, this is the first study that reported the specific cognitive associations of anhedonia in schizophrenia. The findings have added new evidence on the influencing factors of anhedonia and provided clues for the associations between clinical manifestations of schizophrenia.
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Affiliation(s)
- Lingfang Yu
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua Ni
- Shanghai Xuhui Mental Health Center, Shanghai, China
| | - Zenan Wu
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyu Fang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Chen
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dandan Wang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Zhang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Metacognition Is Uniquely Related to Concurrent and Prospective Assessments of Negative Symptoms Independent of Verbal Memory in Serious Mental Illness. J Nerv Ment Dis 2020; 208:837-842. [PMID: 32740145 DOI: 10.1097/nmd.0000000000001219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The inability to synthesize information into experience of self and others could be one significant cause of negative symptoms. To explore this possibility, we examined the relationships between baseline metacognition and concurrent and prospective negative symptoms controlling for verbal memory. The participants were 62 adults diagnosed with serious mental illness enrolled in outpatient treatment. Metacognition was measured with the Metacognitive Assessment Scale-Abbreviated, symptoms were assessed using the Brief Psychiatric Rating Scale, and verbal memory was assessed using the California Verbal Learning Test. Significant correlations were found, indicating that poorer overall metacognition was associated with greater levels of negative symptoms assessed concurrently (r = 0.39) and 1 month later (r = 0.36). A significant relationship persisted after controlling for verbal memory and education. These findings support the idea that metacognitive deficits are related to negative symptoms and point to the potential of metacognitive interventions to positively influence negative symptoms.
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39
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Learning the Affective Value of Others in Schizophrenia: Examining the Role of Negative Symptoms and Cognitive Deficits. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Cohen AS, Schwartz E, Le TP, Cowan T, Kirkpatrick B, Raugh IM, Strauss GP. Digital phenotyping of negative symptoms: the relationship to clinician ratings. Schizophr Bull 2020; 47:44-53. [PMID: 32467967 PMCID: PMC7825094 DOI: 10.1093/schbul/sbaa065] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Negative symptoms are a critical, but poorly understood, aspect of schizophrenia. Measurement of negative symptoms primarily relies on clinician ratings, an endeavor with established reliability and validity. There have been increasing attempts to digitally phenotype negative symptoms using objective biobehavioral technologies, eg, using computerized analysis of vocal, speech, facial, hand and other behaviors. Surprisingly, biobehavioral technologies and clinician ratings are only modestly inter-related, and findings from individual studies often do not replicate or are counterintuitive. In this article, we document and evaluate this lack of convergence in 4 case studies, in an archival dataset of 877 audio/video samples, and in the extant literature. We then explain this divergence in terms of "resolution"-a critical psychometric property in biomedical, engineering, and computational sciences defined as precision in distinguishing various aspects of a signal. We demonstrate how convergence between clinical ratings and biobehavioral data can be achieved by scaling data across various resolutions. Clinical ratings reflect an indispensable tool that integrates considerable information into actionable, yet "low resolution" ordinal ratings. This allows viewing of the "forest" of negative symptoms. Unfortunately, their resolution cannot be scaled or decomposed with sufficient precision to isolate the time, setting, and nature of negative symptoms for many purposes (ie, to see the "trees"). Biobehavioral measures afford precision for understanding when, where, and why negative symptoms emerge, though much work is needed to validate them. Digital phenotyping of negative symptoms can provide unprecedented opportunities for tracking, understanding, and treating them, but requires consideration of resolution.
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Affiliation(s)
- Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA,To whom correspondence should be addressed; Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803; tel: +1-225-578-7017, fax: +1-225-578-4125, e-mail:
| | - Elana Schwartz
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Thanh P Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Tovah Cowan
- Department of Psychology, Louisiana State University, Baton Rouge, LA,Louisiana State University, Center for Computation and Technology, Baton Rouge, LA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
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Abstract
BACKGROUND Patients in every stage of the psychosis continuum can present with negative symptoms. While no treatment is currently available to address these symptoms, a more refined characterization of their course over the lifetime could help in elaborating interventions. Previous reports have separately investigated the prevalence of negative symptoms within each stage of the psychosis continuum. Our aim in this review is to compare those prevalences across stages, thereby disclosing the course of negative symptoms. METHODS We searched several databases for studies reporting prevalences of negative symptoms in each one of our predetermined stages of the psychosis continuum: clinical or ultra-high risk (UHR), first-episode of psychosis (FEP), and younger and older patients who have experienced multiple episodes of psychosis (MEP). We combined results using the definitions of negative symptoms detailed in the Brief Negative Symptom Scale, a recently developed tool. For each negative symptom, we averaged and weighted by the combined sample size the prevalences of each negative symptom at each stage. RESULTS We selected 47 studies totaling 1872 UHR, 2947 FEP, 5039 younger MEP, and 669 older MEP patients. For each negative symptom, the prevalences showed a comparable course. Each negative symptom decreased from the UHR to FEP stages and then increased from the FEP to MEP stages. CONCLUSIONS Certain psychological, environmental, and treatment-related factors may influence the cumulative impact of negative symptoms, presenting the possibility for early intervention to improve the long-term course.
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Do psychosis prodrome onset negative symptoms predict first presentation negative symptoms? Eur Psychiatry 2020; 29:153-9. [DOI: 10.1016/j.eurpsy.2013.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/21/2013] [Accepted: 02/13/2013] [Indexed: 11/19/2022] Open
Abstract
AbstractBackground:Negative symptoms have been previously reported during the psychosis prodrome, however our understanding of their relationship with treatment-phase negative symptoms remains unclear.Objectives:We report the prevalence of psychosis prodrome onset negative symptoms (PONS) and ascertain whether these predict negative symptoms at first presentation for treatment.Methods:Presence of expressivity or experiential negative symptom domains was established at first presentation for treatment using the Scale for Assessment of Negative Symptoms (SANS) in 373 individuals with a first episode psychosis. PONS were established using the Beiser Scale. The relationship between PONS and negative symptoms at first presentation was ascertained and regression analyses determined the relationship independent of confounding.Results:PONS prevalence was 50.3% in the schizophrenia spectrum group (n = 155) and 31.2% in the non-schizophrenia spectrum group (n = 218). In the schizophrenia spectrum group, PONS had a significant unadjusted (χ2 = 10.41, P < 0.001) and adjusted (OR = 2.40, 95% CI = 1.11–5.22, P = 0.027) association with first presentation experiential symptoms, however this relationship was not evident in the non-schizophrenia spectrum group. PONS did not predict expressivity symptoms in either diagnostic group.Conclusion:PONS are common in schizophrenia spectrum diagnoses, and predict experiential symptoms at first presentation. Further prospective research is needed to examine whether negative symptoms commence during the psychosis prodrome.
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The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia. Eur Psychiatry 2020; 30:641-7. [DOI: 10.1016/j.eurpsy.2015.01.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/25/2015] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
AbstractBackgroundThe Brief Negative Symptom Scale (BNSS) was developed to address the main limitations of the existing scales for the assessment of negative symptoms of schizophrenia. The initial validation of the scale by the group involved in its development demonstrated good convergent and discriminant validity, and a factor structure confirming the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). However, only relatively small samples of patients with schizophrenia were investigated. Further independent validation in large clinical samples might be instrumental to the broad diffusion of the scale in clinical research.MethodsThe present study aimed to examine the BNSS inter-rater reliability, convergent/discriminant validity and factor structure in a large Italian sample of outpatients with schizophrenia.ResultsOur results confirmed the excellent inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the main sample (n = 912) and in a subsample without clinically significant levels of depression and extrapyramidal symptoms (n = 496). The BNSS factor structure was supported in both groups.ConclusionsThe study confirms that the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies.
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44
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Wang LL, Ma EPY, Lui SSY, Cheung EFC, Cheng KS, Chan RCK. Validation and extension of the Motivation and Pleasure Scale-Self Report (MAP-SR) across the schizophrenia spectrum in the Chinese context. Asian J Psychiatr 2020; 49:101971. [PMID: 32065963 DOI: 10.1016/j.ajp.2020.101971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/08/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Developed based on the Clinical Assessment Interview for Negative Symptoms (CAINS), the Motivation and Pleasure Scale-Self Report (MAP-SR) was designed to address the conceptual and psychometric limitations of other instruments assessing negative symptoms. We sought to validate and extend the applicability of the MAP-SR in the Chinese context across the schizophrenia spectrum. METHODS Three samples, including college students, individuals with social anhedonia and patients with schizophrenia, were recruited. Test-retest reliability, internal consistency, factor structure, and convergent/discriminant validity of the MAP-SR were examined. The group differences between the three participant groups were examined. RESULTS A four-factor structure of the MAP-SR was found consistently in all three groups of participants. The scale showed convergent/discriminant validity in patients with schizophrenia and individuals with social anhedonia, along with good reliability found in schizophrenia patients. The MAP-SR was also able to distinguish individuals with SocAnh and patients with SZ from matched controls. CONCLUSIONS The MAP-SR is a valid and reliable instrument in assessing negative symptoms in individuals along the schizophrenia spectrum.
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Affiliation(s)
- Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, the University of Chinese Academy of Sciences, Beijing, China
| | - Eugenia P Y Ma
- Departmentof Adult Psychiatry, Kwai Chung Hospital, Hong Kong, China
| | - Simon S Y Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Castle Peak Hospital, Hong Kong, China
| | | | - Kin Shing Cheng
- Departmentof Adult Psychiatry, Kwai Chung Hospital, Hong Kong, China.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, the University of Chinese Academy of Sciences, Beijing, China.
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45
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Blanchard JJ, Andrea A, Orth RD, Savage C, Bennett ME. Sleep disturbance and sleep-related impairment in psychotic disorders are related to both positive and negative symptoms. Psychiatry Res 2020; 286:112857. [PMID: 32087449 PMCID: PMC7416463 DOI: 10.1016/j.psychres.2020.112857] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
A large literature indicates that sleep disturbances are associated with paranoia and other positive symptoms in psychotic disorders. However, few studies have examined the potential association between sleep disturbances and negative symptoms and the results have been inconsistent. The current study examined the hypothesis that sleep problems would be associated with more severe positive and negative symptoms in a transdiagnostic sample of individuals with psychosis (N = 90). Further, we examined whether sleep would be related to negative symptoms above and beyond the contribution of paranoia, other positive symptoms, and depression-anxiety. Results replicated prior research in finding that both sleep disturbance and sleep-related impairment were related to more severe paranoia, other positive symptoms and depression-anxiety. Consistent with our hypothesis, more severe sleep disturbance and sleep-related impairment were related to greater negative symptoms; this was evident across both motivation-pleasure deficits and diminished expression. Sleep variables remained significantly related to motivation-pleasure deficits even after controlling for other non-negative symptoms. These results indicate the broad symptom impact of sleep disturbances and may suggest a novel treatment target to improve negative symptoms.
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Affiliation(s)
- Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, MD 20742, USA.
| | - Alexandra Andrea
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Christina Savage
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, 737 W. Lombard Street, Suite 551 Baltimore, MD 21201, USA; Department of Psychiatry, Baltimore VA Medical Center, 10 North Greene Street, Baltimore, MD 21201, USA
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46
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Pierce KM, Maxwell SD, Olino TM, Cooper S, Ellman LM. Factor Structure, Convergent, and Divergent Validity of the Prodromal Questionnaire-Negative Symptom Subscale. Assessment 2020; 28:153-168. [PMID: 31955596 DOI: 10.1177/1073191119899981] [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] [Indexed: 11/15/2022]
Abstract
Negative symptoms such as anhedonia are associated with psychosis risk and poorer outcomes. The Prodromal Questionnaire (PQ) is a self-report questionnaire used to screen for psychosis spectrum symptoms. However, the convergent and divergent validity and underlying factor structure of the PQ-negative symptom subscale (PQ-N) have yet to be examined. Undergraduates (N = 1,556) completed the PQ, Temporal Experience of Pleasure Scale, and measures assessing anxiety, depression, and motivation. An exploratory factor analysis conducted on the PQ-N yielded a two-factor solution, reflecting subdimensions of social expression and dissociative-depressive experiences, contrary to previous research examining the factor structure of negative symptoms. Associations between the PQ-N, its two factors, and measures of negative symptoms and other psychopathology were examined. Results indicated that the PQ-N and its factors were more strongly correlated with measures of depression and anxiety than with measures of negative symptoms relating to motivation and pleasure, suggesting poor convergent and divergent validity.
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47
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Simamora RH, Loebis B, Husada MS, Effendy E. Folic Acid and Vitamin B12 Supplementation on Male Patients with Schizophrenia Predominant Negative Symptoms. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401314666180620142607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Schizophrenia is a chronic mental disorder that affects approximately 1% of
the world’s population. Particularly, negative symptoms are frequently resistant and are the main contributors
to the disability on schizophrenia patients. Folic acid and vitamin B12 supplementation is the
safe and affordable approach, which can significantly improve the outcome on the patients with residual
symptoms.
Objectives:
We aimed to understand the difference of negative subscale of Positive and Negative Syndrome
Scale (PANSS) Score on patients with schizophrenia who receive risperidone with the addition
folic acid and Vitamin B12 and patients who receive only risperidone after 6 weeks.
Methods:
This study is a quasi experimental pre-test and post-test designs that are divided into two
groups, they are group receiving risperidone with the addition of folic acid and vitamin B12 and the
group receiving only risperidone. Diagnosis of schizophrenia according to the International Classification
of Diseases (ICD-10) criteria and negative symptoms assessed by using negative subscale of
PANSS Scores are observed. Statistical analysis is conducted using Statistical Package for the Social
Sciences (SPSS) software.
Results:
There was a significant difference in the mean score of negative-scale PANSS scores at the
end of week 6 between the group receiving folic acid and vitamin B12 supplementation and the group
receiving only risperidone with p = 0.002; p <0.05.
Conclusion:
Folic acid and vitamin B12 Supplementation provide benefits to patients schizophrenia.
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Affiliation(s)
- Rona Hanani Simamora
- Department of Psychiatry, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Bahagia Loebis
- Department of Psychiatry, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Muhammad Surya Husada
- Department of Psychiatry, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Elmeida Effendy
- Department of Psychiatry, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
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Rodríguez-Testal JF, Perona-Garcelán S, Dollfus S, Valdés-Díaz M, García-Martínez J, Ruíz-Veguilla M, Senín-Calderón C. Spanish validation of the self-evaluation of negative symptoms scale SNS in an adolescent population. BMC Psychiatry 2019; 19:327. [PMID: 31664965 PMCID: PMC6819523 DOI: 10.1186/s12888-019-2314-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/09/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Negative symptoms (NS) may be observed in the general population in an attenuated form and in high-risk mental states. However, they have been less studied in the general population than positive symptoms, in spite of their importance at the insidious onset of schizophrenia and their appearance before positive symptoms. This study aimed to analyze the empirical structure of the Spanish version of the Self-Evaluation of Negative Symptoms (SNS) Scale and find its psychometric properties and invariance of measurement across sex and age in a sample of adolescents. METHODS The sample consisted of 4521 adolescents (53.6% female) from 11 to 18 years of age. RESULTS Confirmatory Factor Analysis of the SNS confirmed an internal structure of five first-order factors by the characteristic dimensions of NS: avolition, social withdrawal, diminished emotional range, anhedonia, alogia, and one second-order factor which includes the total NS score. Multi-group confirmatory factor analysis showed that the scale was invariant across sex and age. Total scale reliability was adequate. A strong relationship was found between the SNS with depressive symptomatology, moderate with ideas of reference and low with aberrant salience. CONCLUSION The results back use of the Spanish version of the SNS scale for detection of NS in the general population of adolescents.
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Affiliation(s)
- Juan F. Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Seville, Spain. Av. Camilo José Cela, 41018 Seville, SN Spain
| | - Salvador Perona-Garcelán
- Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, SN Spain
| | - Sonia Dollfus
- CHU de Caen, Service universitaire de Psychiatrie, Centre Esquirol, Avenue Côte de Nacre, F-14000 Caen, France
- UNICAEN, UFR Médecine, F-14074 Caen, France
| | - María Valdés-Díaz
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
| | - Jesús García-Martínez
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
| | - Miguel Ruíz-Veguilla
- Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, SN Spain
| | - Cristina Senín-Calderón
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
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Cerveri G, Gesi C, Mencacci C. Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm. Neuropsychiatr Dis Treat 2019; 15:1525-1535. [PMID: 31239687 PMCID: PMC6556563 DOI: 10.2147/ndt.s201726] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
The clinical presentation of schizophrenia encompasses symptoms divided into three dimensions: positive, negative, and cognitive. Negative symptoms (NS), in particular, have a major impact on the quality of life of the affected subject, and, differing from positive symptoms, are often associated with a limited response to pharmacotherapy. To date, studies specifically investigating NS in schizophrenia are scant; therefore, proper selection of therapy for NS remains a major unmet medical need. Given the heterogeneity of the clinical presentation of schizophrenia, the treatment of NS, as well as therapy for other associated symptoms, should be largely individualized according to a patient's specific characteristics. In this paper, we review current knowledge on NS and construct a clinical algorithm for the treatment of schizophrenic conditions with pronounced NS. Overall, data from the literature suggest that second-generation antipsychotics, such as cariprazine and amisulpride, should be preferred over first-generation antipsychotics (FGAs), as they are associated with better functional outcomes and lower cognitive impairment. The combination of antipsychotics and antidepressants may also improve NS while addressing some affective disorders associated with schizophrenia; however, no clear information is available on the effects of this combination on primary NS or on the mechanism of action of the combination. In the proposed clinical algorithm, we suggest that cariprazine should be used as first-line treatment for patients with predominant NS, and that amisulpride should be considered as an alternative in cases of cariprazine failure. Further treatment lines may include the use of olanzapine and quetiapine, and add-on therapy with antidepressants.
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Affiliation(s)
| | - Camilla Gesi
- Mental Health Department, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Claudio Mencacci
- Mental Health Department, ASST Fatebenefratelli-Sacco, Milan, Italy
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50
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Li LY, Karcher NR, Kerns JG, Fung CK, Martin EA. The subjective-objective deficit paradox in schizotypy extends to emotion regulation and awareness. J Psychiatr Res 2019; 111:160-168. [PMID: 30772760 DOI: 10.1016/j.jpsychires.2019.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/15/2018] [Accepted: 01/30/2019] [Indexed: 01/22/2023]
Abstract
There is an emerging subjective-objective deficit paradox in schizotypy. Individuals with schizotypy report severe subjective complaints in several key functional domains commensurate with that of individuals with schizophrenia. However, objective assessments of the same domains show relatively intact performance. We examined whether this subjective-objective deficit paradox extends to two closely linked affective processes: emotion regulation and awareness. Individuals with elevated social anhedonia (SocAnh; n = 61) and elevated perceptual aberration/magical ideation (PerMag; n = 73) were compared to control participants (n = 81) on subjective and objective measures of emotion regulation and awareness. Subjective measures included self-report questionnaires assessing regulatory ability, attention to emotion, and emotional clarity. Implicit emotion regulation was assessed by the Emotion Regulation-Implicit Association Test (ER-IAT) while objective emotional awareness was assessed by the Levels of Emotional Awareness Scale (LEAS), a performance-based test. Results showed that both SocAnh and PerMag groups reported notable deficits in almost all subjective measures relative to controls (composite ds > 0.55). In contrast, performance on ER-IAT and LEAS was very similar to controls (composite ds < 0.11). The current study suggests that the subjective-objective deficit paradox extends to emotion regulation and awareness, highlighting the importance of higher-order cognitive bias in understanding emotional abnormalities in schizotypy.
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Affiliation(s)
- Lilian Yanqing Li
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Nicole R Karcher
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Christie K Fung
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA.
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