1
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Hadzi Boskovic D, Smith-Palmer J, Pöhlmann J, Pollock RF, Hwang S, Bruhn D. Systematic Literature Review of Studies Reporting Measures of Functional Outcome or Quality of Life in People with Negative Symptoms of Schizophrenia. Patient Relat Outcome Meas 2024; 15:199-217. [PMID: 38911609 PMCID: PMC11192194 DOI: 10.2147/prom.s454845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/09/2024] [Indexed: 06/25/2024] Open
Abstract
Aim Negative symptoms of schizophrenia (NSS) have been linked with poor functional outcomes. A literature review was performed to identify instruments used to assess functional outcomes and quality of life in clinical trials and observational studies conducted in groups of people with NSS. Methods Literature search strings were designed using Medical Subject Headings combined with free-text terms and searches were performed using the PubMed, Embase and the Cochrane Library databases. For inclusion, articles were required to be published as full-text articles, in English, over the period 2011-2021, include at least one group or treatment arm of people with NSS and report either functional outcomes or quality of life (QoL). Results Literature searches identified a total of 3,268 unique hits. After two rounds of screening, 37 publications (covering 35 individual studies) were included in the review. A total of fourteen different instruments were used to assess functional outcomes and eleven different instruments were used to assess QoL. In studies in people with NSS, the most frequently used functional outcome measures were the Personal and Social Performance scale and the Global Assessment of Functioning. The most frequently used QoL instruments included the Manchester Short Assessment of Quality of Life, the Heinrich Carpenter Quality of Life Scale, the Schizophrenia Quality of Life Scale and the EQ-5D. Conclusion A large number of measures have been used to assess functional outcomes and QoL in people with NSS, these include both generic and condition-specific as well as both interviewer-administered and self-reported instruments.
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Affiliation(s)
- Dusica Hadzi Boskovic
- Global Value and Real World Evidence, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
| | | | | | | | - Steve Hwang
- Global Value and Real World Evidence, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
| | - David Bruhn
- Global Value and Real World Evidence, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA
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2
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Cognitive Dysfunctions Measured with the MCCB in Deficit and Non-Deficit Schizophrenia. J Clin Med 2023; 12:jcm12062257. [PMID: 36983258 PMCID: PMC10053076 DOI: 10.3390/jcm12062257] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
This study compared cognitive domains between deficit schizophrenia (DS) and non-deficit schizophrenia (NDS) patients and healthy controls (HC), analyzing relationships between psychopathological dimensions and cognitive domains. A total of 29 DS patients, 45 NDS patients, and 39 HC subjects participated. Cognitive domains were measured using the Measurement and Treatment Research to Improve Cognition in Schizophrenia Battery. Psychopathological symptoms were evaluated with the Positive and Negative Syndrome Scale. Clinical groups performed poorer than HC groups in regards to speed of processing, attention/vigilance, working memory, verbal and visual learning and memory, reasoning and problem solving, and social cognition. DS patients scored poorer than NDS patients in terms of all cognitive domains and the overall score, except for reasoning and problem solving. Positive, negative, disorganization, and resistance symptoms were related to cognitive functions only in NDS patients. Our findings suggest that the MCCB battery is sensitive to detecting cognitive dysfunctions in both deficit and non-deficit schizophrenia.
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3
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Mahmood Z, Parrish EM, Keller AV, Lykins HC, Pickell D, Granholm E, Twamley EW. Modifiable predictors of self-reported and performance-based functioning in individuals with schizophrenia-spectrum disorders and high levels of negative symptoms. J Psychiatr Res 2022; 151:347-353. [PMID: 35533518 DOI: 10.1016/j.jpsychires.2022.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
Individuals with schizophrenia who have high negative symptoms are at high risk for poor functional outcomes. However, the determinants of psychosocial functioning in this group are not well understood. We aimed to examine modifiable predictors of both objective, performance-based functional capacity and social skills, and self-reported functioning in individuals with schizophrenia and schizoaffective disorder and high negative symptoms. Fifty-five adults with moderate-to-severe negative symptoms were administered measures of neuropsychological performance, performance-based functional capacity and social competence, self-reported functioning, psychiatric symptom severity, defeatist/asocial beliefs, and intrinsic motivation. In the context of multiple significant predictor variables identified through bivariate correlations, multiple regression models showed that neuropsychological performance was the only significant predictor of performance-based functional capacity; neuropsychological performance and motivation/pleasure negative symptoms were significant predictors of performance-based social competence. For two different measures of self-reported functioning, intrinsic motivation, asocial beliefs, and diminished expression emerged as significant predictors. Neurocognitive ability was a better predictor of performance-based functional skills whereas motivation and beliefs more strongly predicted self-reported real-world functioning. The findings of this study suggest a complex picture of predictors of performance-based functional capacity (objective neuropsychological functioning) and self-reported functioning (motivation and beliefs), underscoring the clinical and scientific utility of including both self-reported and objective measures of functioning to identify treatment approach. Individuals with high negative symptoms and a cognitive/functional skills deficit may benefit from interventions such as cognitive remediation or skills training, whereas individuals with motivational difficulties may benefit from treatments such as cognitive behavioral therapy.
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Affiliation(s)
- Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116A, San Diego, CA, 92161, USA.
| | - Emma M Parrish
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116A, San Diego, CA, 92161, USA.
| | - Amber V Keller
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA; Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116A, San Diego, CA, 92161, USA.
| | - Hannah C Lykins
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116A, San Diego, CA, 92161, USA.
| | - Delaney Pickell
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (MC 0603), La Jolla, CA, 92093, USA.
| | - Eric Granholm
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (MC 0603), La Jolla, CA, 92093, USA; Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
| | - Elizabeth W Twamley
- Research Service, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116A, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (MC 0603), La Jolla, CA, 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116A, San Diego, CA, 92161, USA.
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4
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Arnovitz MD, Spitzberg AJ, Davani AJ, Vadhan NP, Holland J, Kane JM, Michaels TI. MDMA for the Treatment of Negative Symptoms in Schizophrenia. J Clin Med 2022; 11:jcm11123255. [PMID: 35743326 PMCID: PMC9225098 DOI: 10.3390/jcm11123255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023] Open
Abstract
The profound economic burden of schizophrenia is due, in part, to the negative symptoms of the disease, which can severely limit daily functioning. There is much debate in the field regarding their measurement and classification and there are no FDA-approved treatments for negative symptoms despite an abundance of research. 3,4-Methylenedioxy methamphetamine (MDMA) is a schedule I substance that has emerged as a novel therapeutic given its ability to enhance social interactions, generate empathy, and induce a state of metaplasticity in the brain. This review provides a rationale for the use of MDMA in the treatment of negative symptoms by reviewing the literature on negative symptoms, their treatment, MDMA, and MDMA-assisted therapy. It reviews recent evidence that supports the safe and potentially effective use of MDMA to treat negative symptoms and concludes with considerations regarding safety and possible mechanisms of action.
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Affiliation(s)
- Mitchell D. Arnovitz
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY 11004, USA; (M.D.A.); (A.J.S.); (A.J.D.); (N.P.V.); (J.M.K.)
| | - Andrew J. Spitzberg
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY 11004, USA; (M.D.A.); (A.J.S.); (A.J.D.); (N.P.V.); (J.M.K.)
| | - Ashkhan J. Davani
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY 11004, USA; (M.D.A.); (A.J.S.); (A.J.D.); (N.P.V.); (J.M.K.)
| | - Nehal P. Vadhan
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY 11004, USA; (M.D.A.); (A.J.S.); (A.J.D.); (N.P.V.); (J.M.K.)
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | | | - John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY 11004, USA; (M.D.A.); (A.J.S.); (A.J.D.); (N.P.V.); (J.M.K.)
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
| | - Timothy I. Michaels
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Queens, NY 11004, USA; (M.D.A.); (A.J.S.); (A.J.D.); (N.P.V.); (J.M.K.)
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Correspondence:
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5
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Morillo-Kraus E, Fonseca-Pedrero E, Senín-Calderón C, Rodríguez-Testal JF. Perception of belonging and social anticipatory pleasure: Mediating variables of negative symptoms in the general population. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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6
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Ahmed AO, Kirkpatrick B, Granholm E, Rowland LM, Barker PB, Gold JM, Buchanan RW, Outram T, Bernardo M, Paz García-Portilla M, Mane A, Fernandez-Egea E, Strauss GP. Two Factors, Five Factors, or Both? External Validation Studies of Negative Symptom Dimensions in Schizophrenia. Schizophr Bull 2022; 48:620-630. [PMID: 35020936 PMCID: PMC9077418 DOI: 10.1093/schbul/sbab148] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Negative symptom studies frequently use single composite scores as indicators of symptom severity and as primary endpoints in clinical trials. Factor analytic and external validation studies do not support this practice but rather suggest a multidimensional construct. The current study used structural equation modeling (SEM) to compare competing dimensional models of negative symptoms to determine the number of latent dimensions that best capture variance in biological, psychological, and clinical variables known to have associations with negative symptoms. METHODS Three independent studies (total n = 632) compared unidimensional, two-factor, five-factor, and hierarchical conceptualizations of negative symptoms in relation to cognition, psychopathology, and community functioning (Study 1); trait emotional experience and defeatist performance beliefs (Study 2); and glutamate and gamma-aminobutyric acid levels in the anterior cingulate cortex quantified using proton magnetic resonance spectroscopy (Study 3). RESULTS SEM favored the five-factor and hierarchical models over the unidimensional and two-factor models regardless of the negative symptom measure or external validator. The five dimensions-anhedonia, asociality, avolition, blunted affect, and alogia-proved vital either as stand-alone domains or as first-order domains influenced by second-order dimensions-motivation and pleasure and emotional expression. The two broader dimensions sometimes masked important associations unique to the five narrower domains. Avolition, anhedonia, and blunted affect showed the most domain-specific associations with external variables across study samples. CONCLUSIONS Five domains and a hierarchical model reflect the optimal conceptualization of negative symptoms in relation to external variables. Clinical trials should consider using the two dimensions as primary endpoints and the five domains as secondary endpoints.
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Affiliation(s)
- Anthony O Ahmed
- To whom correspondence should be addressed; Department of Psychiatry, Weill Cornell Medicine, 21 Bloomingdale Road, White Plains, NY 10605, USA; tel: 914-997-5251, e-mail:
| | - Brian Kirkpatrick
- Department of Psychiatry, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA,Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Laura M Rowland
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peter B Barker
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA,FM Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - James M Gold
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert W Buchanan
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tacina Outram
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain,Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - María Paz García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain,Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Anna Mane
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain,Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain,Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, USA
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7
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Leathem LD, Currin DL, Montoya AK, Karlsgodt KH. Socioemotional mechanisms of loneliness in subclinical psychosis. Schizophr Res 2021; 238:145-151. [PMID: 34688116 PMCID: PMC8896506 DOI: 10.1016/j.schres.2021.10.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 01/31/2023]
Abstract
Loneliness is an important predictor of physical and mental health in the general population and in individuals across the psychosis spectrum, including those experiencing subclinical psychotic-like experiences (PLEs). However, the mechanisms underlying loneliness in the psychosis spectrum are not well understood. Emotion processing deficits are well described across the psychosis spectrum, and socioemotional processing biases are critical for the development and maintenance of loneliness through altered social appraisal, including judgements of rejection. Therefore, we propose that PLEs are associated with increased loneliness, and the relationship is mediated by alterations in socioemotional processing. We also explored how this pathway may be affected by mood and anxiety symptoms, which have been associated with loneliness across the psychosis spectrum. As part of the Human Connectome Project, generally healthy adults (n = 1180) reported symptomatology and social functioning and completed the Penn Emotion Recognition Task to assess efficiency in identifying emotions. We found that higher reported PLEs were associated with elevated levels of loneliness and perceived rejection and that these factors were linked by multiple independent pathways. First, anxiety/depression and emotion processing efficiency independently mediated the PLE-loneliness relationship. Second, we found that the association between PLEs and loneliness was serially mediated through inefficient emotion recognition then higher levels of perceived rejection. These separable mechanisms of increased loneliness in subclinical psychosis have implications for treatment and continued study of social functioning in the psychosis spectrum.
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Affiliation(s)
- Logan D. Leathem
- Department of Psychology, University of California, Los Angeles, United States of America,Corresponding author at: Department of Psychology, UCLA, 502 Portola Plaza, 1285 Psychology Building, Los Angeles, CA 90095, United States of America. (L.D. Leathem)
| | - Danielle L. Currin
- Department of Psychology, University of California, Los Angeles, United States of America
| | - Amanda K. Montoya
- Department of Psychology, University of California, Los Angeles, United States of America
| | - Katherine H. Karlsgodt
- Department of Psychology, University of California, Los Angeles, United States of America,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States of America
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8
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Devoe DJ, Cadenhead KS, Cornblatt B, Granholm E, Addington J. Negative symptoms: associations with defeatist beliefs, self-efficacy, and maladaptive schemas in youth and young adults at-risk for psychosis. Behav Cogn Psychother 2021; 50:1-14. [PMID: 34784991 DOI: 10.1017/s1352465821000461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Investigations into possible mechanisms that may contribute to the development, maintenance, and exacerbation of negative symptoms are needed. Defeatist beliefs, self-efficacy, and early maladaptive schemas have been shown to contribute to negative symptoms in schizophrenia. Likewise, negative symptoms occur in those at clinical high-risk (CHR) for psychosis. AIMS The aim of this study was to determine if negative symptoms were associated with defeatist beliefs, self-efficacy, and early maladaptive schemas in CHR participants of a group therapy intervention study. METHOD All CHR participants (n = 203; 99 males, 104 females) were recruited as part of a three-site randomized control trial: Recovery through Group Study (ReGroup). Negative symptoms, defeatist beliefs, self-efficacy and early maladaptive schemas were assessed by trained clinical raters. Mediation analyses were conducted to examine the relationship between defeatist beliefs, self-efficacy, functioning, and negative symptoms. RESULTS The majority of CHR youth (72.9%) had at least one negative symptom of moderate to above moderate severity at baseline. In multiple mediation analyses, both asocial beliefs and social self-efficacy mediated the effects of social functioning on negative symptoms. Finally, defeatist performance attitudes significantly mediated the effects of role functioning on negative symptoms. CONCLUSIONS These results highlight the importance of considering beliefs and attitudes in relation to functioning and severity of negative symptoms. Psychosocial interventions may wish to target beliefs and attitudes in effort to reduce negative symptoms and improve functioning in CHR youth.
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Affiliation(s)
- Daniel J Devoe
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - K S Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Barbara Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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9
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Lee KH, Yu CH. The moderating effect of mindfulness on self-defeatist beliefs and negative symptoms in a population of chronic schizophrenia patients in Taiwan. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Devoe DJ, Lu L, Cannon TD, Cadenhead KS, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Woods SW, Walker EF, Mathalon DH, Bearden CE, Addington J. Persistent negative symptoms in youth at clinical high risk for psychosis: A longitudinal study. Schizophr Res 2021; 227:28-37. [PMID: 32362460 PMCID: PMC7606256 DOI: 10.1016/j.schres.2020.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 01/29/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Severity of negative symptoms has been associated with poor functioning, cognitive deficits, and defeatist beliefs in schizophrenia patients. However, one area that remains understudied is persistent negative symptoms (PNS). Negative symptoms, including PNS, have been observed in those at clinical high-risk (CHR) for psychosis. The aim of this study was to determine if PNS were associated with functioning, neurocognition, and defeatist beliefs in a CHR sample. METHOD CHR participants (n = 764) were recruited for the North American Prodrome Longitudinal Study. Negative symptoms were rated on the Scale of Psychosis-risk Symptoms. Generalized linear mixed models for repeated measures were used to examine changes over time between and within groups (PNS vs non-PNS). RESULTS The PNS group (n = 67) had significant deficits in functioning at baseline, 6, 12, 18, and 24-months compared to the non-PNS group (n = 673). Functioning improved over time in the non-PNS group, while functioning in the PNS group remained relatively stable and poor over a two-year period. A consistent trend emerged demonstrating higher defeatist beliefs in the PNS group; however, this result was lost when controlling for persistent depressive symptoms. There were no significant differences between the groups on neurocognition, social cognition, and transition to psychosis. CONCLUSIONS PNS exist in youth at CHR for psychosis, resulting in significant and persistent functional impairment, which remains when controlling for persistent depressive symptoms. PNS remain even in CHR youth who do not transition to psychosis. Thus, PNS may represent an unmet therapeutic need in CHR populations for which there are currently no effective treatments.
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Affiliation(s)
- D J Devoe
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - L Lu
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - T D Cannon
- Department of Psychology, Yale University, New Haven, CT, United States
| | - K S Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - B A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Queens, NY, United States
| | - T H McGlashan
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - D O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - L J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States
| | - M T Tsuang
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Institute of Genomic Medicine, University of California, La Jolla, CA, United States
| | - S W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - E F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - D H Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, United States; Psychiatry Service, San Francisco, CA, United States
| | - C E Bearden
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States; Department Biobehavioral Sciences and Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - J Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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11
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Ebrahimi A, Poursharifi H, Dolatshahi B, Rezaee O, Hassanabadi HR, Naeem F. The Cognitive Model of Negative Symptoms in Schizophrenia: A Hierarchical Component Model With PLS-SEM. Front Psychiatry 2021; 12:707291. [PMID: 34366940 PMCID: PMC8339582 DOI: 10.3389/fpsyt.2021.707291] [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: 05/09/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
The cognitive model of negative symptoms suggests that some dysfunctional beliefs mediate the relationship between neurocognitive deficits and negative symptoms and disability. This study tested the hypothesis that dysfunctional performance beliefs mediate neurocognitive deficits, negative symptoms, and disability. We used a hierarchal component model with 85 men patients diagnosed with chronic schizophrenia. Results showed a moderate to strong correlation between dysfunctional performance beliefs, neurocognitive deficits, negative symptoms, and disability. These results support the Hierarchal component model (HCM) of the cognitive model of negative symptoms. Our results indicated that the disability in schizophrenia is mediated through dysfunctional performance beliefs, neurocognitive deficits, and negative symptoms pathway. Further, dysfunctional performance beliefs have a crucial role in this pathway. Therefore, targeting this vicious cycle of dysfunctional beliefs can improve disability in patients with schizophrenia.
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Affiliation(s)
- Ali Ebrahimi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Poursharifi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrooz Dolatshahi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Omid Rezaee
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Hassanabadi
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Kharazmi University, Tehran, Iran
| | - Farooq Naeem
- Department of Psychiatry, University of Toronto & Centre for Addiction and Mental Health, Toronto, ON, Canada
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12
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Zhou C, Li Z. Modelling of self‐management in schizophrenia: The role of neurocognition, self‐efficacy and motivation. J Clin Nurs 2020; 29:3966-3976. [DOI: 10.1111/jocn.15407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Chenxi Zhou
- School of Nursing Peking Union Medical College Beijing China
| | - Zheng Li
- School of Nursing Peking Union Medical College Beijing China
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13
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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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14
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Lyngstad SH, Bettella F, Aminoff SR, Athanasiu L, Andreassen OA, Faerden A, Melle I. Associations between schizophrenia polygenic risk and apathy in schizophrenia spectrum disorders and healthy controls. Acta Psychiatr Scand 2020; 141:452-464. [PMID: 32091622 DOI: 10.1111/acps.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Apathy is a central predictor of a poor functional outcome in schizophrenia. Schizophrenia polygenic risk scores (PRSs) are used to detect genetic associations to key clinical phenotypes in schizophrenia. We explored the associations between schizophrenia PRS and apathy levels in schizophrenia spectrum disorders (n = 281) and matched healthy controls (n = 298), and further how schizophrenia PRS contributed in predicting apathy when added to premorbid and clinical factors in the patient sample. METHOD Schizophrenia PRSs were computed for each participant. Apathy was assessed with the Apathy Evaluation Scale. Bivariate correlation analyses were used to investigate associations between schizophrenia PRS and apathy, and between apathy and premorbid and clinical factors. Multiple hierarchical regression analyses were employed to evaluate the contributions of clinical variables and schizophrenia PRS to apathy levels. RESULTS We found no significant associations between schizophrenia PRS and apathy in patients and healthy controls. Several premorbid and clinical characteristics significantly predicted apathy in patients, but schizophrenia PRS did not. CONCLUSION Since the PRSs are based on common genetic variants, our results do not preclude associations to other types of genetic factors. The results could also indicate that environmentally based biological or psychological factors contribute to apathy levels in schizophrenia.
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Affiliation(s)
- S H Lyngstad
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bettella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S R Aminoff
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - L Athanasiu
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - A Faerden
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - I Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Anticipatory feelings: Neural correlates and linguistic markers. Neurosci Biobehav Rev 2020; 113:308-324. [PMID: 32061891 DOI: 10.1016/j.neubiorev.2020.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 02/12/2020] [Indexed: 02/07/2023]
Abstract
This review introduces anticipatory feelings (AF) as a new construct related to the process of anticipation and prediction of future events. AF, defined as the state of awareness of physiological and neurocognitive changes that occur within an oganism in the form of a process of adapting to future events, are an important component of anticipation and expectancy. They encompass bodily-related interoceptive and affective components and are influenced by intrapersonal and dispositional factors, such as optimism, hope, pessimism, or worry. In the present review, we consider evidence from animal and human research, including neuroimaging studies, to characterize the brain structures and brain networks involved in AF. The majority of studies reviewed revealed three brain regions involved in future oriented feelings: 1) the insula; 2) the ventromedial prefrontal cortex (vmPFC); and 3) the amygdala. Moreover, these brain regions were confirmed by a meta-analysis, using a platform for large-scale, automated synthesis of fMRI data. Finally, by adopting a neurolinguistic and a big data approach, we illustrate how AF are expressed in language.
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16
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Wright A, Browne J, Mueser KT, Cather C. Evidence-Based Psychosocial Treatment for Individuals with Early Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:211-223. [PMID: 31708048 DOI: 10.1016/j.chc.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coordinated specialty care (CSC) first-episode models are an evidence-based practice in the treatment of first-episode psychosis. Group, individual, and family therapies in CSC aim to help the client and family understand and cope with the experience of psychosis, promote symptomatic and functional recovery and improve quality of life, and support the pursuit of personally meaningful goals of the client. Common elements to these interventions include building a therapeutic alliance, recovery orientation, education, and skills training, which can be directed to a range of targets, including problem-solving, communication, social skills, and social cognition.
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Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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17
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Correll CU, Schooler NR. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatr Dis Treat 2020; 16:519-534. [PMID: 32110026 PMCID: PMC7041437 DOI: 10.2147/ndt.s225643] [Citation(s) in RCA: 295] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptom constellations. The objective of this review was to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia. Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. The term negative symptoms describes a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal/emotional expression. The negative symptom domain consists of five key constructs: blunted affect, alogia (reduction in quantity of words spoken), avolition (reduced goal-directed activity due to decreased motivation), asociality, and anhedonia (reduced experience of pleasure). Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. While secondary negative symptoms can improve as a consequence of treatment to improve symptoms in other domains (ie, positive symptoms, depressive symptoms or extrapyramidal symptoms), primary negative symptoms generally do not respond well to currently available antipsychotic treatment with dopamine D2 antagonists or partial D2 agonists. Since some patients may lack insight about the presence of negative symptoms, these are generally not the reason that patients seek clinical care, and clinicians should be especially vigilant for their presence. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, New York, NY, USA.,Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Nina R Schooler
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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18
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Alvarez-Jimenez M, Bendall S, Koval P, Rice S, Cagliarini D, Valentine L, D’Alfonso S, Miles C, Russon P, Penn DL, Phillips J, Lederman R, Wadley G, Killackey E, Santesteban-Echarri O, Mihalopoulos C, Herrman H, Gonzalez-Blanch C, Gilbertson T, Lal S, Chambers R, Daglas-Georgiou R, Latorre C, Cotton SM, McGorry PD, Gleeson JF. HORYZONS trial: protocol for a randomised controlled trial of a moderated online social therapy to maintain treatment effects from first-episode psychosis services. BMJ Open 2019; 9:e024104. [PMID: 30782893 PMCID: PMC6368148 DOI: 10.1136/bmjopen-2018-024104] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Specialised early intervention services have demonstrated improved outcomes in first-episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many patients with FEP remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has developed a moderated online social media therapy (HORYZONS) designed to enhance social functioning and maintain clinical gains from specialist FEP services. HORYZONS merges: (1) peer-to-peer social networking; (2) tailored therapeutic interventions; (3) expert and peer-moderation; and (4) new models of psychological therapy (strengths and mindfulness-based interventions) targeting social functioning. The aim of this trial is to determine whether following 2 years of specialised support and 18-month online social media-based intervention (HORYZONS) is superior to 18 months of regular care. METHODS AND ANALYSIS This study is a single-blind randomised controlled trial. The treatment conditions include HORYZONS plus treatment as usual (TAU) or TAU alone. We recruited 170 young people with FEP, aged 16-27 years, in clinical remission and nearing discharge from Early Psychosis Prevention and Intervention Centre, Melbourne. The study includes four assessment time points, namely, baseline, 6-month, 12-month and 18-month follow-up. The study is due for completion in July 2018 and included a 40-month recruitment period and an 18-month treatment phase. The primary outcome is social functioning at 18 months. Secondary outcome measures include rate of hospital admissions, cost-effectiveness, vocational status, depression, social support, loneliness, self-esteem, self-efficacy, anxiety, psychological well-being, satisfaction with life, quality of life, positive and negative psychotic symptoms and substance use. Social functioning will be also assessed in real time through our Smartphone Ecological Momentary Assessment tool. ETHICS AND DISSEMINATION Melbourne Health Human Research Ethics Committee (2013.146) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. TRIAL REGISTRATION NUMBER ACTRN12614000009617; Pre-results.
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Affiliation(s)
- Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniela Cagliarini
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Lee Valentine
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Simon D’Alfonso
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher Miles
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Penni Russon
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Penn
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
- Department of Psychology, University of North Carolina Chapel Hill, NC, United Stated
| | - Jess Phillips
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Olga Santesteban-Echarri
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Calgary, Alberta, Canada
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Tamsyn Gilbertson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- University of Montreal Hospital Research Center, Health Innovation and Evaluation Hub, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | - Rothanthi Daglas-Georgiou
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John F Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
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19
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Beck AT, Himelstein R, Grant PM. In and out of schizophrenia: Activation and deactivation of the negative and positive schemas. Schizophr Res 2019; 203:55-61. [PMID: 29169775 DOI: 10.1016/j.schres.2017.10.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
Theorists, clinicians, and investigators have attempted to find a common source for the negative and positive symptoms of schizophrenia. We propose that a unified theory, based on a common cognitive structure not only has explanatory value, but can serve as a framework for a psychotherapeutic intervention. Specifically, we propose that the cognitive triad - the negative view of the self, others, and the future - is the source of the content for the negative and positive symptoms. We report literature supporting the relationship between each facet of the negative triad and each of the key symptoms: expressive negative symptoms, delusions, and verbal hallucinations. We conclude that the literature supports the validity of the cognitive model of negative and positive symptoms. The cognitive model furthers the understanding of the positive and negative symptoms of schizophrenia, and we describe how this provides a framework for a psychotherapeutic intervention.
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Affiliation(s)
- Aaron T Beck
- Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Paul M Grant
- Perelman School of Medicine, University of Pennsylvania, USA..
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20
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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21
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Alvarez-Jimenez M, Gleeson JF, Bendall S, Penn DL, Yung AR, Ryan RM, Eleftheriadis D, D'Alfonso S, Rice S, Miles C, Russon P, Lederman R, Chambers R, Gonzalez-Blanch C, Lim MH, Killackey E, McGorry PD, Nelson B. Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy. Schizophr Res 2018; 202:369-377. [PMID: 30031616 DOI: 10.1016/j.schres.2018.07.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments. AIMS The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning. METHODS An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants. RESULTS System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage. CONCLUSION MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.
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Affiliation(s)
- M Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - J F Gleeson
- School of Psychology, Australian Catholic University, Melbourne, Australia
| | - S Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - D L Penn
- School of Psychology, Australian Catholic University, Melbourne, Australia; University of North Carolina Chapel Hill, USA
| | - A R Yung
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - R M Ryan
- Australian Catholic University, Institute for Positive Psychology and Education, Australia; University of Rochester, Meliora Hall, Rochester, NY, United States
| | - D Eleftheriadis
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S D'Alfonso
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; The School of Computing and Information Systems, The University of Melbourne, Australia
| | - S Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - C Miles
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P Russon
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - R Lederman
- The School of Computing and Information Systems, The University of Melbourne, Australia
| | | | | | - M H Lim
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Australia
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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22
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Yang Y, Yang ZY, Zou YM, Shi HS, Wang Y, Xie DJ, Zhang RT, Lui SSY, Cohen AC, Strauss GP, Cheung EFC, Chan RCK. Low-pleasure beliefs in patients with schizophrenia and individuals with social anhedonia. Schizophr Res 2018; 201:137-144. [PMID: 29804927 DOI: 10.1016/j.schres.2018.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/14/2018] [Accepted: 05/12/2018] [Indexed: 12/26/2022]
Abstract
Anhedonia in schizophrenia has been suggested to comprise a set of low-pleasure beliefs, defined as beliefs that certain things/activities were not pleasurable or that one does not feel pleasant generally. However, no instrument has been intentionally developed to specifically measure low-pleasure beliefs, and there is a paucity of empirical evidence for low-pleasure beliefs and their relationship with anhedonia in both patients with schizophrenia and individuals with high social anhedonia. We developed and validated the Beliefs About Pleasure Scale (BAPS) using non-clinical (Studies 1, 2 & 3), chronic schizophrenia (Study 2), and first episode schizophrenia (Study 3) samples. Across these studies, we examined psychometric properties of the BAPS, including temporal stability, internal consistency, factor structure, and convergent validity. The 22 BAPS items loaded onto 4 factors, namely the "Devaluation of Pleasure", the "Pleasurable Activity Expectancies", the "Negative Outcomes Expectancies", and the "Attention to Pleasure". The measure demonstrated good internal consistency and convergent validity in each sample. Moreover, both individual with schizophrenia and non-clinical participants with high social anhedonia scored higher on the BAPS than controls (Study 3), supporting construct validity. These findings provide preliminary evidence for the presence of low-pleasure beliefs in both clinical and subclinical groups and suggest that the BAPS has promising initial psychometric properties. The BAPS will be useful for exploring the cognitive component of anhedonia and provides a novel assessment for mechanism of change in psychosocial treatment studies.
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Affiliation(s)
- Yin Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zhuo-Ya Yang
- 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
| | - Ying-Min Zou
- 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
| | - Hai-Song Shi
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; North China Electric Power University, Beijing, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Dong-Jie Xie
- 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
| | - Rui-Ting Zhang
- 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
- 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 Special Administrative Region, China
| | - Alex C Cohen
- Department of Psychology, Louisiana State University, United States
| | | | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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23
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Reddy LF, Horan WP, Barch DM, Buchanan RW, Gold JM, Marder SR, Wynn JK, Young J, Green MF. Understanding the Association Between Negative Symptoms and Performance on Effort-Based Decision-Making Tasks: The Importance of Defeatist Performance Beliefs. Schizophr Bull 2018; 44:1217-1226. [PMID: 29140501 PMCID: PMC6192468 DOI: 10.1093/schbul/sbx156] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Effort-based decision-making paradigms are increasingly utilized to gain insight into the nature of motivation deficits. Research has shown associations between effort-based decision making and experiential negative symptoms; however, the associations are not consistent. The current study had two primary goals. First, we aimed to replicate previous findings of a deficit in effort-based decision making among individuals with schizophrenia on a test of cognitive effort. Second, in a large sample combined from the current and a previous study, we sought to examine the association between negative symptoms and effort by including the related construct of defeatist beliefs. The results replicated previous findings of impaired cognitive effort-based decision making in schizophrenia. Defeatist beliefs significantly moderated the association between negative symptoms and effort-based decision making such that there was a strong association between high negative symptoms and deficits in effort-based decision making, but only among participants with high levels of defeatist beliefs. Thus, our findings suggest the relationship between negative symptoms and effort performance may be understood by taking into account the role of defeatist beliefs, and finding that might explain discrepancies in previous studies.
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Affiliation(s)
- L Felice Reddy
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA,To whom correspondence should be addressed; tel: (310) 478–3711, fax: (310) 268–4056, e-mail:
| | - William P Horan
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Deanna M Barch
- Departments of Psychology, Psychiatry, and Radiology, Washington University, St. Louis, MO
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen R Marder
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Jonathan K Wynn
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Jared Young
- Department of Psychiatry, University of California, San Diego,Research Service, VA San Diego Healthcare System, San Diego, CA
| | - Michael F Green
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA,UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
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Pillny M, Krkovic K, Lincoln TM. Development of the Demotivating Beliefs Inventory and Test of the Cognitive Triad of Amotivation. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9940-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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25
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Hu HX, Chu MY, Yang Y, Wang LL, Zhang RT, Lui SSY, Cheung EFC, Chan RCK. Mediation effect of beliefs about pleasure and emotional experience between social anhedonia and prediction of pleasant events. Psychiatry Res 2018; 264:39-45. [PMID: 29626830 DOI: 10.1016/j.psychres.2018.03.070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/24/2018] [Accepted: 03/25/2018] [Indexed: 11/17/2022]
Abstract
Few studies have examined whether there is a relationship between social anhedonia and prediction of future events and the role of beliefs about pleasure and emotional experience. In this study, 513 college students were recruited to complete a set of self-reported questionnaires, including the Revised Social Anhedonia Scale (CSAS), the Temporal Experience of Pleasure Scale (TEPS), the Belief about Pleasure Scale (BAPS) and the Beck Depression Inventory. Moreover, a checklist of 100 daily life events was also administrated to all participants. Mediation analysis found that social anhedonia had a direct impact on prediction of pleasant events. Emotional experience partly mediated the relationship between social anhedonia and subjective prediction of pleasant events. However, beliefs about pleasure had no significant mediation effect between social anhedonia and prediction of pleasant events, but were shown to influence the subjective prediction of pleasant events completely through emotional experience. These findings suggest that beliefs about pleasure and emotional experience may be considered promising factors for interventions in individuals with anhedonia.
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Affiliation(s)
- Hui-Xin Hu
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min-Yi Chu
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yin Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Ling-Ling Wang
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Rui-Ting Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, Chinese Academy of Sciences, Beijing, 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 Special Administrative Region, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, 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, Chinese Academy of Sciences, Beijing, China.
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26
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Grant PM, Perivoliotis D, Luther L, Bredemeier K, Beck AT. Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery-oriented cognitive therapy. Psychol Med 2018; 48:261-268. [PMID: 28637521 DOI: 10.1017/s003329171700160x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Negative symptoms significantly contribute to disability and lack of community participation for low functioning individuals with schizophrenia. Cognitive therapy has been shown to improve negative symptoms and functional outcome in this population. Elucidation of the mechanisms of the therapy would lead to a better understanding of negative symptoms and the development of more effective interventions to promote recovery. The objective of this study was to determine (1) whether guided success at a card-sorting task will produce improvement in defeatist beliefs, positive beliefs about the self, mood, and card-sorting performance, and (2) whether these changes in beliefs and mood predict improvements in unguided card-sorting. METHODS Individuals with schizophrenia having prominent negative symptoms and impaired neurocognitive performance (N = 35) were randomized to guided success (n = 19) or a control (n = 16) condition. RESULTS Controlling for baseline performance, the experimental group performed significantly better, endorsed defeatist beliefs to a lesser degree, reported greater positive self-concept, and reported better mood than the control condition immediately after the experimental session. A composite index of change in defeatist beliefs, self-concept, and mood was significantly correlated with improvements in card-sorting. CONCLUSIONS This analogue study supports the rationale of cognitive therapy and provides a general therapeutic model in which experiential interventions that produce success have a significant immediate effect on a behavioral task, mediated by changes in beliefs and mood. The rapid improvement is a promising indicator of the responsiveness of this population, often regarded as recalcitrant, to cognitively-targeted behavioral interventions.
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Affiliation(s)
- P M Grant
- Perelman School of Medicine,University of Pennsylvania,Philadelphia,USA
| | - D Perivoliotis
- VA San Diego Healthcare System and Department of Psychiatry,University of California,San Diego,California
| | - L Luther
- Department of Psychology,Indiana University-Purdue University,Indianapolis,USA
| | - K Bredemeier
- Center for Health Assessment Research and Translation,College of Health Sciences,University of Delaware,USA
| | - A T Beck
- Perelman School of Medicine,University of Pennsylvania,Philadelphia,USA
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27
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Takeda K, Sumiyoshi T, Matsumoto M, Murayama K, Ikezawa S, Matsumoto K, Nakagome K. Neural Correlates for Intrinsic Motivational Deficits of Schizophrenia; Implications for Therapeutics of Cognitive Impairment. Front Psychiatry 2018; 9:178. [PMID: 29922185 PMCID: PMC5996091 DOI: 10.3389/fpsyt.2018.00178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
The ultimate goal of the treatment of schizophrenia is recovery, a notion related to improvement of cognitive and social functioning. Cognitive remediation therapies (CRT), one of the most effective cognition enhancing methods, have been shown to moderately improve social functioning. For this purpose, intrinsic motivation, related to internal values such as interest and enjoyment, has been shown to play a key role. Although the impairment of intrinsic motivation is one of the characteristics of schizophrenia, its neural mechanisms remain unclear. This is related to the lack of feasible measures of intrinsic motivation, and its response to treatment. According to the self-determination theory (SDT), not only intrinsic motivation, but extrinsic motivation has been reported to enhance learning and memory in healthy subjects to some extent. This finding suggests the contribution of different types of motivation to potentiate the ability of the CRT to treat cognitive impairment of schizophrenia. In this paper, we provide a review of psychological characteristics, assessment methods, and neural correlates of intrinsic motivation in healthy subjects and patients with schizophrenia. Particularly, we focus on neuroimaging studies of intrinsic motivation, including our own. These considerations are relevant to enhancement of functional outcomes of schizophrenia.
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Affiliation(s)
- Kazuyoshi Takeda
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Madoka Matsumoto
- Department of Neuropsychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Kou Murayama
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom.,Research Institute, Kochi University of Technology, Kochi, Japan
| | - Satoru Ikezawa
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Kazuyuki Nakagome
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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28
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Bora E, Binnur Akdede B, Alptekin K. Neurocognitive impairment in deficit and non-deficit schizophrenia: a meta-analysis. Psychol Med 2017; 47:2401-2413. [PMID: 28468693 DOI: 10.1017/s0033291717000952] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Most studies suggested that patients with deficit schizophrenia have more severe impairment compared with patients with non-deficit schizophrenia. However, it is not clear whether deficit and non-deficit schizophrenia are associated with differential neurocognitive profiles. METHODS The aim of this meta-analytic review was to compare cognitive performances of deficit and non-deficit patients with each other and with healthy controls. In the current meta-analysis, differences in cognitive abilities between 897 deficit and 1636 non-deficit patients with schizophrenia were examined. Cognitive performances of 899 healthy controls were also compared with 350 patients with deficit and 592 non-deficit schizophrenia. RESULTS Both deficit (d = 1.04-1.53) and non-deficit (d = 0.68-1.19) schizophrenia were associated with significant deficits in all cognitive domains. Deficit patients underperformed non-deficit patients in all cognitive domains (d = 0.24-0.84) and individual tasks (d = 0.39-0.93). The relationship between deficit syndrome and impairment in olfaction, social cognition, verbal fluency, and speed-based cognitive tasks were relatively stronger. CONCLUSIONS Our findings suggest that there is consistent evidence for a significant relationship between deficit syndrome and more severe cognitive impairment in schizophrenia.
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Affiliation(s)
- E Bora
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
| | - B Binnur Akdede
- Department of Psychiatry,Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health,Carlton South, Victoria 3053,Australia
| | - K Alptekin
- Department of Psychiatry,Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health,Carlton South, Victoria 3053,Australia
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29
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Serper M, Payne E, Dill C, Portillo C, Taliercio J. Allocating effort and anticipating pleasure in schizophrenia: Relationship with real world functioning. Eur Psychiatry 2017; 46:57-64. [PMID: 29031122 DOI: 10.1016/j.eurpsy.2017.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/29/2017] [Accepted: 07/13/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Poor motivation to engage in goal-oriented behavior has been recognized as a hallmark feature of schizophrenia spectrum disorders (SZ). Low drive in SZ may be related to anticipating rewards as well as to poor working memory. However, few studies to date have examined beliefs about self-efficacy and satisfaction for future rewards (anticipatory pleasure). Additionally, few studies to date have examined how these deficits may impact SZ patients' real world functioning. METHOD The present study examined SZ patients' (n=57) anticipatory pleasure, working memory, self-efficacy and real world functioning in relation to their negative symptom severity. RESULTS Results revealed that SZ patients' negative symptom severity was related to decisions in effort allocation and reward probability, working memory deficits, self-efficacy and anticipatory pleasure for future reward. Effort allocation deficits also predicted patients' daily functioning skills. CONCLUSIONS SZ patients with high levels of negative symptoms are not merely effort averse, but have more difficulty effectively allocating effort and anticipating pleasure engaging in effortful activities. It may be the case that continuously failing to achieve reinforcement from engagement and participation may lead SZ patients to form certain negative beliefs about their abilities which contributes to amotivation and cognitive deficits. Lastly, our findings provide further support for a link between SZ patients functional daily living skills their effort allocation.
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Affiliation(s)
- M Serper
- Department of Psychology, Hofstra University, New York, NY, USA; Department of Psychiatry, Ichan Mount Sinai School of Medicine, New York, NY, USA.
| | - E Payne
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | - C Dill
- Department of Psychology, Hofstra University, New York, NY, USA
| | - C Portillo
- Department of Psychology, Hofstra University, New York, NY, USA
| | - J Taliercio
- Department of Psychology, Hofstra University, New York, NY, USA
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30
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Anxiety does not contribute to social withdrawal in the subchronic phencyclidine rat model of schizophrenia. Behav Pharmacol 2017; 28:512-520. [PMID: 28704273 DOI: 10.1097/fbp.0000000000000325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Social withdrawal should not be considered a direct measure of the negative symptoms of schizophrenia as it may result not only from asociality (primary negative symptom) but also from other altered processes such as anxiety. To understand the contribution of these two factors to social deficit, we investigated whether the social withdrawal observed in the subchronic phencyclidine (PCP) rat model of schizophrenia could be attributed to increased anxiety. Compared to saline controls, PCP-treated rats (5 mg/kg, twice daily for 7 days, followed by a washout period) spent significantly less time in social interaction, but did not show anxiety-like behaviors in different relevant behavioral paradigms. In addition, their social deficit was not affected by a behavioral procedure known to reduce anxiety-like behavior (repeated exposure to the same partner) nor by systemic administration of the classical anxiolytic diazepam. In contrast, PCP-induced social withdrawal was reversed by the cannabinoid agonist CP55,940, a drug with known anxiogenic properties. Furthermore, when using the social approach task, PCP-treated animals performed similarly to control animals treated with diazepam, but not to those treated with the anxiogenic compound pentylenetetrazole. Taken together, our results indicate that PCP-induced social withdrawal cannot be attributed to increased anxiety. These data are discussed in the context of primary versus secondary negative symptoms and the deficit syndrome of schizophrenia.
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31
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Abstract
We previously proposed that people with schizophrenia who have primary, enduring negative symptoms have a disease-deficit schizophrenia (DS)-that is separate from that affecting people with schizophrenia without these features. Additional evidence consistent with the separate disease hypothesis has accumulated in recent years. White matter changes may be widespread in deficit compared to nondeficit patients and may relate to problems in early brain migration. These 2 patient groups also appear to differ on metabolic measures prior to antipsychotic treatment. Studies of reward and defeatist beliefs provide the basis for future treatment trials. The 2 factors or groups within negative symptoms broadly defined (both primary and secondary) have also been found in DS, and recent evidence suggests these 2 symptom groups have different correlates and reflect the existence of 2 groups with in DS. Negative symptoms are found in disorders other than schizophrenia, and excess summer birth, a deficit risk factor, has been found in a non-patient group with deficit-like features. It may be useful in future research to determine whether findings in DS extend to patients with other neuropsychiatric disorders who also have negative symptoms.
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Affiliation(s)
- Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada Reno School of Medicine, Reno, NV
| | - Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli (SUN); University Hospital SUN, Naples, Italy
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32
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Affiliation(s)
- William T. Carpenter
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert W. Buchanan
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
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33
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Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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34
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Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. WORLD PSYCHIATRY : OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA) 2017. [PMID: 28127915 DOI: 10.1002/wps.20385.] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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35
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Campellone TR, Sanchez AH, Kring AM. Defeatist Performance Beliefs, Negative Symptoms, and Functional Outcome in Schizophrenia: A Meta-analytic Review. Schizophr Bull 2016; 42:1343-1352. [PMID: 26980144 PMCID: PMC5049520 DOI: 10.1093/schbul/sbw026] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Negative symptoms are a strong predictor of poor functional outcome in people with schizophrenia. Unfortunately there are few effective interventions for either negative symptoms or functional outcome, despite the identification of potential mechanisms. Recent research, however, has elucidated a new potential mechanism for negative symptoms and poor functional outcome: defeatist performance beliefs (DPB), or negative thoughts about one's ability to successfully perform goal-directed behavior that can prevent behavior initiation and engagement. We conducted 2 meta-analyses examining the relationship between DPB and both negative symptoms (n = 10 studies) and functional outcome (n = 8 studies) in people with schizophrenia. We found a small effect size for the relationship between DPB and negative symptoms, regardless of how negative symptoms were measured. We also found a small effect size for the relationship between DPB and functional outcome, which was significantly moderated by the method of assessing DPB and moderated by the sex composition of the study at a trend level. These findings highlight the potential of targeting DPB in psychosocial interventions for both negative symptoms and functional outcome.
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Affiliation(s)
- Timothy R. Campellone
- First authorship is shared between these 2 authors.,*To whom correspondence should be addressed; Department of Psychology, University of California, Berkeley, 3210 Tolman Hall, Berkeley, CA 94720-1690, US; tel: 510-643-4098, fax: 510-642-5293, e-mail:
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36
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Pillny M, Lincoln TM. Predictors of improved functioning in patients with psychosis: The role of amotivation and defeatist performance beliefs. Psychiatry Res 2016; 244:117-22. [PMID: 27479101 DOI: 10.1016/j.psychres.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/28/2016] [Accepted: 07/09/2016] [Indexed: 11/29/2022]
Abstract
Defeatist performance beliefs (DPBs) are associated with the severe impairments in functioning of patients with negative symptoms of schizophrenia. This association has been found to be mediated by amotivation, a core aspect of negative symptoms. Although causality is assumed, longitudinal evidence for this is lacking. The current study aimed to extend previous findings by investigating both cross-sectional and longitudinal associations between DPBs, motivational impairments and functioning in a sample of patients with psychotic disorders (N=58). We hypothesized, that DPBs would be related to functioning in cross-sectional and longitudinal analyses and that this link would be mediated by motivational impairments. Data was assessed at baseline and post-treatment in a trial on the effects of cognitive behavior therapy for psychosis. At baseline, amotivation mediated the association between DPBs and functioning. From baseline to post-treatment, reduction of amotivation was associated with improvement of functioning significantly, whereas reduction of DPBs was unrelated to improvements in functioning or amotivation. The findings suggest that improvement in amotivation accounts for favorable treatment outcomes in regard to functioning but question the causal role of DPBs in negative symptoms and functioning.
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Affiliation(s)
- Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
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37
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Neurocognitive impairment in the deficit subtype of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2016; 266:397-407. [PMID: 26260899 DOI: 10.1007/s00406-015-0629-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 08/03/2015] [Indexed: 12/26/2022]
Abstract
Schizophrenia is a heterogeneous disorder characterized by numerous diverse signs and symptoms. Individuals with prominent, persistent, and idiopathic negative symptoms are thought to encompass a distinct subtype of schizophrenia. Previous work, including studies involving neuropsychological evaluations, has supported this position. The present study sought to further examine whether deficit patients are cognitively distinct from non-deficit patients with schizophrenia. A comprehensive neurocognitive battery including tests of verbal memory, vigilance, processing speed, reasoning, and working memory was administered to 657 patients with schizophrenia. Of these, 144 (22 %) patients were classified as deficit patients using a proxy identification method based on severity, persistence over time, and possible secondary sources (e.g., depression) of negative symptoms. Deficit patients with schizophrenia performed worse on all tests of cognition relative to non-deficit patients. These patients were characterized by a generalized cognitive impairment on the order of about 0.4 standard deviations below that of non-deficit patients. However, when comparing deficit patients to non-deficit patients who also present with negative symptoms, albeit not enduring or primary, no group differences in cognitive performance were found. Furthermore, a discriminant function analysis classifying patients into deficit/non-deficit groups based on cognitive scores demonstrated only 62.3 % accuracy, meaning over one-third of individuals were misclassified. The deficit subtype of schizophrenia is not markedly distinct from non-deficit schizophrenia in terms of neurocognitive performance. While deficit patients tend to have poorer performance on cognitive tests, the magnitude of this effect is relatively modest, translating to over 70 % overlap in scores between groups.
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38
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Luther L, Salyers MP, Firmin RL, Marggraf MP, Davis B, Minor KS. Additional support for the cognitive model of schizophrenia: evidence of elevated defeatist beliefs in schizotypy. Compr Psychiatry 2016; 68:40-7. [PMID: 27234181 DOI: 10.1016/j.comppsych.2016.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 03/03/2016] [Accepted: 03/22/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The cognitive model of poor functioning in schizophrenia posits that defeatist performance beliefs-overgeneralized negative beliefs about one's ability to perform tasks-develop prior to the onset of psychosis and contribute to the development and maintenance of negative symptoms and poor functioning. Although several studies with schizophrenia samples have provided support for the model, there is a paucity of research investigating these beliefs in individuals with schizotypy-those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had two aims: to examine whether defeatist performance beliefs (1) are elevated in schizotypy compared to controls and (2) are associated with decreased quality of life and working memory and increased negative but not positive schizotypy traits in the schizotypy group. METHODS Schizotypy (n=48) and control (n=53) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. RESULTS Analyses revealed that the schizotypy group reported significantly more defeatist performance beliefs than the control group. Within the schizotypy group, increased defeatist performance beliefs were significantly associated with greater negative schizotypy traits and lower quality of life. No significant associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. CONCLUSIONS Results generally support the theoretical validity of the cognitive model of poor functioning in schizophrenia and suggest that elevated defeatist performance beliefs may contribute to the manifestation of subclinical negative symptom traits and reduced quality of life among those with a latent vulnerability for schizophrenia.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Michelle P Salyers
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Ruth L Firmin
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Matthew P Marggraf
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Beshaun Davis
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
| | - Kyle S Minor
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., LD 124, Indianapolis, IN, 46202, USA.
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Kalisz A, Cechnicki A. The stability of negative syndrome, persistent negative syndrome and deficit syndrome in a twenty-year follow-up study of schizophrenia patients. Psychiatry Res 2016; 238:236-241. [PMID: 27086239 DOI: 10.1016/j.psychres.2016.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 11/20/2022]
Abstract
AIMS To assess the prevalence and stability of negative symptoms in schizophrenia according to the BPRS-withdrawal/retardation, persistent negative symptoms and deficit syndrome over twenty years. METHOD Fifty people diagnosed with schizophrenia were evaluated during their first psychiatric hospitalisation and after three, seven, twelve and twenty years. the presence of negative symptoms was assumed when at least one of the BPRS-withdrawal/retardation symptoms (blunted affect, emotional withdrawal, motor retardation), equalled three or more points at the discharge from the index hospitalisation. The groups with persistent negative symptoms and deficit syndrome were identified based on two measurements taken at the index discharge and one year later. The Proxy for the Deficit Syndrome (PDS) was employed to identify deficit syndrome. RESULTS The prevalence of BPRS-withdrawal/retardation, persistent negative symptoms and deficit syndrome after one year was 20%, 4% and 6% respectively. Four of the ten people with BPRS-withdrawal/retardation symptoms maintained them at all follow-ups. No symptoms, however, were found in any of the members of the persistent negative symptoms and deficit syndrome group after twelve and twenty years. CONCLUSIONS The prevalence of primary, persistent negative symptoms after the first episode of psychosis was minimal. A long-term observation does not confirm their stability.
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Affiliation(s)
- Aneta Kalisz
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University, Pl. Sikorskiego 2/8, 31-115, Kraków, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Collegium Medicum, Jagiellonian University, Pl. Sikorskiego 2/8, 31-115, Kraków, Poland.
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40
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Engel M, Fritzsche A, Lincoln TM. Anticipation and experience of emotions in patients with schizophrenia and negative symptoms. An experimental study in a social context. Schizophr Res 2016; 170:191-7. [PMID: 26673972 DOI: 10.1016/j.schres.2015.11.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/19/2015] [Accepted: 11/29/2015] [Indexed: 01/02/2023]
Abstract
Negative symptoms play a central role in the impairment of social functioning in schizophrenia. Healthy individuals use anticipated emotions to guide their decisions to seek out social interactions. It is unknown whether social withdrawal in negative symptoms is related to a biased anticipation of emotions that will arise in social situations. This study thus examined differences between patients with negative symptoms of schizophrenia and healthy controls in the anticipation and experience of positive and negative emotions related to a social interaction. In a between-subject factorial design, participants were instructed to either predict or to experience emotions related to a simulated social inclusion and exclusion interaction. Overall, patients anticipated more intense negative emotions than controls. Divided by the type of social situation, however, patients reported less intense positive emotions than controls with regard to social inclusion, but not with regard to social exclusion. The lack of an overall deficit in anticipation of positive emotions speaks against the assumption that anticipation abnormalities in negative symptoms are due to a neurocognitive deficit. Rather, the findings seem to reflect negative beliefs about potentially rewarding social situations in people with negative symptoms.
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Affiliation(s)
- Maike Engel
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Anja Fritzsche
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Tania M Lincoln
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany.
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Engel M, Fritzsche A, Lincoln TM. Subclinical negative symptoms and the anticipation, experience and recall of emotions related to social interactions: An experimental study. Psychiatry Res 2015; 230:350-6. [PMID: 26412382 DOI: 10.1016/j.psychres.2015.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/12/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
Healthy individuals use anticipated and recalled emotions to guide their decisions to seek out social interactions. It is unknown whether individuals with negative symptoms of schizophrenia, who are commonly observed to socially withdraw, show a bias in anticipation and recall of emotions related to a social interaction. To close this knowledge gap, this study examines whether higher levels of subclinical negative symptoms are associated with less positive and more negative anticipated and recalled emotions related to a social interaction. In a mixed model design participants were instructed to either predict or to experience and then recall emotions related to a simulated social inclusion- or exclusion-interaction. Disregarding the type of situation, participants with higher levels of subclinical negative symptoms anticipated more intense fear than participants with lower levels of subclinical negative symptoms. Divided by type of situation, however, participants with higher levels of negative symptoms experienced and recalled more sadness related to being socially included and even recalled more positive emotions after being excluded. These specific associations are likely to reflect negative expectations about potentially rewarding social situations in people with negative symptoms. A replication in populations with clinically relevant negative symptoms and inclusion of measures to assess memory is warranted.
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Affiliation(s)
- Maike Engel
- University of Hamburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Anja Fritzsche
- University of Hamburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Tania Marie Lincoln
- University of Hamburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
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42
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Hesse K, Kriston L, Wittorf A, Herrlich J, Wölwer W, Klingberg S. Longitudinal relations between symptoms, neurocognition, and self-concept in schizophrenia. Front Psychol 2015; 6:917. [PMID: 26191025 PMCID: PMC4490211 DOI: 10.3389/fpsyg.2015.00917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/19/2015] [Indexed: 12/18/2022] Open
Abstract
Objective: Cognitive models suggest that the self-concept of persons with psychosis can be fundamentally affected. Self-concepts were found to be related to different symptom domains when measured concurrently. Longitudinal investigations to disentangle the possible causal associations are rare. Method: We examined a sample of 160 people with a diagnosis of schizophrenia who took part in a psychotherapy study. All participants had the DSM-IV diagnosis of a schizophrenia and pronounced negative symptoms. Neurocognition, symptoms, and self-concepts were assessed at two time points 12 months apart. Structural equation modeling was used to test whether symptoms influence self-concepts (scar-model) or self-concepts affect symptoms (vulnerability model). Results: Negative symptoms correlated concurrently with self-concepts. Neurocognitive deficits are associated with more negative self-concepts 12 months later. Interpersonal self-concepts were found to be relevant for paranoia. Conclusion: The findings implicate that if deficits in neurocognition are present, fostering a positive self-concept should be an issue in therapy. Negative interpersonal self-concept indicates an increased risk for paranoid delusions in the course of 1 year. New aspects for cognitive models in schizophrenia and clinical implications are discussed.
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Affiliation(s)
- Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
| | - Jutta Herrlich
- Department of Psychiatry and Psychotherapy, University of Frankfurt Frankfurt, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duesseldorf Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen Tübingen, Germany
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43
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White RG, Lysaker P, Gumley AI, McLeod H, McCleery M, O'Neill D, MacBeth A, Giurgi-Oncu C, Mulholland CC. Plasma cortisol levels and illness appraisal in deficit syndrome schizophrenia. Psychiatry Res 2014; 220:765-71. [PMID: 25262562 DOI: 10.1016/j.psychres.2014.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 12/01/2022]
Abstract
Research investigating the association between negative symptoms and plasma cortisol levels in individuals with schizophrenia has produced inconsistent findings. This study investigated whether deficit syndrome schizophrenia (characterized by high levels of primary negative symptoms) is associated with comparatively high morning plasma cortisol levels, more negative appraisals about illness and higher levels of depression. Participants were 85 individuals diagnosed with schizophrenia and 85 individuals with no history of contact with psychiatric services matched for age and gender. All participants provided fasting 9.00a.m. plasma cortisol samples. There were no significant differences between the schizophrenia and control participants in plasma cortisol levels. The Proximal Deficit Syndrome method was used to identify individuals with deficit syndrome schizophrenia. Contrary to what had been hypothesized, participants with deficit syndrome schizophrenia had significantly lower plasma cortisol levels than both non-deficit syndrome participants and control participants. Participants with the deficit syndrome reported significantly less negative appraisals about illness (assessed by PBIQ) and lower levels of depression (assessed by BDI-II). Differences in cortisol levels continued to trend toward significance when levels of depression were controlled for. The patterns of illness-related appraisals and plasma cortisol levels raise the possibility that the deficit syndrome could be a form of adaptation syndrome.
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Affiliation(s)
- Ross G White
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK.
| | - Paul Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Andrew I Gumley
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Hamish McLeod
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Muriel McCleery
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Donnacha O'Neill
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Angus MacBeth
- Centre for Rural Health, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Catalina Giurgi-Oncu
- The Victor Babeș University of Medicine and Pharmacy of Timișoara, 300041, Romania
| | - Ciaran C Mulholland
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
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Hayhurst KP, Massie JA, Dunn G, Lewis SW, Drake RJ. Validity of subjective versus objective quality of life assessment in people with schizophrenia. BMC Psychiatry 2014; 14:365. [PMID: 25539658 PMCID: PMC4300039 DOI: 10.1186/s12888-014-0365-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is considered an important outcome in health research. It can be rated by the patient, or by an external assessor. We wished to identify the predictors of any discrepancies between these two approaches in people with schizophrenia. METHODS Patients with DSM schizophrenia and related disorders (N = 80) completed both patient-rated (Lancashire Quality of Life Profile; LQOLP) and assessor-rated (Heinrich's Quality of Life Scale; QLS) measures of QoL. RESULTS Patient-rated (LQOLP) and assessor-rated (QLS) measures showed a modest correlation (r = 0.38). In a regression analysis, independent predictors of subjectively-rated QoL being higher than objectively-assessed QoL in the same patient, were low insight score (BIS), negative symptoms (PANSS), absence of depression (CDSS), and less positive attitude toward prescribed treatment (DAI). CONCLUSIONS In people with schizophrenia, scores on objectively- and subjectively-rated measures of quality of life can differ markedly. When comparing subjective to objective assessments, patients with depressive symptoms will value their QoL lower, and those with low insight will value their QoL higher. This has important implications for the utility and interpretation of QoL measures in schizophrenia.
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Affiliation(s)
- Karen P Hayhurst
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, UK.
| | - Jennifer A Massie
- Laureate House Mental Health Unit, Manchester Mental Health & Social Care Trust, Wythenshawe Hospital, Southmoor Road, Manchester, UK.
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK.
| | - Shôn W Lewis
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, UK.
| | - Richard J Drake
- Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, UK.
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Ventura J, Subotnik KL, Ered A, Gretchen-Doorly D, Hellemann GS, Vaskinn A, Nuechterlein KH. The relationship of attitudinal beliefs to negative symptoms, neurocognition, and daily functioning in recent-onset schizophrenia. Schizophr Bull 2014; 40:1308-18. [PMID: 24561318 PMCID: PMC4193707 DOI: 10.1093/schbul/sbu002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In the early course of schizophrenia, premorbid functioning, negative symptoms, and neurocognition have been robustly associated with several domains of daily functioning. Research with chronic schizophrenia patients suggests that attitudinal beliefs may influence daily functioning. However, these relationships have not been examined in recent-onset schizophrenia patients. METHODS The sample consisted of recent-onset schizophrenia outpatients (n = 71) who were on average 21.7 (SD = 3.3) years old, had 12.5 (SD = 1.8) years of education, and 5.9 (SD = 6.3) months since psychosis onset. Patients were assessed for premorbid adjustment, positive and negative symptoms, neurocognition, attitudinal beliefs, and daily functioning. Normal controls (n = 20) were screened for psychopathology and demographically matched to the patients. RESULTS Comparisons indicated that recent-onset patients had higher levels of dysfunctional attitudes and lower self-efficacy compared to healthy controls (t = 3.35, P < .01; t = -4.1, P < .01, respectively). Dysfunctional attitudes (r = -.34) and self-efficacy (r = .36) were significantly correlated with daily functioning. Negative symptoms were found to mediate the relationship between self-efficacy and daily functioning (Sobel test, P < .01), as well as between dysfunctional attitudes and daily functioning (Sobel test, P < .05). Neurocognition was a significant mediator of the relationship between self-efficacy and daily functioning (Sobel test, P < .05). DISCUSSION Early course schizophrenia patients have significantly more dysfunctional attitudes and lower self-efficacy than healthy subjects. Both self-efficacy and dysfunctional attitudes partially contribute to negative symptoms, which in turn influence daily functioning. In addition, self-efficacy partially contributes to neurocognition, which in turn influences daily functioning.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA;
| | - Kenneth L. Subotnik
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA
| | - Arielle Ered
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA
| | - Denise Gretchen-Doorly
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA
| | - Gerhard S. Hellemann
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA
| | - Anja Vaskinn
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Keith H. Nuechterlein
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA;,UCLA Department of Psychology, University of California Los Angeles, Los Angeles, CA
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46
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Üçok A, Ergül C. Persistent negative symptoms after first episode schizophrenia: A 2-year follow-up study. Schizophr Res 2014; 158:241-6. [PMID: 25107850 DOI: 10.1016/j.schres.2014.07.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study is to determine the rate of persistent negative symptoms according to different criteria during two years of follow-up after first-episode schizophrenia. METHODS The study sample consisted of 105 patients with first-episode schizophrenia who completed at least 12 months of follow-up period. We used 6 different definitions of persistent negative symptoms (PNS) based on the Scale for the Assessment of Negative Symptoms subscale scores at seven time points throughout the follow-up. In some definitions of PNS, patients with suprathreshold depressive symptoms were excluded. Premorbid adjustment and baseline cognitive performances of the patients were assessed. RESULTS The PNS rates were between 14.2 and 27.9% in the first year and 11.1 and 25.8% in the second year. Seventy-eight percent of the patients who met the strictest PNS criteria during the first 12 months met the same criteria also during the second 12-month-period. Those with PNS had earlier onset, lower premorbid functioning, worse executive functioning and attention at baseline, and lower rates of working/studying during the 2-year follow-up. Duration of education and untreated psychosis are the independent variables that contribute to the PNS status at the first year of follow-up in logistic regression analysis. CONCLUSION Our findings suggest that PNS has specific predictors and effect on the course of illness after first-episode schizophrenia.
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Affiliation(s)
- Alp Üçok
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Çapa, Fatih, Istanbul, Turkey.
| | - Ceylan Ergül
- Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Millet Street, Çapa, Fatih, Istanbul, Turkey
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47
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Schlosser DA, Fisher M, Gard D, Fulford D, Loewy RL, Vinogradov S. Motivational deficits in individuals at-risk for psychosis and across the course of schizophrenia. Schizophr Res 2014; 158:52-7. [PMID: 25008792 PMCID: PMC4152418 DOI: 10.1016/j.schres.2014.06.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 01/18/2023]
Abstract
Motivational impairment is a critical factor that contributes to functional disability in schizophrenia and undermines an individual's ability to engage in and adhere to effective treatment. However, little is known about the developmental trajectory of deficits in motivation and whether these deficits are present prior to the onset of psychosis. We assessed several components of motivation including anticipatory versus consummatory pleasure (using the Temporal Experience of Pleasure Scale (TEPS)), and behavioral drive, behavioral inhibition, and reward responsivity (using the Behavioral Inhibition Scale/Behavioral Activation Scale (BIS/BAS)). A total of 234 participants completed study measures, including 60 clinical high risk (CHR) participants, 60 recent-onset schizophrenia participants (RO), 78 chronic schizophrenia participants (SZ) and 29 healthy controls (HC) age matched to the CHR group. CHR participants endorsed greater deficits in anticipatory pleasure and reward responsivity, relative to HC comparison participants and individuals diagnosed with schizophrenia. Motivational deficits were not more pronounced over the course of illness. Depressed mood was uniquely associated with impairments in motivation in the CHR sample, but not the schizophrenia participants. The results suggest that CHR individuals experience multiple contributors to impaired motivation, and thus multiple leverage points for treatment.
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Affiliation(s)
| | - Melissa Fisher
- University of California at San Francisco; San Francisco, CA,San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA
| | - David Gard
- San Francisco State University, San Francisco, CA
| | - Daniel Fulford
- University of California at San Francisco; San Francisco, CA,Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Rachel L. Loewy
- University of California at San Francisco; San Francisco, CA
| | - Sophia Vinogradov
- University of California at San Francisco; San Francisco, CA,San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA
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48
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Gard DE, Sanchez AH, Starr J, Cooper S, Fisher M, Rowlands A, Vinogradov S. Using self-determination theory to understand motivation deficits in schizophrenia: the 'why' of motivated behavior. Schizophr Res 2014; 156:217-22. [PMID: 24853060 PMCID: PMC4084414 DOI: 10.1016/j.schres.2014.04.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/21/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
Self-determination theory (SDT) provides a model for understanding motivation deficits in schizophrenia, and recent research has focused on problems with intrinsic motivation. However, SDT emphasizes that motivated behavior results from three different factors: intrinsic motivators (facilitated by needs for autonomy, competency, and relatedness), extrinsic motivators (towards reward or away from punishment), or when intrinsic and extrinsic motivators are absent or thwarted a disconnect-disengagement occurs resulting in behavior driven by boredom or 'passing time'. Using a novel approach to Ecological Momentary Assessment, we assessed the degree to which people with schizophrenia were motivated by these factors relative to healthy control participants. Forty-seven people with and 41 people without schizophrenia were provided with cell phones and were called four times a day for one week. On each call participants were asked about their goals, and about the most important reason motivating each goal. All responses were coded by independent raters (blind to group and hypotheses) on all SDT motivating factors, and ratings were correlated to patient functioning and symptoms. We found that, relative to healthy participants, people with schizophrenia reported goals that were: (1) less motivated by filling autonomy and competency needs, but equivalently motivated by relatedness; (2) less extrinsically rewarding, but equivalently motivated by punishment; (3) more disconnected-disengaged. Higher disconnected-disengaged goals were significantly associated with higher negative symptoms and lower functioning. These findings indicate several important leverage points for behavioral treatments and suggest the need for vigorous psychosocial intervention focusing on autonomy, competence, and reward early in the course of illness.
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Affiliation(s)
- David E. Gard
- Department of Psychology, San Francisco State University,Please address correspondence to: David E. Gard, Ph.D., SFSU Department of Psychology, 1600 Holloway Avenue, San Francisco CA 94138, Phone: 415-338-1440, Fax: 415-338-2398,
| | - Amy H. Sanchez
- Department of Psychology, San Francisco State University
| | - Jessica Starr
- Department of Psychology, San Francisco State University
| | - Shanna Cooper
- Department of Psychology, San Francisco State University
| | - Melissa Fisher
- San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA,Department of Psychiatry, University of California, San Francisco
| | - Abby Rowlands
- San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA
| | - Sophia Vinogradov
- San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA,Department of Psychiatry, University of California, San Francisco
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49
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Millan MJ, Fone K, Steckler T, Horan WP. Negative symptoms of schizophrenia: clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. Eur Neuropsychopharmacol 2014; 24:645-92. [PMID: 24820238 DOI: 10.1016/j.euroneuro.2014.03.008] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 12/11/2022]
Abstract
Schizophrenia is a complex and multifactorial disorder generally diagnosed in young adults at the time of the first psychotic episode of delusions and hallucinations. These positive symptoms can be controlled in most patients by currently-available antipsychotics. Conversely, they are poorly effective against concomitant neurocognitive dysfunction, deficits in social cognition and negative symptoms (NS), which strongly contribute to poor functional outcome. The precise notion of NS has evolved over the past century, with recent studies - underpinned by novel rating methods - suggesting two major sub-domains: "decreased emotional expression", incorporating blunted affect and poverty of speech, and "avolition", which embraces amotivation, asociality and "anhedonia" (inability to anticipate pleasure). Recent studies implicate a dysfunction of frontocortico-temporal networks in the aetiology of NS, together with a disruption of cortico-striatal circuits, though other structures are also involved, like the insular and parietal cortices, amygdala and thalamus. At the cellular level, a disruption of GABAergic-glutamatergic balance, dopaminergic signalling and, possibly, oxytocinergic and cannibinoidergic transmission may be involved. Several agents are currently under clinical investigation for the potentially improved control of NS, including oxytocin itself, N-Methyl-d-Aspartate receptor modulators and minocycline. Further, magnetic-electrical "stimulation" strategies to recruit cortical circuits and "cognitive-behavioural-psychosocial" therapies likewise hold promise. To acquire novel insights into the causes and treatment of NS, experimental study is crucial, and opportunities are emerging for improved genetic, pharmacological and developmental modelling, together with more refined readouts related to deficits in reward, sociality and "expression". The present article comprises an integrative overview of the above issues as a platform for this Special Issue of European Neuropsychopharmacology in which five clinical and five preclinical articles treat individual themes in greater detail. This Volume provides, then, a framework for progress in the understanding - and ultimately control - of the debilitating NS of schizophrenia.
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Affiliation(s)
- Mark J Millan
- Pole of Innovation in Neuropsychiatry, Institut de Recherche Servier, 125 Chemin de Ronde, 78290 Croissy-sur-Seine, Paris, France.
| | - Kevin Fone
- School of Biomedical Sciences, Medical School, Queen׳s Medical Centre, Nottingham University, Nottingham NG72UH, UK
| | - Thomas Steckler
- Janssen Research and Development, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - William P Horan
- VA Greater Los Angeles Healthcare System, University of California, Los Angeles, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA
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50
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Abstract
BACKGROUND Clinical equipoise regarding preventative treatments for psychosis has encouraged the development and evaluation of psychosocial treatments, such as cognitive behavioural therapy (CBT). METHOD A systematic review and meta-analysis was conducted, examining the evidence for the effectiveness of CBT-informed treatment for preventing psychosis in people who are not taking antipsychotic medication, when compared to usual or non-specific control treatment. Included studies had to meet basic quality criteria, such as concealed and random allocation to treatment groups. RESULTS Our search produced 1940 titles, out of which we found seven completed trials (six published). The relative risk (RR) of developing psychosis was reduced by more than 50% for those receiving CBT at every time point [RR at 6 months 0.47, 95% confidence interval (CI) 0.27-0.82, p = 0.008 (fixed-effects only: six randomized controlled trials (RCTs), n = 800); RR at 12 months 0.45, 95% CI 0.28-0.73, p = 0.001 (six RCTs, n = 800); RR at 18-24 months 0.41, 95% CI 0.23-0.72, p = 0.002 (four RCTs, n = 452)]. Heterogeneity was low in every analysis and the results were largely robust to the risk of an unpublished 12-month study having unfavourable results. CBT was also associated with reduced subthreshold symptoms at 12 months, but not at 6 or 18-24 months. No effects on functioning, symptom-related distress or quality of life were observed. CBT was not associated with increased rates of clinical depression or social anxiety (two studies). CONCLUSIONS CBT-informed treatment is associated with a reduced risk of transition to psychosis at 6, 12 and 18-24 months, and reduced symptoms at 12 months. Methodological limitations and recommendations for trial reporting are discussed.
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Affiliation(s)
- P Hutton
- Greater Manchester West Mental Health NHS Foundation Trust, UK
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