1
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Didier PR, Moore TM, Calkins ME, Prettyman G, Levinson T, Savage C, de Moraes Leme LFV, Kohler CG, Kable J, Satterthwaite T, Gur RC, Gur RE, Wolf DH. Evaluation of a new intrinsic and extrinsic motivation scale in youth with psychosis spectrum symptoms. Compr Psychiatry 2023; 127:152413. [PMID: 37696094 PMCID: PMC10644398 DOI: 10.1016/j.comppsych.2023.152413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Impairment in intrinsic motivation (IM), the drive to satisfy internal desires like mastery, may play a key role in disability in psychosis. However, we have limited knowledge regarding relative impairments in IM compared to extrinsic motivation (EM) or general motivation (GM), in part due to limitations in existing measures. METHODS Here we address this gap using a novel Trait Intrinsic and Extrinsic Motivation self-report scale in a sample of n = 243 participants including those with schizophrenia, psychosis-risk, and healthy controls. Each of the 7 IM and 6 EM items used a 7-point Likert scale assessing endorsement of dispositional statements. Bifactor analyses of these items yielded distinct IM, EM, and GM factor scores. Convergent and discriminant validity were examined in relation to General Causality Orientation Scale (GCOS-CP) and Quality of Life 3-item IM measure (QLS-IM). Utility was assessed in relation to psychosis-spectrum (PS) status and CAINS clinical amotivation. RESULTS IM and EM showed acceptable inter-item consistency (IM: α = 0.88; EM: α = 0.66); the bifactor model exhibited fit that varied from good to borderline to inadequate depending on the specific fit metric (SRMR = 0.038, CFI = 0.94, RMSEA = 0.106 ± 0.014). IM scores correlated with established IM measures: GCOS-CP Autonomy (rho = 0.38, p < 0.01) and QLS-IM (rho = 0.29, p < 0.01). Supporting discriminant validity, IM did not correlate with GCOS-CP Control (rho = -0.14, p > 0.05). Two-year stability in an available longitudinal subset (n = 35) was strong (IM: rho = 0.64, p < 0.01; EM: rho = 0.55, p < 0.01). Trait IM was lower in PS youth (t = 4.24, p < 0.01), and correlated with clinical amotivation (rho = -0.36, p < 0.01); EM did not show significant clinical associations. CONCLUSIONS These results demonstrate the clinical relevance of IM in psychosis risk. They also provide preliminary support for the reliability, validity and utility of this new Trait IM-EM scale, which addresses a measurement gap and can facilitate identification of neurobehavioral and clinical correlates of IM deficits.
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Affiliation(s)
- Paige R Didier
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychology, University of Maryland, College Park, MD 20742, USA.
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Greer Prettyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tess Levinson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Lynch School of Education and Human Development, Boston College, Chestnut Hill, MA 02467, USA
| | - Chloe Savage
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Vilamala S, Puig M, Ochoa S, Martín-Martínez JR, Hernández A, Balsera J, Verdaguer-Rodríguez M, Villellas R, Arenas O, García-Franco M. Assessment of the treatment needs of community recovery Services in Spain: From the perspective of service users, families, and mental health professionals. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5819-e5830. [PMID: 36073979 DOI: 10.1111/hsc.14013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/19/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Profile of Community Recovery Services users has changed over the years and has become more diverse. To explore the evolution of treatment needs, this study aimed to identify users' needs, from the point of view of different agents implicated in the recovery process. We explored the consistency between the agents using the focus group technique. We defined four groups (n = 58): service users, family members, professionals, and referring professionals. We pre-identified topics related to recovery, such as illness-related losses, imaginary of CRS, expectations, activities, and life goals. All agents recognised losses related to the mental illness, the need for carrying activities out of the Community Recovery Services, and for including families in the recovery process. The groups differed in some areas, such as the identification of activities that should be encouraged, or the importance of promoting vital expectations. Our findings suggest that it is important to identify the needs of different agents involved in the recovery process. There is consistency in the service users' needs, but there are some differences that need to be considered. Interventions should be personalised, covering functional, cognitive, and relational losses related to the mental illness.
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Affiliation(s)
- Sonia Vilamala
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Marta Puig
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ana Hernández
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Joaquin Balsera
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
| | - Raul Villellas
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
| | | | - Mar García-Franco
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Barcelona, Spain
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3
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Schniedermann I, Dehn LB, Micheel S, Beblo T, Driessen M. Evaluation of a supported education and employment program for adolescents and young adults with mental health problems: A study protocol of the StAB project. PLoS One 2022; 17:e0271803. [PMID: 35905081 PMCID: PMC9337640 DOI: 10.1371/journal.pone.0271803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
The majority of mental illnesses begins in childhood, adolescence and young adulthood before the age of 25. The transition from adolescence to adulthood is a particularly vulnerable time for adolescents with mental illness, affecting psychosocial functioning and participation in work life. Therefore, they need—in contrast to classic standard vocational interventions—a long-term, holistic and individually oriented vocational rehabilitation program. With the innovative model project "Start in education and employment (StAB)”, adolescents and young adults with mental illnesses are to be supported with regard to their vocational perspectives and participation by a new type of individualized, holistic, long-term job coaching. It follows the Individual Placement and Support (IPS) concept, as a manualized form of the Supported Employment Approach and is based on the "first place–then train" principle. In order to evaluate the effectiveness and feasibility of the StAB program, a double-centre prospective single arm evaluation study in a mixed-methods design will be conducted. The focus is on quantitative research analysing pre-post-effects of the StAB intervention in a two-year observational study. Young people between 15 and 25 years with a psychiatric diagnosis who are currently in receipt of means-tested benefits or are entitled to them will be recruited. The study will take place in two major cities in the north-western part of Germany, Bielefeld and Dortmund. We expect to contribute to gain more empirical data about the implementation of Supported Employment and Education to severely mentally ill adolescents and young adults in German settings. Moreover, these results may also provide the scientific foundation for future measures focusing the improvement of vocational rehabilitation for young people with mental illness. The study was registered in the German Clinical Trials Register (DRKS00027576) on March 10, 2022.
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Affiliation(s)
- Ina Schniedermann
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Lorenz B. Dehn
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- * E-mail:
| | - Sabrina Micheel
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
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4
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Collins DE, Luther L, Raugh IM, Condray R, Allen DN, Strauss GP. The Role of Disability Benefits as an Environmental Factor Contributing to Negative Symptoms. Schizophr Bull 2022; 49:1-4. [PMID: 35808961 PMCID: PMC9810000 DOI: 10.1093/schbul/sbac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ruth Condray
- Biometrics Research Program, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Gregory P Strauss
- To whom correspondence should be addressed; Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA 30602; tel: +1-706-542-0307, fax: +1-706-542-3275,
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5
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DeTore NR, Balogun-Mwangi O, Tepper M, Cather C, Russinova Z, Lanca M, Mueser KT. The interrelationships of motivation, positive symptoms, stigma, and role functioning in early psychosis. Early Interv Psychiatry 2022; 16:736-743. [PMID: 34431230 DOI: 10.1111/eip.13213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
AIM Avolition, or the lack of motivation, has consistently been shown to be a significant predictor of poor psychosocial outcome, with decreased overall motivation as the single strongest predictor of poor work or school outcome in first episode psychosis. This study aimed to better understand the ways in which motivation impacts work and school functioning. This study first examined the factors related to motivation in people recovering from a recent onset of psychosis, then explored the unique interrelationships between positive symptoms, stigma, and motivation and how they influence role functioning. METHODS A total of 40 participants with early psychosis were recruited for this cross-sectional design study; with a mean of 14.5 months of treatment prior to study assessment. RESULTS Neither experienced nor internalized stigma were related to motivation in this sample, but internalized stigma was related to work and school functioning. Positive symptoms were significantly inversely related to both work and school functioning and motivation, with mediation analyses showing that motivation significantly mediates the relationship between positive symptoms and role functioning. CONCLUSION This relationship may shed light on the link between motivational deficits and work and school outcomes early in the course of psychosis, an area of critical importance for early intervention.
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Affiliation(s)
- Nicole R DeTore
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA
| | | | - Miriam Tepper
- Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Corinne Cather
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zlatka Russinova
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA
| | - Margaret Lanca
- Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA.,Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
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6
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Kesby JP, Murray GK, Knolle F. Neural Circuitry of Salience and Reward Processing in Psychosis. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 3:33-46. [PMID: 36712572 PMCID: PMC9874126 DOI: 10.1016/j.bpsgos.2021.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 02/01/2023] Open
Abstract
The processing of salient and rewarding stimuli is integral to engaging our attention, stimulating anticipation for future events, and driving goal-directed behaviors. Widespread impairments in these processes are observed in psychosis, which may be associated with worse functional outcomes or mechanistically linked to the development of symptoms. Here, we summarize the current knowledge of behavioral and functional neuroimaging in salience, prediction error, and reward. Although each is a specific process, they are situated in multiple feedback and feedforward systems integral to decision making and cognition more generally. We argue that the origin of salience and reward processing dysfunctions may be centered in the subcortex during the earliest stages of psychosis, with cortical abnormalities being initially more spared but becoming more prominent in established psychotic illness/schizophrenia. The neural circuits underpinning salience and reward processing may provide targets for delaying or preventing progressive behavioral and neurobiological decline.
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Affiliation(s)
- James P. Kesby
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia,Address correspondence to James Kesby, Ph.D.
| | - Graham K. Murray
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Franziska Knolle
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom,Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany,Franziska Knolle, Ph.D.
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7
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Uchino T, Nemoto T, Kojima A, Takubo Y, Kotsuji Y, Yamaguchi E, Yamaguchi T, Katagiri N, Tsujino N, Tanaka K, Mizuno M. Effects of motivation domains on social functioning in schizophrenia with consideration of the factor structure and confounding influences. J Psychiatr Res 2021; 133:106-112. [PMID: 33338732 DOI: 10.1016/j.jpsychires.2020.12.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/23/2020] [Accepted: 12/09/2020] [Indexed: 12/21/2022]
Abstract
In patients with schizophrenia, motivation has been assumed to act as an intervening factor between cognitive function and social functioning. Motivation is thought to comprise three domains defined by their orientations: intrinsic motivation, extrinsic motivation, and amotivation. Although these orientations can confound each other, the effects of motivation domains on social functioning remain obscure. We investigated these relationships after confirming the factor structure of social functioning using the Social Functioning Scale (SFS). A total of 97 stable outpatients with schizophrenia were recruited. In addition to the SFS, the General Causality Orientations Scale (GCOS) was used to measure the motivation domains. First, we examined the factor structure of the SFS using exploratory and confirmatory factor analyses. Next, we conducted structural equation modeling to examine the effects of motivation domains on social functioning. The SFS showed a two-factor structure: interpersonal and intrapersonal functioning. The structural equation model revealed that (1) amotivation was negatively related to both intrapersonal and interpersonal functioning, (2) intrinsic motivation was positively related only to intrapersonal functioning, and (3) extrinsic motivation was positively related only to interpersonal functioning. Each motivation domain was associated with different factors of social functioning. Future interventions aimed at improving social functioning should consider these motivation domains based on their orientations. Cognitive remediation accompanied by considerations for and approaches to each of the domains may maximize recovery in patients with schizophrenia.
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Affiliation(s)
- Takashi Uchino
- Department of Neuropsychiatry, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan; Tokyo Adachi Hospital, 5-23-20 Hokima, Adachi-ku, Tokyo, 121-0064, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Akiko Kojima
- Department of Neuropsychiatry, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Youji Takubo
- Department of Neuropsychiatry, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Yumi Kotsuji
- Tokyo Adachi Hospital, 5-23-20 Hokima, Adachi-ku, Tokyo, 121-0064, Japan
| | - Eriko Yamaguchi
- Department of Neuropsychiatry, Toho University Graduate School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Taiju Yamaguchi
- Department of Neuropsychiatry, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Naoyuki Katagiri
- Department of Neuropsychiatry, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Kuniaki Tanaka
- Tokyo Adachi Hospital, 5-23-20 Hokima, Adachi-ku, Tokyo, 121-0064, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University Faculty of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
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8
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Apathy is not associated with reduced ventral striatal volume in patients with schizophrenia. Schizophr Res 2020; 223:279-288. [PMID: 32928618 DOI: 10.1016/j.schres.2020.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/04/2020] [Accepted: 08/24/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND A growing body of neuroimaging research has revealed a relationship between blunted activation of the ventral striatum (VS) and apathy in schizophrenia. In contrast, the association between reduced striatal volume and apathy is less well established, while the relationship between VS function and structure in patients with schizophrenia remains an open question. Here, we aimed to replicate previous structural findings in a larger independent sample and to investigate the relationship between VS hypoactivation and VS volume. METHODS We included brain structural magnetic resonance imaging (MRI) data from 60 patients with schizophrenia (SZ) that had shown an association of VS hypoactivation with apathy during reward anticipation and 58 healthy controls (HC). To improve replicability, we applied analytical methods employed in two previously published studies: Voxel-based morphometry and the Multiple Automatically Generated Templates (MAGeT) algorithm. VS and dorsal striatum (DS) volume were correlated with apathy correcting for age, gender and total brain volume. Additionally, left VS activity was correlated with left VS volume. RESULTS We failed to replicate the association between apathy and reduced VS volume and did not find a correlation with DS volume. Functional and structural left VS measures exhibited a trend-level correlation (rs = 0.248, p = 0.067, r2 = 0.06). CONCLUSIONS Our present data suggests that functional and structural striatal neuroimaging correlates of apathy can occur independently. Replication of previous findings may have been limited by other factors (medication, illness duration, age) potentially related to striatal volume changes in SZ. Finally, associations between reward-related VS function and structure should be further explored.
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9
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Learning and Motivation for Rewards in Schizophrenia: Implications for Behavioral Rehabilitation. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Sevy S, Lindenmayer JP, Khan A, Ljuri I, Kulsa MKC, Jones O. Differential improvement of negative-symptom subfactors after cognitive remediation in low-functioning individuals with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 19:100145. [PMID: 31828020 PMCID: PMC6889361 DOI: 10.1016/j.scog.2019.100145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Background Negative symptoms and cognitive deficits have a substantial predictive value for functional deficits and recovery in schizophrenia. However, the relationship between negative symptoms and cognitive abnormalities is unclear possibly due to the heterogeneity of negative symptoms. This study used the model of expressive and experiential negative symptoms subfactors to decrease this heterogeneity. It examined these subfactors and cognition before and after treatment with computerized cognitive remediation training (CRT) in chronically-hospitalized individuals with psychosis and predominant negative symptoms. Methods Seventy-eight adult participants with a DSM-IV-TR diagnosis of schizophrenia or schizoaffective disorder were enrolled in a 12-week CRT program. Assessments of demographic and illness variables, baseline and endpoint assessments of psychopathology (Positive and Negative Syndrome Scale) and cognition (MATRICS Consensus Cognitive Battery - MCCB) were conducted. Results The baseline expressive negative subfactor was associated with Processing Speed (r = −0.352, p ≤ 0.001) and Reasoning/Problem Solving (r = −0.338, p ≤ 0.001). Following CRT, there was a significant decrease in the experiential negative subfactor (p < 0.01) but not of the expressive negative subfactor. Change in MCCB domains after CRT accounted for 51.1% and 50.2% of the variance of change in expressive and experiential negative subfactor scores, respectively. For both subfactors, Visual Learning was a significant predictor of change (p < 0.05). Conclusion Our findings suggest that CRT has benefits for negative symptoms in very low-functioning patients and that this change may be in part mediated by change in cognitive functions after CRT.
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Affiliation(s)
- Serge Sevy
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA
| | - Jean-Pierre Lindenmayer
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Anzalee Khan
- Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,NeuroCog Trials, 3211 Shannon Road #300, Durham, NC 27707, USA
| | - Isidora Ljuri
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
| | - Mila Kirstie C Kulsa
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.,Teachers College Columbia University, 525 West 120 Street, New York, NY 10027, USA
| | - Owen Jones
- Manhattan Psychiatric Center, 600 East 125 Street Wards Island, New York, NY 10035, USA.,Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA
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11
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Husain MO, Chaudhry IB, Thomasson R, Kiran T, Bassett P, Husain MI, Naeem F, Husain N. Cognitive function in early psychosis patients from a lower middle-income country. Int J Psychiatry Clin Pract 2018. [PMID: 28645229 DOI: 10.1080/13651501.2017.1341987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To establish evidence of cognitive changes in early psychosis (EP) patients compared to healthy controls (HC) in Pakistan. METHODS Fifty-one participants with EP were recruited from psychiatric units in Karachi and Rawalpindi, Pakistan and matched with 51 HC. Neurocognitive domains were assessed using standardised neuropsychological tests [the Stroop test, block design, Matrix Reasoning, picture completion, object assembly, oral fluency, memory for design, Coughlan learning task (verbal and visual)]. RESULTS EP patients had higher scores than controls for both Stroop tests (T1: EP = 122 HC = 65, p <.001; T2: EP = 190 HC = 153, p = .007) and memory for design test (EP = 10 HC = 3, p = .005). EP group had lower values for block design (EP = 4, HC = 11, p = .01), category fluency (EP = 18.9, HC = 26.1, p < .001), Coughlan verbal tasks (EP = 36.4 NC = 51.5, p < .001), matrix reasoning (EP = 4 NC = 10, p < .001), picture completion (EP = 4 NC = 6, p = .003) and object assembly (EP = 10.7, HC = 15.5, p = .002). There were limited significant associations between cognitive performance and PANSS scores. CONCLUSIONS Reduced cognitive performance was found across multiple domains in Pakistani EP patients, which suggests that impaired cognitive performance is homogenous in patients with schizophrenia, regardless of ethnicity.
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Affiliation(s)
- Muhammed Omair Husain
- a Faculty of Medical and Human Sciences , University of Manchester , Manchester , UK
| | - Imran B Chaudhry
- a Faculty of Medical and Human Sciences , University of Manchester , Manchester , UK
| | - Rachel Thomasson
- b Department of Psychiatry , Greater Manchester West NHS Foundation Trust , Manchester , UK
| | - Tayyeba Kiran
- c Global Health, Pakistan Institute of Learning and Living , Karachi , Pakistan
| | | | - Muhammad I Husain
- e Complex Depression, Anxiety and Trauma, Camden and Islington NHS Foundation Trust , London , UK
| | - Farooq Naeem
- f Department of Psychiatry , Queens' University , Kingston , Ontario , Canada
| | - Nusrat Husain
- g Division of Psychology and Mental Health , University of Manchester , Manchester , UK
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Caravaggio F, Fervaha G, Iwata Y, Plitman E, Chung JK, Nakajima S, Mar W, Gerretsen P, Kim J, Chakravarty MM, Mulsant B, Pollock B, Mamo D, Remington G, Graff-Guerrero A. Amotivation is associated with smaller ventral striatum volumes in older patients with schizophrenia. Int J Geriatr Psychiatry 2018; 33:523-530. [PMID: 29110353 PMCID: PMC5807115 DOI: 10.1002/gps.4818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/08/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Motivational deficits are prevalent in patients with schizophrenia, persist despite antipsychotic treatment, and predict long-term outcomes. Evidence suggests that patients with greater amotivation have smaller ventral striatum (VS) volumes. We wished to replicate this finding in a sample of older, chronically medicated patients with schizophrenia. Using structural imaging and positron emission tomography, we examined whether amotivation uniquely predicted VS volumes beyond the effects of striatal dopamine D2/3 receptor (D2/3 R) blockade by antipsychotics. METHODS Data from 41 older schizophrenia patients (mean age: 60.2 ± 6.7; 11 female) were reanalysed from previously published imaging data. We constructed multivariate linear stepwise regression models with VS volumes as the dependent variable and various sociodemographic and clinical variables as the initial predictors: age, gender, total brain volume, and antipsychotic striatal D2/3 R occupancy. Amotivation was included as a subsequent step to determine any unique relationships with VS volumes beyond the contribution of the covariates. In a reduced sample (n = 36), general cognition was also included as a covariate. RESULTS Amotivation uniquely explained 8% and 6% of the variance in right and left VS volumes, respectively (right: β = -.38, t = -2.48, P = .01; left: β = -.31, t = -2.17, P = .03). Considering cognition, amotivation levels uniquely explained 9% of the variance in right VS volumes (β = -.43, t = -0.26, P = .03). CONCLUSION We replicate and extend the finding of reduced VS volumes with greater amotivation. We demonstrate this relationship uniquely beyond the potential contributions of striatal D2/3 R blockade by antipsychotics. Elucidating the structural correlates of amotivation in schizophrenia may help develop treatments for this presently irremediable deficit.
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Affiliation(s)
- Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Gagan Fervaha
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Yusuke Iwata
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Eric Plitman
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Jun Ku Chung
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Shinichiro Nakajima
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Wanna Mar
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Julia Kim
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - M. Mallar Chakravarty
- Department of Biological & Biomedical Engineering, McGill University, Montreal, Quebec, Canada. H4H 1R3
- Cerebral Imaging Centre, Douglas Mental Health Institute, McGill University, Montreal, Quebec, Canada. H4H 1R3
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada. H4H 1R3
| | - Benoit Mulsant
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Bruce Pollock
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - David Mamo
- Department of Psychiatry, University of Malta, Malta
| | - Gary Remington
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada. M5T 1R8
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