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Cai R, Huang C, Ni L, Liu Z, Zhang S, Qiu Y, Hu J, Gao J, Yu M, Tang X, Zhou C, Zhang X, Zhang X, Fang X. The motivation and pleasure deficits but not expressivity affects social functioning through cognitive function in male patients with schizophrenia: A structural equation model. Asian J Psychiatr 2023; 85:103616. [PMID: 37163944 DOI: 10.1016/j.ajp.2023.103616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study aims to compare cognitive function and social functioning in male schizophrenia patients with deficit syndrome (DS) and non-DS, and to explore the associations among two different dimensions of negative symptoms (motivation and pleasure (MAP) and expressivity (EXP) deficits), cognitive function and social functioning base on a Structural Equation Model (SEM). METHODS The current study enrolled 161 male schizophrenia patients and 120 age- and education- matched healthy controls. The DS and non-DS group were categorized by the Chinese version of Schedule for the Deficit Syndrome (SDS). The psychotic and negative symptoms were evaluated by the Brief Psychiatric Rating Scale (BPRS) and the Brief Negative Symptoms Scale (BNSS). The Social functioning was measured by Scale of Social function in Psychosis Inpatients (SSPI). A battery of classical neurocognitive tests was used for assessing cognition including sustained vigilance/attention, cognitive flexibility, ideation fluency and visuospatial memory. RESULTS Our study indicated that DS patients performed worser in cognitive function and social functioning than non-DS patients. The SEM model demonstrated that MAP significantly affected social functioning through direct influence and mediation of cognitive function. However, our results found that EXP had little influence on cognitive function and social function. CONCLUSION Our findings provided evidence supporting that DS may represent as a subtype of schizophrenia, and the MAP factor play a pivotal role to influence the cognitive and social functioning in schizophrenia patients.
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Affiliation(s)
- Renliang Cai
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chengbing Huang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Psychiatry, The Third People's Hospital of Huai'an, Huaian 223001, China
| | - Longyan Ni
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zihan Liu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Sijie Zhang
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Yufeng Qiu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Jianing Hu
- Fourth Clinical College of Nanjing Medical University, Nanjing, China
| | - Ju Gao
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou, Jiangsu 215008, China
| | - Miao Yu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaowei Tang
- Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, Medical College of Soochow University, Suzhou, Jiangsu 215008, China; Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China.
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Rabinowitz J, Staner C, Saoud J, Weiser M, Kuchibhatla R, Davidson M, Harvey PD, Luthringer R. Long-term effects of Roluperidone on negative symptoms of schizophrenia. Schizophr Res 2023; 255:9-13. [PMID: 36933291 DOI: 10.1016/j.schres.2023.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 03/20/2023]
Abstract
Roluperidone has antagonist properties for 5-HT2A, sigma2, α1A- and α1B-adrenergic receptors, but no dopaminergic binding affinities. In 2 randomized controlled trials (RCT), treatment improved negative symptoms of schizophrenia and social functioning among patients with moderate to severe negative symptoms. We report results of the protocol specified analysis of 2 open-label extension studies of 24 and 40 weeks investigating whether improvement of negative symptoms was sustained without significant adverse effects or worsening of psychosis. Following 12-week double-blind phase of both RCTs, patients were eligible to receive monotherapy roluperidone 32 mg/day or 64 mg/day for 24 weeks (trial 1) or 40 weeks (trial 2) in open-label extension study. Trial 1 included 244 patients of whom 142 entered 24-week open-label extension and trial 2 included 513 patients of whom 341 entered 40-week open-label extension. Trial 1 had PANSS negative factor score of Pentagonal Structure Model as primary outcome. Trial 2 had Marder Negative Symptoms Factor Score as primary outcome measure and Personal and Social Performance (PSP) Total score as secondary outcome. During open-label extensions, continued improvements in negative symptoms and on PSP were observed. Overall rate of symptomatic worsening requiring discontinuation of roluperidone and treatment with an antipsychotic was <10 %. Roluperidone was well tolerated with no meaningful changes in vital signs, laboratory values, weight gain, metabolic indices, or extrapyramidal symptoms. Results of 2 open-label extension trials support roluperidone as a treatment of negative symptoms and social functioning deficits in patients with moderate to severe negative symptoms of schizophrenia.
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Affiliation(s)
| | - Corinne Staner
- PPRS, 4e Av. du Général de Gaulle, 68000 Colmar, Grand EST, France
| | - Jay Saoud
- Minerva Neurosciences, 1601 Trapelo Rd., Watham, MA 02451, USA
| | - Mark Weiser
- University of Tel Aviv School of Medicine, Ramat Aviv 699780, Israel
| | | | - Michael Davidson
- Minerva Neurosciences, 1601 Trapelo Rd., Watham, MA 02451, USA; Department of Psychiatry Nicosia Cyprus, Nicosia University Medical School, 93 Ayiou Nikolaou Street, Egkomi 2408, Cyprus
| | - Phillip D Harvey
- University of Miami Miller School of Medicine, Suite 1450, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Remy Luthringer
- Minerva Neurosciences, 1601 Trapelo Rd., Watham, MA 02451, USA
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Could psychedelic drugs have a role in the treatment of schizophrenia? Rationale and strategy for safe implementation. Mol Psychiatry 2023; 28:44-58. [PMID: 36280752 DOI: 10.1038/s41380-022-01832-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/02/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023]
Abstract
Schizophrenia is a widespread psychiatric disorder that affects 0.5-1.0% of the world's population and induces significant, long-term disability that exacts high personal and societal cost. Negative symptoms, which respond poorly to available antipsychotic drugs, are the primary cause of this disability. Association of negative symptoms with cortical atrophy and cell loss is widely reported. Psychedelic drugs are undergoing a significant renaissance in psychiatric disorders with efficacy reported in several conditions including depression, in individuals facing terminal cancer, posttraumatic stress disorder, and addiction. There is considerable evidence from preclinical studies and some support from human studies that psychedelics enhance neuroplasticity. In this Perspective, we consider the possibility that psychedelic drugs could have a role in treating cortical atrophy and cell loss in schizophrenia, and ameliorating the negative symptoms associated with these pathological manifestations. The foremost concern in treating schizophrenia patients with psychedelic drugs is induction or exacerbation of psychosis. We consider several strategies that could be implemented to mitigate the danger of psychotogenic effects and allow treatment of schizophrenia patients with psychedelics to be implemented. These include use of non-hallucinogenic derivatives, which are currently the focus of intense study, implementation of sub-psychedelic or microdosing, harnessing of entourage effects in extracts of psychedelic mushrooms, and blocking 5-HT2A receptor-mediated hallucinogenic effects. Preclinical studies that employ appropriate animal models are a prerequisite and clinical studies will need to be carefully designed on the basis of preclinical and translational data. Careful research in this area could significantly impact the treatment of one of the most severe and socially debilitating psychiatric disorders and open an exciting new frontier in psychopharmacology.
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Gao T, Huang Z, Huang B, Zhou T, Shi C, Yu X, Pu C. Negative symptom dimensions and social functioning in Chinese patients with schizophrenia. Front Psychiatry 2022; 13:1033166. [PMID: 36561640 PMCID: PMC9763280 DOI: 10.3389/fpsyt.2022.1033166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Negative symptoms can seriously affect social functioning in patients with schizophrenia. However, the role of various components of negative symptoms in social functioning remains unclear. This study aimed to explore the associations among three different dimensions of negative symptoms (i.e., communication, emotion, and motivation) and social functioning to identify potential therapeutic targets. METHODS This cross-sectional study enrolled 202 Chinese participants with schizophrenia. Negative symptoms were evaluated using the Negative Symptom Assessment (NSA). Social functioning was represented by the Personal and Social Performance Scale (PSP) total score and employment status. Correlation analysis was conducted to clarify the relationship between negative symptoms and the PSP total score. Regression analysis was performed to explore the determinants of the PSP total score and employment status, considering negative symptoms and possible confounders, such as demographic features, positive symptoms, cognitive symptoms, depressive symptoms, and extrapyramidal side effects. RESULTS The PSP total score was correlated with all three dimensions of negative symptoms (i.e., emotion, motivation, and communication; rs = -0.509, -0.662, and -0.657, respectively). Motivation, instead of emotion or communication, predicted both low PSP total scores and unemployment. CONCLUSION Social functioning in patients with schizophrenia was significantly related to motivation. Further studies should focus on motivation and consider it as a therapeutic target to improve patients' social functioning.
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Affiliation(s)
- Tianqi Gao
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,National Health Commission Key Laboratory of Mental Health, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Zetao Huang
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,National Health Commission Key Laboratory of Mental Health, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Bingjie Huang
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,National Health Commission Key Laboratory of Mental Health, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Tianhang Zhou
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,National Health Commission Key Laboratory of Mental Health, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,National Health Commission Key Laboratory of Mental Health, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,National Health Commission Key Laboratory of Mental Health, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
| | - Chengcheng Pu
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,National Health Commission Key Laboratory of Mental Health, Peking University, Beijing, China.,National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China
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5
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Giordano GM, Brando F, Pezzella P, De Angelis M, Mucci A, Galderisi S. Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature. Front Psychiatry 2022; 13:970210. [PMID: 36117655 PMCID: PMC9476599 DOI: 10.3389/fpsyt.2022.970210] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.
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Affiliation(s)
| | | | | | | | - Armida Mucci
- University of Campania Luigi Vanvitelli, Naples, Italy
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6
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Havers L, Cardno A, Freeman D, Ronald A. The Latent Structure of Negative Symptoms in the General Population in Adolescence and Emerging Adulthood. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac009. [PMID: 35156042 PMCID: PMC8827402 DOI: 10.1093/schizbullopen/sgac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Negative symptoms predict adverse outcomes within psychotic disorders, in individuals at high-risk for psychosis, and in young people in the community. There is considerable interest in the dimensional structure of negative symptoms in clinical samples, and accumulating evidence suggests a 5-factor structure. Little is known about the underlying structure of negative symptoms in young people despite the importance of this developmental stage for mental health. We used confirmatory factor analysis to test the structure of parent-reported negative symptoms at mean ages 16.32 (SD 0.68, N = 4974), 17.06 (SD 0.88, N = 1469) and 22.30 (SD 0.93, N = 5179) in a community sample. Given previously reported associations between total negative symptoms and genome-wide polygenic scores (GPS) for major depressive disorder (MDD) and schizophrenia in adolescence, we assessed associations between individual subdomains and these GPSs. A 5-factor model of flat affect, alogia, avolition, anhedonia, and asociality provided the best fit at each age and was invariant over time. The results of our linear regression analyses showed associations between MDD GPS with avolition, flat affect, anhedonia, and asociality, and between schizophrenia GPS with avolition and flat affect. We showed that a 5-factor structure of negative symptoms is present from ages 16 to 22 in the community. Avolition was most consistently associated with polygenic liability to MDD and schizophrenia, and alogia was least associated. These findings highlight the value of dissecting negative symptoms into psychometrically derived subdomains and may offer insights into early manifestation of genetic risk for MDD and schizophrenia.
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Affiliation(s)
- Laura Havers
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Alastair Cardno
- Division of Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Angelica Ronald
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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7
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Wang LL, Lam CYT, Huang J, Cheung EFC, Lui SSY, Chan RCK. Range-Adaptive Value Representation in Different Stages of Schizophrenia: A Proof of Concept Study. Schizophr Bull 2021; 47:1524-1533. [PMID: 34420057 PMCID: PMC8530390 DOI: 10.1093/schbul/sbab099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Amotivation is related to value representation. A comprehensive account of amotivation requires a mechanistic understanding of how the brain exploits external information to represent value. To achieve maximal value discriminability, brain valuation system will dynamically adapt its coding sensitivity to the range of values available in any given condition, so-called range adaptive coding. We administered an experimental task to 30 patients with chronic schizophrenia (C-SCZ), 30 first-episode schizophrenia (FE-SCZ), 34 individuals with high social anhedonia (HSoA), and their paired controls to assess range adaptation ability. C-SCZ patients exhibited over-adaptation and their performances were negatively correlated with avolition symptoms and positive symptoms and positively correlated with blunted-affect symptoms and self-reported consummatory interpersonal pleasure scores, though the results were non-significant. FE-SCZ patients exhibited reduced adaptation, which was significantly and negatively correlated with avolition symptoms and positively correlated with the overall proportion of choosing to exert more effort. Although HSoA participants exhibited comparable range adaptation to controls, their performances were significantly and negatively correlated with the proportion of choosing to exert more effort under the lowest value condition. Our results suggest that different stages of schizophrenia spectrum showed distinct range adaptation patterns. Range adaptation impairments may index a possible underlying mechanism for amotivation symptoms in FE-SCZ and more complicated and pervasive effects on clinical symptoms in C-SCZ.
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Affiliation(s)
- Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Christina Y T Lam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Jia Huang
- 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
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
- Department of Psychiatry, The University of Hong Kong, 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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Lim K, Peh OH, Yang Z, Rekhi G, Rapisarda A, See YM, Rashid NAA, Ang MS, Lee SA, Sim K, Huang H, Lencz T, Lee J, Lam M. Large-scale evaluation of the Positive and Negative Syndrome Scale (PANSS) symptom architecture in schizophrenia. Asian J Psychiatr 2021; 62:102732. [PMID: 34118560 DOI: 10.1016/j.ajp.2021.102732] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022]
Abstract
Although the Positive and Negative Syndrome Scale (PANSS) is widely utilized in schizophrenia research, variability in specific item loading exist, hindering reproducibility and generalizability of findings across schizophrenia samples. We aim to establish a common PANSS factor structure from a large multi-ethnic sample and validate it against a meta-analysis of existing PANSS models. Schizophrenia participants (N = 3511) included in the current study were part of the Singapore Translational and Clinical Research Program (STCRP) and the Clinical Antipsychotic Trials for Intervention Effectiveness (CATIE). Exploratory Factor Analysis (EFA) was conducted to identify the factor structure of PANSS and validated with a meta-analysis (N = 16,171) of existing PANSS models. Temporal stability of the PANSS model and generalizability to individuals at ultra-high risk (UHR) of psychosis were evaluated. A five-factor solution best fit the PANSS data. These were the i) Positive, ii) Negative, iii) Cognitive/disorganization, iv) Depression/anxiety and v) Hostility factors. Convergence of PANSS symptom architecture between EFA model and meta-analysis was observed. Modest longitudinal reliability was observed. The schizophrenia derived PANSS factor model fit the UHR population, but not vice versa. We found that two other domains, Social Amotivation (SA) and Diminished Expression (DE), were nested within the negative symptoms factor. Here, we report one of the largest transethnic factorial structures of PANSS symptom domains (N = 19,682). Evidence reported here serves as crucial consolidation of a common PANSS structure that could aid in furthering our understanding of schizophrenia.
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Affiliation(s)
- Keane Lim
- Research Division, Institute of Mental Health, Singapore
| | - Oon-Him Peh
- Research Division, Institute of Mental Health, Singapore
| | - Zixu Yang
- Research Division, Institute of Mental Health, Singapore
| | - Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health, Singapore; Duke-NUS Medical School, Singapore
| | - Yuen-Mei See
- Research Division, Institute of Mental Health, Singapore
| | | | - Mei-San Ang
- Research Division, Institute of Mental Health, Singapore
| | - Sara-Ann Lee
- Research Division, Institute of Mental Health, Singapore
| | - Kang Sim
- Research Division, Institute of Mental Health, Singapore
| | - Hailiang Huang
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Todd Lencz
- Feinstein Institute of Medical Research, The Zucker Hillside Hospital, New York, United States
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; Department of Psychosis, Institute of Mental Health, Singapore; Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Max Lam
- Research Division, Institute of Mental Health, Singapore; Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, United States; Feinstein Institute of Medical Research, The Zucker Hillside Hospital, New York, United States.
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Zierhut MM, Bernard RM, Turner E, Mohamad S, Hahn E, Bajbouj M. Electroconvulsive therapy for negative symptoms in schizophrenia: a literature review from 2000 to 2021. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AbstractNegative symptoms in schizophrenia remain a clinical challenge with small effect sizes and evidence for pharmacological or psychotherapeutic treatment approaches. Studies suggest that electroconvulsive therapy (ECT) holds some promise as a treatment option of often persistent negative symptoms with clinically meaningful effects. This review summarizes the existing evidence on the efficacy of ECT on negative symptoms in patients with schizophrenia. Thirty-five publications were included in this literature review comprising 21 studies, two meta-analyses, eight reviews and four case reports. Conclusions should be interpreted cautiously, given the small number and methodological shortcomings of the included publications with a variation of study designs and missing standardized protocols. Implications for future research and practice are critically discussed. Recommendations are given to provide more evidence that will meet the clinical challenge of reducing the negative symptoms in schizophrenia. Study designs that focus explicitly on negative symptoms and assess patients over longer follow up periods could be helpful. Future research should include control groups, and possibly establish international multicentered studies to get a sufficient study population. Findings suggest that patients with schizophrenia resistant to pharmacological treatment might benefit from ECT. A risk and benefit assessment speaks in favour of the ECT treatment. Future practice of ECT should include a combination treatment with antipsychotics. Whereas the use of anaesthetics and electrode placement does not seem to play a role, the recommendation regarding frequency of ECT treatments is currently three times a week, For the assessment of negative symptoms the assessment tool should be chosen carefully.
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10
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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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Trajectory and early predictors of apathy development in first-episode psychosis and healthy controls: a 10-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2020; 270:709-722. [PMID: 32130475 PMCID: PMC7423800 DOI: 10.1007/s00406-020-01112-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/08/2020] [Indexed: 12/28/2022]
Abstract
Apathy is prevalent in first-episode psychosis (FEP) and associated with reduced global functioning. Investigations of the trajectory of apathy and its early predictors are needed to develop new treatment interventions. We here measured the levels of apathy over the first 10 years of treatment in FEP and in healthy controls (HC). We recruited 198 HC and 198 FEP participants. We measured apathy with the Apathy Evaluation Scale, self-report version, psychotic symptoms with the Positive and Negative Syndrome Scale, depression with the Calgary Depression Scale for Schizophrenia, functioning with the Global Assessment of Functioning Scale, and also estimated the duration of untreated psychosis (DUP). The longitudinal development of apathy and its predictors were explored using linear mixed models analyses. Associations to functioning at 10 years were investigated using multiple hierarchical linear regression analyses. In HC, mean apathy levels were low and stable. In FEP, apathy levels decreased significantly during the first year of treatment, followed by long-term stability. High individual levels of apathy at baseline were associated with higher apathy levels during the follow-up. Long DUP and high baseline levels of depression predicted higher apathy levels at follow-ups. The effect of DUP was persistent, while the effect of baseline depression decreased over time. At 10 years, apathy was statistically significantly associated with reduced functioning. The early phase of the disorder may be critical to the development of apathy in FEP.
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12
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Goldsmith DR, Rapaport MH. Inflammation and Negative Symptoms of Schizophrenia: Implications for Reward Processing and Motivational Deficits. Front Psychiatry 2020; 11:46. [PMID: 32153436 PMCID: PMC7044128 DOI: 10.3389/fpsyt.2020.00046] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/20/2020] [Indexed: 01/08/2023] Open
Abstract
Negative symptoms of schizophrenia are debilitating and chronic in nature, are difficult to treat, and contribute to poor functional outcomes. Motivational deficits are a core negative symptom and may involve alterations in reward processing, which involve subcortical regions such as the basal ganglia. More specifically, dopamine-rich regions like the ventral striatum, have been implicated in these reward-processing deficits. Inflammation is one mechanism that may underlie negative symptoms, and specifically motivational deficits, via the effects of inflammatory cytokines on the basal ganglia. Previous work has demonstrated that inflammatory stimuli decrease neural activity in the ventral striatum and decrease connectivity in reward-relevant neural circuitry. The immune system has been shown to be involved in the pathophysiology of schizophrenia, and inflammatory cytokines have been shown to be altered in patients with the disorder. This paper reviews the literature on associations between inflammatory markers and negative symptoms of schizophrenia as well as the role of anti-inflammatory drugs to target negative symptoms. We also review the literature on the role of inflammation and reward processing deficits in both healthy controls and individuals with depression. We use the literature on inflammation and depression as a basis for a model that explores potential mechanisms responsible for inflammation modulating certain aspects of negative symptoms in patients with schizophrenia. This approach may offer novel targets to treat these symptoms of the disorder that are significant barriers to functional recovery and do not respond well to available antipsychotic medications.
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Affiliation(s)
- David R Goldsmith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Mark Hyman Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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13
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MEDEIROS HEYDRICHLOPESVIRGULINODE, SILVA ANTÔNIOMEDEIROSPEREGRINODA, RODIG RIEGMICHAELERICH, SOUZA SANDRALOPESDE, SOUGEY EVERTONBOTELHO, VASCONCELOS SELENECORDEIRO, LIMA MURILODUARTEDACOSTA. Cross-cultural adaptation, reliability, and content validity of the Brief Negative Symptom Scale (BNSS) for use in Brazil. ARCH CLIN PSYCHIAT 2019. [DOI: 10.1590/0101-60830000000211] [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: 11/22/2022] Open
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14
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López-González I, Pinacho R, Vila È, Escanilla A, Ferrer I, Ramos B. Neuroinflammation in the dorsolateral prefrontal cortex in elderly chronic schizophrenia. Eur Neuropsychopharmacol 2019; 29:384-396. [PMID: 30630651 DOI: 10.1016/j.euroneuro.2018.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/07/2018] [Accepted: 12/16/2018] [Indexed: 01/11/2023]
Abstract
Cognitive deterioration and symptom progression occur in schizophrenia over the course of the disorder. A dysfunction of the immune system/neuroinflammatory pathways has been linked to schizophrenia (SZ). These altered processes in the dorsolateral prefrontal cortex (DLPFC) could contribute to the worsening of the deficits. However, limited studies are available in this brain region in elderly population with long-term treatments. In this study, we explore the possible deregulation of 21 key genes involved in immune homeostasis, including pro- and anti-inflammatory cytokines, cytokine modulators (toll-like receptors, colony-stimulating factors, and members of the complement system) and microglial and astroglial markers in the DLPFC in elderly chronic schizophrenia. We used quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) on extracts from postmortem DLPFC of elderly subjects with chronic SZ (n = 14) compared to healthy control individuals (n = 14). We report that CSF1R, TLR4, IL6, TNFα, TNFRSF1A, IL10, IL10RA, IL10RB, and CD68 were down-regulated in elderly SZ subjects. Moreover, we found that the expression levels of all the altered inflammatory genes in SZ correlated with the microglial marker CD68. However, no associations were found with the astroglial marker GFAP. This study reveals a decrease in the gene expression of cytokines and immune response/inflammation mediators in the DLPFC of elderly subjects with chronic schizophrenia, supporting the idea of a dysfunction of these processes in aged patients and its possible relationship with active microglia abundance. These findings include elements that might contribute to the cognitive decline and symptom progression linked to DLPFC functioning at advanced stages of the disease.
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Affiliation(s)
- Irene López-González
- Neuropathology, Bellvitge University Hospital, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raquel Pinacho
- Psiquiatria Molecular, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Èlia Vila
- Psiquiatria Molecular, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain; Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain
| | - Ana Escanilla
- Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain; Banc de Teixits Neurologics, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
| | - Isidre Ferrer
- Neuropathology, Bellvitge University Hospital, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Patologia i Terapeutica Experimental, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; CIBERNED (Biomedical Network Research Center of Neurodegenerative Diseases), Ministry of Economy, Industry and Competitiveness Institute of Health Carlos III, Madrid, Spain.
| | - Belén Ramos
- Psiquiatria Molecular, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain; Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (Biomedical Network Research Center of Mental Health), Ministry of Economy, Industry and Competitiveness Institute of Health Carlos III, Madrid, Spain; Dept. de Bioquímica i Biologia Molecular, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain.
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15
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Mahmood Z, Clark JMR, Twamley EW. Compensatory Cognitive Training for psychosis: Effects on negative symptom subdomains. Schizophr Res 2019; 204:397-400. [PMID: 30293693 PMCID: PMC6402965 DOI: 10.1016/j.schres.2018.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/06/2018] [Accepted: 09/27/2018] [Indexed: 01/30/2023]
Abstract
Research identifying the effects of cognitive training on negative symptoms of psychosis is limited. We examined the effects of Compensatory Cognitive Training (CCT) on expressive deficits and social amotivation in a randomized controlled trial comparing CCT to standard pharmacotherapy alone in 43 individuals with psychosis. ANCOVA analyses demonstrated significant CCT-associated effects on both expressive deficits and social amotivation. Moreover, improvements in both sub-domains were associated with improvements in global life satisfaction, with improvements in social amotivation also related to increased social contact. CCT appears to be a beneficial treatment approach for improving multiple aspects of negative symptoms.
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Affiliation(s)
- Zanjbeel Mahmood
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, United States of America
| | - Jillian M R Clark
- Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, United States of America; Department of Psychiatry, University of California San Diego, United States of America
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, United States of America; Center of Excellence for Stress and Mental Health and Research Service, VA San Diego Healthcare System, United States of America.
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16
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Enomoto T, Ikeda K. [Translational behavioral research using common marmosets in the psychiatric field]. Nihon Yakurigaku Zasshi 2019; 153:28-34. [PMID: 30643089 DOI: 10.1254/fpj.153.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The drug discovery activities for novel compounds with the superior efficacies to current drugs have been largely unsuccessful in the psychiatric field. One of the main reasons is the lack of appropriate behavioral assays and animal models for psychiatric disorders. Since the prefrontal cortex has great roles in their pathophysiology, non-human primate common marmosets with the well-developed prefrontal cortex would be useful as experimental animals in the future translational research. To measure objectively and quantitatively the psychiatric symptoms like motivational deficits, negative affective bias and cognitive impairments in patients with schizophrenia or major depressive disorder, the clinical laboratory tasks have been developed. The development of marmoset behavioral paradigms, which may correspond to the clinical laboratory tasks, have been progressed for the translational research. On the other hand, there are still limitations to develop the marmoset models resembling the pathophysiology of psychiatric disorders. We review the current state and future perspective of translational behavioral research using marmosets.
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Affiliation(s)
- Takeshi Enomoto
- Higher Brain Function Research, Drug Research Division, Sumitomo Dainippon Pharma Co., Ltd
| | - Kazuhito Ikeda
- Higher Brain Function Research, Drug Research Division, Sumitomo Dainippon Pharma Co., Ltd
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17
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Yohn SE, Conn PJ. Pick Your Model Wisely: Understanding the Negative Symptoms of Schizophrenia in Rodent Models. ACS Chem Neurosci 2019; 10:33-35. [PMID: 30346132 DOI: 10.1021/acschemneuro.8b00553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
While the negative symptoms comprise one of the cardinal symptom domains of schizophrenia, there are numerous deficits that are included in this category of symptoms. Therefore, when modeling negative symptoms preclinically, it is important to consider which symptom is being modeled by a specific assay and to try to gain an understanding of the translational value of the findings. It is hoped that enhancing the translational value of animal models will allow for better treatment outcomes for the negative symptoms of schizophrenia in the future.
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Affiliation(s)
- Samantha E. Yohn
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee 37232, United States
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee 37232, United States
| | - P. Jeffrey Conn
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee 37232, United States
- Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee 37232, United States
- Vanderbilt Kennedy Center, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, United States
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18
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de Medeiros HLV, Vasconcelos SC, Elkis H, Martins DR, de Alexandria Leite RM, de Albuquerque ACL, Freitas RR, Scardoelli MA, Di Sarno E, Napolitano I, Oliveira GM, Vizzotto A, da Silva AMP, da Costa Lima MD. The Brief Negative Symptom Scale: Validation in a multicenter Brazilian study. Compr Psychiatry 2018; 85:42-47. [PMID: 29966891 DOI: 10.1016/j.comppsych.2018.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Negative symptoms are a core feature of schizophrenia. The Brief Negative Symptom Scale (BNSS) is a scale developed to measure negative symptoms in schizophrenia. METHODS The present study aimed to examine the construct validity of BNSS, by using convergent and divergent validities as well as factor analysis, in a Brazilian sample of 111 outpatients diagnosed with schizophrenia by DSM-5. Patients were evaluated by the Brazilian version of the BNSS and positive and negative subscales of the Positive and Negative Syndrome Scale (PANSS). RESULTS Assessment of patients by both instruments revealed an excellent internal consistency (Cronbach's alpha = 0.938) or inter-rater reliability (ICC = 0.92), as well as a strong correlation between BNSS and Marder negative PANSS (r = 0.866) and a weak correlation of the instrument with the positive PANSS (r = 0.292), thus characterizing convergent and discriminant validities, respectively. The exploratory factor analysis identified two distinct factors, namely, motivation/pleasure and emotional expressivity, accounting for 68.63% of the total variance. CONCLUSION The study shows that the Brazilian version of the BNSS has adequate psychometric properties and is a reliable instrument for the assessment of negative symptoms in schizophrenia, either for clinical practice or research.
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Affiliation(s)
| | | | - Helio Elkis
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
| | - Diana Rocha Martins
- Federal University of Paraíba, Jardim Universitário STr, João Pessoa, PB, Brazil
| | | | | | | | | | - Elaine Di Sarno
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
| | - Isabel Napolitano
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
| | | | - Adriana Vizzotto
- University of São Paulo, 785, Ovídio Pires de Campos ST, São Paulo, SP, Brazil
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19
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Binford SS, Hubbard EM, Flowers E, Miller BL, Leutwyler H. Serum BDNF Is Positively Associated With Negative Symptoms in Older Adults With Schizophrenia. Biol Res Nurs 2017; 20:63-69. [PMID: 29050493 DOI: 10.1177/1099800417735634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Older adults with chronic schizophrenia are at greater risk for functional disability and poorer health outcomes than those without serious mental illness. These individuals comprise 1-2% of the elderly population in the United States and are projected to number approximately 15 million by 2030. The symptoms of schizophrenia can be disabling for individuals, significantly reducing quality of life. Often, the negative symptoms (NS) are the most resistant to treatment and are considered a marker of illness severity, though they are challenging to measure objectively. Biomarkers can serve as objective indicators of health status. Brain-derived neurotrophic factor (BDNF) is a potential biomarker for schizophrenia and may serve as an important indicator of illness severity. METHODS A cross-sectional study with 30 older adults with chronic schizophrenia. Participants were assessed on serum levels of BDNF and psychiatric symptoms (Positive and Negative Syndrome Scale). Pearson's bivariate correlations (two-tailed) and linear regression models were used. RESULTS A significant positive association ( p < .05) was found between higher serum levels of BDNF and greater severity for the NS items of passive, apathetic, social withdrawal, and emotional withdrawal. In multivariate analyses, the association remained significant. CONCLUSIONS Although the association between BDNF and NS was not in the expected direction, the data corroborate findings from previous work in patients with schizophrenia. It is possible that higher serum levels of BDNF reflect compensatory neuronal mechanisms resulting from neurodevelopmental dysfunction.
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Affiliation(s)
- Sasha S Binford
- 1 Memory and Aging Center, University of California, San Francisco, CA, USA.,2 Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Erin M Hubbard
- 2 Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Elena Flowers
- 3 Department of Physiological Nursing, Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- 1 Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Heather Leutwyler
- 2 Department of Physiological Nursing, University of California, San Francisco, CA, USA
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20
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Ouellet-Plamondon C, Abdel-Baki A, Salvat É, Potvin S. Specific impact of stimulant, alcohol and cannabis use disorders on first-episode psychosis: 2-year functional and symptomatic outcomes. Psychol Med 2017; 47:2461-2471. [PMID: 28424105 DOI: 10.1017/s0033291717000976] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Many studies have concluded that cannabis use disorder (CUD) negatively influences outcomes in first-episode psychosis (FEP). However, few have taken into account the impact of concurrent misuse of other substances. METHODS This 2-year, prospective, longitudinal study of FEP patients, aged between 18 and 30 years, admitted to early intervention programs in Montreal, Quebec, Canada, examined the specific influence of different substance use disorders (SUD) (alcohol, cannabis, cocaine, amphetamines) on service utilization, symptomatic and functional outcomes in FEP. RESULTS Drugs and alcohol were associated with lower functioning, but drugs had a greater negative impact on most measures at 2-year follow-up. Half of CUD patients and more than 65% of cocaine or amphetamine abusers presented polysubstance use disorder (poly-SUD). The only group that deteriorated from years 1 to 2 (symptoms and functioning) were patients with persistent CUD alone. Outcome was worse in CUD than in the no-SUD group at 2 years. Cocaine, amphetamines and poly-SUD were associated with worse symptomatic and functional outcomes from the 1st year of treatment, persisting over time with higher service utilization (hospitalization). CONCLUSION The negative impact attributed to CUD in previous studies could be partly attributed to methodological flaws, like including polysubstance abusers among cannabis misusers. However, our investigation confirmed the negative effect of CUD on outcome. Attention should be paid to persistent cannabis misusers, since their condition seems to worsen over time, and to cocaine and amphetamine misusers, in view of their poorer outcome early during follow-up and high service utilization.
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Affiliation(s)
- C Ouellet-Plamondon
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - A Abdel-Baki
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - É Salvat
- Centre de recherche,Centre hospitalier de l'Université de Montréal (CRCHUM),Montreal, Quebec,Canada
| | - S Potvin
- Department of Psychiatry, Faculty of Medicine,Université de Montréal,Montreal, Quebec,Canada
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21
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Aleman A, Lincoln TM, Bruggeman R, Melle I, Arends J, Arango C, Knegtering H. Treatment of negative symptoms: Where do we stand, and where do we go? Schizophr Res 2017; 186:55-62. [PMID: 27293137 DOI: 10.1016/j.schres.2016.05.015] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022]
Abstract
Negative symptoms, e.g. social withdrawal, reduced initiative, anhedonia and affective flattening, are notoriously difficult to treat. In this review, we take stock of recent research into treatment of negative symptoms by summarizing psychosocial as well as pharmacological and other biological treatment strategies. Major psychosocial approaches concern social skills training, cognitive behavior therapy for psychosis, cognitive remediation and family intervention. Some positive findings have been reported, with the most robust improvements observed for social skills training. Although cognitive behavior therapy shows significant effects for negative symptoms as a secondary outcome measure, there is a lack of data to allow for definite conclusions of its effectiveness for patients with predominant negative symptoms. With regard to pharmacological interventions, antipsychotics have been shown to improve negative symptoms, but this seems to be limited to secondary negative symptoms in acute patients. It has also been suggested that antipsychotics may aggravate negative symptoms. Recent studies have investigated glutamatergic compounds, e.g. glycine receptor inhibitors and drugs that target the NMDA receptor or metabotropic glutamate 2/3 (mGlu2/3) receptor, but no consistent evidence of improvement of negative symptoms was found. Finally, some small studies have suggested improvement of negative symptoms after non-invasive electromagnetic neurostimulation, but this has only been partly replicated and it is still unclear whether these are robust improvements. We address methodological issues, in particular the heterogeneity of negative symptoms and treatment response, and suggest avenues for future research. There is a need for more detailed studies that focus on different dimensions of negative symptoms.
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Affiliation(s)
- André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Hamburg, Germany
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen and Rob Giel Research Center, Department of Psychiatry, Groningen, The Netherlands
| | - Ingrid Melle
- NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Johan Arends
- GGZ Drenthe Mental Health Center, Department of Psychotic Disorders, Assen, The Netherlands
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands; GGZ Lentis Mental Health Center, Department of Psychotic Disorders, Groningen, The Netherlands
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22
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Kaiser S, Lyne J, Agartz I, Clarke M, Mørch-Johnsen L, Faerden A. Individual negative symptoms and domains - Relevance for assessment, pathomechanisms and treatment. Schizophr Res 2017; 186:39-45. [PMID: 27453425 DOI: 10.1016/j.schres.2016.07.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 12/12/2022]
Abstract
The negative symptoms of schizophrenia can be divided into two domains. Avolition/apathy includes the individual symptoms of avolition, asociality and anhedonia. Diminished expression includes blunted affect and alogia. Until now, causes and treatment of negative symptoms have remained a major challenge, which is partially related to the focus on negative symptoms as a broad entity. Here, we propose that negative symptoms may become more tractable when the different domains and individual symptoms are taken into account. There is now increasing evidence that the relationship with clinical variables - in particular outcome - differs between the domains of avolition/apathy and diminished expression. Regarding models of negative symptom formation, those relevant to avolition/apathy are now converging on processes underlying goal-directed behavior and dysfunctions of the reward system. In contrast, models of the diminished expression domains are only beginning to emerge. The aim of this article is to review the specific clinical, behavioral and neural correlates of individual symptoms and domains as a better understanding of these areas may facilitate specific treatment approaches.
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Affiliation(s)
- Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
| | - John Lyne
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland; North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team (DETECT) Services, Dublin, Ireland
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Services, Dublin, Ireland; College of Life Sciences, University College Dublin, Dublin, Ireland
| | - Lynn Mørch-Johnsen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Ann Faerden
- NORMENT and K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Woolley JD, Chuang B, Fussell C, Scherer S, Biagianti B, Fulford D, Mathalon DH, Vinogradov S. Intranasal oxytocin increases facial expressivity, but not ratings of trustworthiness, in patients with schizophrenia and healthy controls. Psychol Med 2017; 47:1311-1322. [PMID: 28091349 PMCID: PMC6939989 DOI: 10.1017/s0033291716003433] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Blunted facial affect is a common negative symptom of schizophrenia. Additionally, assessing the trustworthiness of faces is a social cognitive ability that is impaired in schizophrenia. Currently available pharmacological agents are ineffective at improving either of these symptoms, despite their clinical significance. The hypothalamic neuropeptide oxytocin has multiple prosocial effects when administered intranasally to healthy individuals and shows promise in decreasing negative symptoms and enhancing social cognition in schizophrenia. Although two small studies have investigated oxytocin's effects on ratings of facial trustworthiness in schizophrenia, its effects on facial expressivity have not been investigated in any population. METHOD We investigated the effects of oxytocin on facial emotional expressivity while participants performed a facial trustworthiness rating task in 33 individuals with schizophrenia and 35 age-matched healthy controls using a double-blind, placebo-controlled, cross-over design. Participants rated the trustworthiness of presented faces interspersed with emotionally evocative photographs while being video-recorded. Participants' facial expressivity in these videos was quantified by blind raters using a well-validated manualized approach (i.e. the Facial Expression Coding System; FACES). RESULTS While oxytocin administration did not affect ratings of facial trustworthiness, it significantly increased facial expressivity in individuals with schizophrenia (Z = -2.33, p = 0.02) and at trend level in healthy controls (Z = -1.87, p = 0.06). CONCLUSIONS These results demonstrate that oxytocin administration can increase facial expressivity in response to emotional stimuli and suggest that oxytocin may have the potential to serve as a treatment for blunted facial affect in schizophrenia.
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Affiliation(s)
- J D Woolley
- Department of Psychiatry,San Francisco Veterans Affairs Medical Center,San Francisco,CA,USA
| | - B Chuang
- Department of Psychiatry,San Francisco Veterans Affairs Medical Center,San Francisco,CA,USA
| | - C Fussell
- Department of Psychiatry,San Francisco Veterans Affairs Medical Center,San Francisco,CA,USA
| | - S Scherer
- Institute for Creative Technologies,University of Southern California,Los Angeles,CA,USA
| | - B Biagianti
- Department of Psychiatry,University of California San Francisco,San Francisco,CA,USA
| | - D Fulford
- Departments of Occupational Therapy and Psychological & Brain Sciences,Boston University,Boston,MA,USA
| | - D H Mathalon
- Department of Psychiatry,San Francisco Veterans Affairs Medical Center,San Francisco,CA,USA
| | - S Vinogradov
- Department of Psychiatry,San Francisco Veterans Affairs Medical Center,San Francisco,CA,USA
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24
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Abnormal effective fronto-limbic connectivity during emotion processing in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2017; 72:1-8. [PMID: 27528110 DOI: 10.1016/j.pnpbp.2016.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Schizophrenia is associated with core emotional dysfunctions. At the neural level, functional neuro-imaging studies have highlighted fronto-limbic alterations during emotion processing in schizophrenia, as well as impaired connectivity between the amygdala and the prefrontal cortex. However, the direction of the impaired fronto-limbic connections remains largely unknown. To clarify this issue, we performed an effective connectivity study on emotion processing in schizophrenia. METHODS Forty-one healthy individuals and 39 schizophrenia patients (DSM-IV criteria) viewed negative, positive and neutral images during an fMRI session. Effective connectivity between significantly activated regions was examined using Granger causality and psychophysical interaction analyses. RESULTS Subjective ratings of emotionally neutral images were higher in schizophrenia patients than in controls. Across groups, significant activations were observed in the dorso-medial prefrontal cortex (dmPFC) and the bilateral amygdala. The Granger connectivity from the right amygdala to the dmPFC was significantly reduced in schizophrenia patients, relative to controls, during the negative and neutral conditions. The Granger connectivity from the left amygdala to the dmPFC was significantly reduced in schizophrenia patients, relative to controls, during the positive condition. DISCUSSION The finding of a reduced lagged connectivity from the bilateral amygdala to the dmPFC in schizophrenia suggests that the bottom-up mechanisms involved in the processing of highly arousing emotional stimuli are impaired in this disorder. The finding of an impaired lagged connectivity from the right amygdala to the dmPFC during the processing of emotionally neutral stimuli in schizophrenia is novel and may explain why these patients tend to confer emotional significance to irrelevant stimuli.
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Bischof M, Obermann C, Hartmann MN, Hager OM, Kirschner M, Kluge A, Strauss GP, Kaiser S. The brief negative symptom scale: validation of the German translation and convergent validity with self-rated anhedonia and observer-rated apathy. BMC Psychiatry 2016; 16:415. [PMID: 27876020 PMCID: PMC5118879 DOI: 10.1186/s12888-016-1118-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 11/07/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Negative symptoms are considered core symptoms of schizophrenia. The Brief Negative Symptom Scale (BNSS) was developed to measure this symptomatic dimension according to a current consensus definition. The present study examined the psychometric properties of the German version of the BNSS. To expand former findings on convergent validity, we employed the Temporal Experience Pleasure Scale (TEPS), a hedonic self-report that distinguishes between consummatory and anticipatory pleasure. Additionally, we addressed convergent validity with observer-rated assessment of apathy with the Apathy Evaluation Scale (AES), which was completed by the patient's primary nurse. METHODS Data were collected from 75 in- and outpatients from the Psychiatric Hospital, University Zurich diagnosed with either schizophrenia or schizoaffective disorder. We assessed convergent and discriminant validity, internal consistency and inter-rater reliability. RESULTS We largely replicated the findings of the original version showing good psychometric properties of the BNSS. In addition, the primary nurses evaluation correlated moderately with interview-based clinician rating. BNSS anhedonia items showed good convergent validity with the TEPS. CONCLUSIONS Overall, the German BNSS shows good psychometric properties comparable to the original English version. Convergent validity extends beyond interview-based assessments of negative symptoms to self-rated anhedonia and observer-rated apathy.
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Affiliation(s)
- Martin Bischof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland.
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Matthias N. Hartmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland ,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Bluemlisalpstrasse 10, 8006 Zurich, Switzerland
| | - Oliver M. Hager
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland ,Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Bluemlisalpstrasse 10, 8006 Zurich, Switzerland
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Agne Kluge
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Gregory P. Strauss
- Department of Psychology, State University of New York at Binghamton, Binghamton, NY 13902-6000 USA
| | - Stefan Kaiser
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Bluemlisalpstrasse 10, 8006 Zurich, Switzerland
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Fervaha G, Takeuchi H, Foussias G, Agid O, Remington G. Using poverty of speech as a case study to explore the overlap between negative symptoms and cognitive dysfunction. Schizophr Res 2016; 176:411-416. [PMID: 27242067 DOI: 10.1016/j.schres.2016.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/17/2016] [Accepted: 05/21/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Negative symptoms and cognitive impairment are both regarded as important prognostic markers in schizophrenia. Although these two domains are viewed as distinct and separable, conceptual overlap exists. We sought to illustrate this overlap using speech deficits among patients with schizophrenia. METHOD Reductions in verbal output were rated by a clinician following an interview, and these ratings were taken to represent negative symptoms (i.e., alogia). Patients were also asked to recount words from specific categories in a standardized manner, and the number of words was recorded as per standard protocol for verbal fluency tests. These scores were taken to represent cognitive impairment. The cross-sectional and longitudinal relationships between these two variables were then examined. RESULTS Patients with more severe alogia produced significantly less words on the verbal fluency tests. This relationship was stronger than that observed with other negative symptoms, and also held after controlling for a number of sociodemographic and clinical variables (e.g., severity of illness). Prospective increases in the number of words produced during the verbal fluency test were associated with improvements in clinical alogia ratings, a longitudinal relationship that was not observed with other negative symptoms. CONCLUSIONS Some negative symptoms are conceptually related and therefore not fully distinct from cognitive impairments. Here, we demonstrate that clinical ratings of alogia and words produced during a cognitive test are tapping into a similar construct. Whether a specific deficit is classified as a negative versus cognitive symptom may be matter of semantics rather than reflective of divisible underlying processes.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Hiroyoshi Takeuchi
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Sahin C, Doostdar N, Neill JC. Towards the development of improved tests for negative symptoms of schizophrenia in a validated animal model. Behav Brain Res 2016; 312:93-101. [DOI: 10.1016/j.bbr.2016.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/09/2016] [Accepted: 06/11/2016] [Indexed: 12/12/2022]
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Treisman GJ, Jayaram G, Margolis RL, Pearlson GD, Schmidt CW, Mihelish GL, Kennedy A, Howson A, Rasulnia M, Misiuta IE. Perspectives on the Use of eHealth in the Management of Patients With Schizophrenia. J Nerv Ment Dis 2016; 204:620-9. [PMID: 26828911 PMCID: PMC4972482 DOI: 10.1097/nmd.0000000000000471] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mobile devices, digital technologies, and web-based applications-known collectively as eHealth (electronic health)-could improve health care delivery for costly, chronic diseases such as schizophrenia. Pharmacologic and psychosocial therapies represent the primary treatment for individuals with schizophrenia; however, extensive resources are required to support adherence, facilitate continuity of care, and prevent relapse and its sequelae. This paper addresses the use of eHealth in the management of schizophrenia based on a roundtable discussion with a panel of experts, which included psychiatrists, a medical technology innovator, a mental health advocate, a family caregiver, a health policy maker, and a third-party payor. The expert panel discussed the uses, benefits, and limitations of emerging eHealth with the capability to integrate care and extend service accessibility, monitor patient status in real time, enhance medication adherence, and empower patients to take a more active role in managing their disease. In summary, to support this technological future, eHealth requires significant research regarding implementation, patient barriers, policy, and funding.
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Affiliation(s)
- Glenn J. Treisman
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Geetha Jayaram
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Russell L. Margolis
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Godfrey D. Pearlson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Chester W. Schmidt
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Gary L. Mihelish
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Adrienne Kennedy
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Alexandra Howson
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Maziar Rasulnia
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
| | - Iwona E. Misiuta
- *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Olin Neuropsychiatry Research Center, Hartford; ‡Department of Psychiatry and Neurobiology, Yale University, New Haven, CT; §Johns Hopkins HealthCare LLC, Glen Burnie, MD; ∥NAMI, Arlington, VA; ¶NAMI, Austin, TX; #Thistle Editorial, LLC, Snoqualmie, WA; **M Consulting LLC, Birmingham, AL; and ††Med-IQ, Baltimore, MD
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Hershenberg R, Satterthwaite TD, Daldal A, Katchmar N, Moore TM, Kable JW, Wolf DH. Diminished effort on a progressive ratio task in both unipolar and bipolar depression. J Affect Disord 2016; 196:97-100. [PMID: 26919058 PMCID: PMC4808384 DOI: 10.1016/j.jad.2016.02.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/11/2016] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Amotivation, or decisional anhedonia, is a prominent and disabling feature of depression. However, this aspect of depression remains understudied, and no prior work has applied objective laboratory tests of motivation in both unipolar and bipolar depression. METHODS We assessed motivation deficits using a Progressive Ratio Task (PRT) that indexes willingness to exert effort for monetary reward. The PRT was administered to 96 adults ages 18-60 including 25 participants with a current episode of unipolar depression, 28 with bipolar disorder (current episode depressed), and 43 controls without any Axis I psychiatric disorders. RESULTS Depressed participants exhibited significantly lower motivation than control participants as objectively defined by progressive ratio breakpoints. Both the unipolar and bipolar groups were lower than controls but did not differ from each other. LIMITATIONS Medication use differed across groups, and we did not have a separate control task to measure psychomotor activity; however neither medication effects or psychomotor slowing are likely to explain our findings. CONCLUSIONS Our study fills an important gap in the literature by providing evidence that diminished effort on the PRT is present across depressed patients who experience either unipolar or bipolar depression. This adds to growing evidence for shared mechanisms of reward and motivation dysfunction, and highlights the importance of improving the assessment and treatment of motivation deficits across the mood disorders spectrum.
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Affiliation(s)
- Rachel Hershenberg
- ,,Corresponding author: Daniel H. Wolf, Department of Psychiatry, University of Pennsylvania, 10th Floor Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, tel: (215)-662-3692, fax: (215)-662-7903,
| | - Theodore D. Satterthwaite
- ,Corresponding author: Daniel H. Wolf, Department of Psychiatry, University of Pennsylvania, 10th Floor Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, tel: (215)-662-3692, fax: (215)-662-7903,
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Abstract
Interest in the negative symptoms of schizophrenia has increased rapidly over the last several decades, paralleling a growing interest in functional, in addition to clinical, recovery, and evidence underscoring the importance negative symptoms play in the former. Efforts continue to better define and measure negative symptoms, distinguish their impact from that of other symptom domains, and establish effective treatments as well as trials to assess these. Multiple interventions have been the subject of investigation, to date, including numerous pharmacological strategies, brain stimulation, and non-somatic approaches. Level and quality of evidence vary considerably, but to this point, no specific treatment can be recommended. This is particularly problematic for individuals burdened with negative symptoms in the face of mild or absent positive symptoms. Presently, clinicians will sometimes turn to interventions that are seen as more “benign” and in line with routine clinical practice. Strategies include use of atypical antipsychotics, ensuring the lowest possible antipsychotic dose that maintains control of positive symptoms (this can involve a shift from antipsychotic polypharmacy to monotherapy), possibly an antidepressant trial (given diagnostic uncertainty and the frequent use of these drugs in schizophrenia), and non-somatic interventions (e.g., cognitive behavioral therapy, CBT). The array and diversity of strategies currently under investigation highlight the lack of evidence-based treatments and our limited understanding regarding negative symptoms underlying etiology and pathophysiology. Their onset, which can precede the first psychotic break, also means that treatments are delayed. From this perspective, identification of biomarkers and/or endophenotypes permitting earlier diagnosis and intervention may serve to improve treatment efficacy as well as outcomes.
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Stiekema APM, Liemburg EJ, van der Meer L, Castelein S, Stewart R, van Weeghel J, Aleman A, Bruggeman R. Confirmatory Factor Analysis and Differential Relationships of the Two Subdomains of Negative Symptoms in Chronically Ill Psychotic Patients. PLoS One 2016; 11:e0149785. [PMID: 26895203 PMCID: PMC4760738 DOI: 10.1371/journal.pone.0149785] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/04/2016] [Indexed: 01/30/2023] Open
Abstract
Research suggests a two factor structure for negative symptoms in patients with psychotic disorders: social amotivation (SA) and expressive deficits (ED). Applying this two-factor structure in clinical settings may provide valuable information with regard to outcomes and to target treatments. We aimed to investigate 1) whether the factor structure is also supported in chronically ill patients with a psychotic disorder and 2) what the relationship is between these factors and functioning (overall functioning and living situation), depressive symptoms and quality of life. 1157 Patients with a psychotic disorder and a duration of illness of 5 years or more were included in the analysis (data selected from the Pharmacotherapy Monitoring Outcome Survey; PHAMOUS). A confirmatory factor analysis was performed using items of the Positive and Negative Syndrome Scale that were previously identified to reflect negative symptoms (N1-4, N6, G5, G7, G13, G16). Subsequently, regression analysis was performed on outcomes. The results confirmed the distinction between SA (N2, N4, G16) and ED (N1, N3, N6, G5, G7, G13) in chronically ill patients. Both factors were related to worse overall functioning as measured with the Health of the Nation Outcome Scales, ED was uniquely associated with residential living status. Higher scores for SA were associated with more depressive symptoms and worse quality of life. Thus, SA is most strongly related to level of social-emotional functioning, while ED are more related to living situation and thereby are indicative of level of everyday functioning. This subdivision may be useful for research purposes and be a valuable additional tool in clinical practice and treatment development.
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Affiliation(s)
- Annemarie P. M. Stiekema
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, the Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
| | - Edith J. Liemburg
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Department, Lentis Center for Mental Health Care, Groningen, the Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, the Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stynke Castelein
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Department, Lentis Center for Mental Health Care, Groningen, the Netherlands
| | - Roy Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap van Weeghel
- Parnassia Group, Dijk en Duin Mental Health Center, Castricum, the Netherlands
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific center for Care and Welfare, Tilburg, the Netherlands
- Phrenos, Center of Expertise on severe mental illness, Utrecht, the Netherlands
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University Center of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Potvin S, Tikàsz A, Mendrek A. Emotionally Neutral Stimuli Are Not Neutral in Schizophrenia: A Mini Review of Functional Neuroimaging Studies. Front Psychiatry 2016; 7:115. [PMID: 27445871 PMCID: PMC4916183 DOI: 10.3389/fpsyt.2016.00115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/10/2016] [Indexed: 11/13/2022] Open
Abstract
Reliable evidence shows that schizophrenia patients tend to experience negative emotions when presented with emotionally neutral stimuli. Similarly, several functional neuroimaging studies show that schizophrenia patients have increased activations in response to neutral material. However, results are heterogeneous. Here, we review the functional neuroimaging studies that have addressed this research question. Based on the 36 functional neuroimaging studies that we retrieved, it seems that the increased brain reactivity to neutral stimuli is fairly common in schizophrenia, but that the regions involved vary considerably, apart from the amygdala. Prefrontal and cingulate sub-regions and the hippocampus may also be involved. By contrasts, results in individuals at risk for psychosis are less consistent. In schizophrenia patients, results are less consistent in the case of studies using non-facial stimuli, explicit processing paradigms, and/or event-related designs. This means that human faces may convey subtle information (e.g., trustworthiness) other than basic emotional expressions. It also means that the aberrant brain reactivity to neutral stimuli is less likely to occur when experimental paradigms are too cognitively demanding as well as in studies lacking statistical power. The main hypothesis proposed to account for this increased brain reactivity to neutral stimuli is the aberrant salience hypothesis of psychosis. Other investigators propose that the aberrant brain reactivity to neutral stimuli in schizophrenia results from abnormal associative learning, untrustworthiness judgments, priming effects, and/or reduced habituation to neutral stimuli. In the future, the effects of antipsychotics on this aberrant brain reactivity will need to be determined, as well as the potential implication of sex/gender.
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Affiliation(s)
- Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Andràs Tikàsz
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Adrianna Mendrek
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychology, Bishop's University, Sherbrooke, QC, Canada
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Clinical (but not cognitive) recovery in schizophrenia through the experience of fictional cinema. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:189-194. [PMID: 29114462 PMCID: PMC5609648 DOI: 10.1016/j.scog.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction One of the criticisms of rehabilitation techniques is their limited application to the patient’s daily life. In the past, cinema has been used as a psychiatric rehabilitation tool, with the primary objective of facilitating training in social abilities and communication. In this study, we consider the use of film not only as a clinical recovery tool but also as a novel cognitive recovery tool for additional rehabilitation not only for communication and social abilities but also for all of the basic cognitive and social cognition processes. Methods In this randomized clinical trial, 48 patients with schizophrenia were assigned to an experimental or control group. Both of the groups received treatment sessions that included viewing episodes of the television series The Sopranos. Next, the experimental group participated in a structured cognitive training session that featured questions and exercises based on the episodes. The control group participated in an idea-sharing session (of the same duration and frequency) about what the group members saw in the episode. Results At the end of the treatment, both the positive and negative clinical symptoms of the experimental group improved significantly compared with the control group. However, this improvement was not observed in basic or social cognitive functions. Discussion A brief intervention based on transforming the activities of daily life can be an effective tool for psychiatric rehabilitation. However, the study’s current characteristics and sample did not produce benefits in cognitive parameters.
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Lam M, Abdul Rashid NA, Lee SA, Lim J, Foussias G, Fervaha G, Ruhrman S, Remington G, Lee J. Baseline social amotivation predicts 1-year functioning in UHR subjects: A validation and prospective investigation. Eur Neuropsychopharmacol 2015; 25:2187-96. [PMID: 26553972 DOI: 10.1016/j.euroneuro.2015.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/17/2015] [Accepted: 10/22/2015] [Indexed: 12/15/2022]
Abstract
Social amotivation and diminished expression have been reported to underlie negative symptomatology in schizophrenia. In the current study we sought to establish and validate these negative symptom domains in a large cohort of schizophrenia subjects (n=887) and individuals who are deemed to be Ultra-High Risk (UHR) for psychosis. Confirmatory factor analysis conducted on PANSS item domains demonstrate that the dual negative symptom domains exist in schizophrenia and UHR subjects. We further sought to examine if these negative symptom domains were associated with functioning in UHR subjects. Linear regression analyses confirmed that social amotivation predicted functioning in UHR subjects prospectively at 1 year follow up. Results suggest that the association between social amotivation and functioning is generalisable beyond schizophrenia populations to those who are at-risk of developing psychosis. Social amotivation may be an important dimensional clinical construct to be studied across a range of psychiatric conditions.
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Affiliation(s)
- Max Lam
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Sara-Ann Lee
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jeanette Lim
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Stephan Ruhrman
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore; Department of General Psychiatry 1, Institute of Mental Health, Singapore, Singapore; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.
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Recuperación Clinica Pero No Cognitiva En Esquizofrenia A Traves De La Experiencia Del Cine De Ficcion. Schizophr Res Cogn 2015. [DOI: 10.1016/j.scog.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Brzózka MM, Unterbarnscheidt T, Schwab MH, Rossner MJ. OSO paradigm--A rapid behavioral screening method for acute psychosocial stress reactivity in mice. Neuroscience 2015; 314:1-11. [PMID: 26628400 DOI: 10.1016/j.neuroscience.2015.11.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 12/27/2022]
Abstract
Chronic psychosocial stress is an important environmental risk factor for the development of psychiatric diseases. However, studying the impact of chronic psychosocial stress in mice is time consuming and thus not optimally suited to 'screen' increasing numbers of genetically manipulated mouse models for psychiatric endophenotypes. Moreover, many studies focus on restraint stress, a strong physical stressor with limited relevance for psychiatric disorders. Here, we describe a simple and a rapid method based on the resident-intruder paradigm to examine acute effects of mild psychosocial stress in mice. The OSO paradigm (open field--social defeat--open field) compares behavioral consequences on locomotor activity, anxiety and curiosity before and after exposure to acute social defeat stress. We first evaluated OSO in male C57Bl/6 wildtype mice where a single episode of social defeat reduced locomotor activity, increased anxiety and diminished exploratory behavior. Subsequently, we applied the OSO paradigm to mouse models of two schizophrenia (SZ) risk genes. Transgenic mice with neuronal overexpression of Neuregulin-1 (Nrg1) type III showed increased risk-taking behavior after acute stress exposure suggesting that NRG1 dysfunction is associated with altered affective behavior. In contrast, Tcf4 transgenic mice displayed a normal stress response which is in line with the postulated predominant contribution of TCF4 to cognitive deficits of SZ. In conclusion, the OSO paradigm allows for rapid screening of selected psychosocial stress-induced behavioral endophenotypes in mouse models of psychiatric diseases.
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Affiliation(s)
- M M Brzózka
- Department of Psychiatry, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany.
| | - T Unterbarnscheidt
- Max Planck Institute of Experimental Medicine, Hermann-Rein-Strasse 3, 37075 Göttingen, Germany; Cellular Neurophysiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - M H Schwab
- Max Planck Institute of Experimental Medicine, Hermann-Rein-Strasse 3, 37075 Göttingen, Germany; Cellular Neurophysiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - M J Rossner
- Department of Psychiatry, Ludwig-Maximilian-University, Nussbaumstrasse 7, 80336 Munich, Germany; Max Planck Institute of Experimental Medicine, Hermann-Rein-Strasse 3, 37075 Göttingen, Germany.
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Cathomas F, Hartmann MN, Seifritz E, Pryce CR, Kaiser S. The translational study of apathy-an ecological approach. Front Behav Neurosci 2015; 9:241. [PMID: 26441571 PMCID: PMC4563080 DOI: 10.3389/fnbeh.2015.00241] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022] Open
Abstract
Apathy, a quantitative reduction in goal-directed behavior, is a prevalent symptom dimension with a negative impact on functional outcome in various neuropsychiatric disorders including schizophrenia and depression. The aim of this review is to show that interview-based assessment of apathy in humans and observation of spontaneous rodent behavior in an ecological setting can serve as an important complementary approach to already existing task-based assessment, to study and understand the neurobiological bases of apathy. We first discuss the paucity of current translational approaches regarding animal equivalents of psychopathological assessment of apathy. We then present the existing evaluation scales for the assessment of apathy in humans and propose five sub-domains of apathy, namely self-care, social interaction, exploration, work/education and recreation. Each of the items in apathy evaluation scales can be assigned to one of these sub-domains. We then show that corresponding, well-validated behavioral readouts exist for rodents and that, indeed, three of the five human apathy sub-domains have a rodent equivalent. In conclusion, the translational ecological study of apathy in humans and rodents is possible and will constitute an important approach to increase the understanding of the neurobiological bases of apathy and the development of novel treatments.
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Affiliation(s)
- Flurin Cathomas
- Preclinical Laboratory for Translational Research into Affective Disorders (PLaTRAD), Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland
| | - Matthias N Hartmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Neuroscience Center, Swiss Federal Institute of Technology, University of Zurich Zurich, Switzerland
| | - Christopher R Pryce
- Preclinical Laboratory for Translational Research into Affective Disorders (PLaTRAD), Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Neuroscience Center, Swiss Federal Institute of Technology, University of Zurich Zurich, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich Zurich, Switzerland ; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich Zurich, Switzerland ; Zurich Center for Integrative Human Physiology, University of Zurich Zurich, Switzerland
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Lodge D, Mercier MS. Ketamine and phencyclidine: the good, the bad and the unexpected. Br J Pharmacol 2015; 172:4254-76. [PMID: 26075331 DOI: 10.1111/bph.13222] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022] Open
Abstract
The history of ketamine and phencyclidine from their development as potential clinical anaesthetics through drugs of abuse and animal models of schizophrenia to potential rapidly acting antidepressants is reviewed. The discovery in 1983 of the NMDA receptor antagonist property of ketamine and phencyclidine was a key step to understanding their pharmacology, including their psychotomimetic effects in man. This review describes the historical context and the course of that discovery and its expansion into other hallucinatory drugs. The relevance of these findings to modern hypotheses of schizophrenia and the implications for drug discovery are reviewed. The findings of the rapidly acting antidepressant effects of ketamine in man are discussed in relation to other glutamatergic mechanisms.
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Affiliation(s)
- D Lodge
- Centre for Synaptic Plasticity, School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | - M S Mercier
- Centre for Synaptic Plasticity, School of Physiology and Pharmacology, University of Bristol, Bristol, UK
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