Self-reported ambivalence in schizophrenia and associations with negative mood

Neural Basis of Ambivalence towards Ideal Self-Image in Schizophrenia

OBJECTIVE

Little has been explored about a reflection towards self-image in schizophrenia, though it can be related to heterogeneous symptoms of the illness. We identified the neural basis of ambivalence towards ideal self-image in patients with schizophrenia.

METHODS

20 patients with schizophrenia and 20 healthy controls underwent functional MRI while the self-image reflection tasks of determining whether to agree with sentences describing their actual or ideal self-image that contained one of the adjective pairs with opposite valence. The interaction between the group and ideal ambivalence score was examined, and group differences in functional connectivity related to ambivalence towards ideal self-image were further studied.

RESULTS

The interaction of group-by-ideal ambivalence score was shown in the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex, where activities were positively correlated with the level of ideal self-image ambivalence in patients, but not in controls. Task-related decrease in functional connectivity was shown between the orbitofrontal cortex and cerebellum in patients.

CONCLUSION

The process of reflecting on ambivalent ideal self-image in schizophrenia may be related to aberrant prefrontal activity and connectivity. Abnormality in the prefrontal regions that take part in cognitive conflict monitoring and value judgment may underlie the pathophysiology of increased ambivalence towards ideal self-image.

Predicting the future in schizophrenia: The discrepancy between anticipatory and consummatory pleasure

When predicting future emotions we use inaccurate biases which rely on our most salient and recent experiences. In schizophrenia, there appears to be a specific deficit in this anticipatory process which is associated with reduced motivation and engagement. The nature of this deficit and how it differs to the general population is unclear. This study introduces a new task examining the discrepancy between anticipated and experienced pleasure and investigates its potential usefulness to characterise the pleasure deficit in people with schizophrenia. Forty-eight healthy controls and 50 individuals with schizophrenia completed the Components of Pleasure Task (COP) which uses a range of images to generate anticipatory and experiential ratings. Participants also completed measures of mood and symptoms. Individuals with schizophrenia had a larger anticipatory-consummatory discrepancy score. This was due to under-anticipating highly pleasant stimuli and over-anticipating low pleasantness stimuli. People with schizophrenia are blunted compared to controls when anticipating stimuli, considering highly and lowly rated stimuli alike. A greater discrepancy between anticipated and experienced pleasure may contribute to negative symptoms such as poor motivation and social withdrawal. Reducing the discrepancy between experienced and anticipated pleasure may be a target for interventions aiming to reduce negative symptoms.

Further examination of ambivalence in relation to the schizophrenia spectrum

It remains unclear whether ambivalence reflects genetic liability for schizophrenia-spectrum disorders. This study examined whether task-measured ambivalence is 1) increased in schizophrenia/schizoaffective disorder, 2) significantly associated with schizophrenia symptoms, and/or 3) increased in first-degree biological relatives of probands. Consistent with previous research, ambivalence was elevated in schizophrenia/schizoaffective probands and significantly related to current emotional state, but not to symptoms. Ambivalence was not elevated in relatives, suggesting that it may be unrelated to genetic liability. These results suggest that emotional state may differentially influences ambivalence across groups. Future research would benefit from examination of this question in a larger cohort.