Trait emotional experience in individuals with schizophrenia and youth at clinical high risk for psychosis

Environmental context predicts state fluctuations in negative symptoms in youth at clinical high risk for psychosis

BACKGROUND

Negative symptoms (avolition, anhedonia, asociality) are a prevalent symptom in those across the psychosis-spectrum and also occur at subclinical levels in the general population. Recent work has begun to examine how environmental contexts (e.g. locations) influence negative symptoms. However, limited work has evaluated how environments may contribute to negative symptoms among youth at clinical high risk for psychosis (CHR). The current study uses Ecological Momentary Assessment to assess how four environmental contexts (locations, activities, social interactions, social interaction method) impact state fluctuations in negative symptoms in CHR and healthy control (CN) participants.

METHODS

CHR youth (n = 116) and CN (n = 61) completed 8 daily surveys for 6 days assessing negative symptoms and contexts.

RESULTS

Mixed-effects modeling demonstrated that negative symptoms largely varied across contexts in both groups. CHR participants had higher negative symptoms than CN participants in most contexts, but groups had similar symptom reductions during recreational activities and phone call interactions. Among CHR participants, negative symptoms were elevated in several contexts, including studying/working, commuting, eating, running errands, and being at home.

CONCLUSIONS

Results demonstrate that negative symptoms dynamically change across some contexts in CHR participants. Negative symptoms were more intact in some contexts, while other contexts, notably some used to promote functional recovery, may exacerbate negative symptoms in CHR. Findings suggest that environmental factors should be considered when understanding state fluctuations in negative symptoms among those at CHR participants.

Moment-to-moment affective dynamics in schizophrenia and bipolar disorder

BACKGROUND

Affective disturbances in schizophrenia and bipolar disorder may represent a transdiagnostic etiological process as well as a target of intervention. Hypotheses on similarities and differences in various parameters of affective dynamics (intensity, successive/acute changes, variability, and reactivity to stress) between the two disorders were tested.

METHODS

Experience sampling method was used to assess dynamics of positive and negative affect, 10 times a day over 6 consecutive days. Patients with schizophrenia (n = 46) and patients with bipolar disorder (n = 46) were compared against age-matched healthy controls (n = 46).

RESULTS

Compared to controls, the schizophrenia group had significantly more intense momentary negative affect, a lower likelihood of acute changes in positive affect, and reduced within-person variability of positive affect. The bipolar disorder group was not significantly different from either the schizophrenia group or the healthy control group on any affect indexes. Within the schizophrenia group, level of depression was associated with weaker reactivity to stress for negative affect. Within the bipolar disorder group, level of depression was associated with lower positive affect.

CONCLUSIONS

Patients with schizophrenia endured a more stable and negative affective state than healthy individuals, and were less likely to be uplifted in response to happenings in daily life. There is little evidence that these affective constructs characterize the psychopathology of bipolar disorder; such investigation may have been limited by the heterogeneity within group. Our findings supported the clinical importance of assessing multiple facets of affective dynamics beyond the mean levels of intensity.

The Role of Shame in Schizophrenia Delusion: The Interplay Between Cognitive-Perceptual and Emotional Traits

ABSTRACT

Through a strictly dimensional approach, the present study aimed at evaluating the interplay between cognitive-perceptual disturbances and emotional dispositions, particularly shame proneness, in schizophrenia delusion. One hundred one outpatients with schizophrenia were administered the Peters et al. Delusions Inventory, the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS), the Perceptual Aberration Scale (PAS), the Positive and Negative Affect Schedule and the Experiences of Shame Scale (ESS). The severity of delusional ideation was positively related to all the cognitive-perceptual scales (REF, MIS, and PAS) and to shame proneness (ESS). Referential thinking (REF) emerged as the strongest predictor of delusion severity. The experience of shame played a mediation role in the relationship between cognitive-perceptual traits and delusional severity. These data suggest that severity delusion in schizophrenia depends, at least in part, on a complex interplay between cognitive-perceptual disturbances and experiences of shame.

Responses to positive affect and unique resting-state connectivity in individuals at clinical high-risk for psychosis

Individuals at clinical high-risk for psychosis (CHR) report dampened positive affect, while this deficit appears to be an important clinical marker, our current understanding of underlying causes is limited. Dysfunctional regulatory strategies (i.e., abnormal use of dampening, self-focused, or emotion-focused strategies) may account for dampening affect but has not yet been examined. Participants (57 CHR and 56 healthy controls) completed the Response to Positive Affect Scale, clinical interviews, and resting-state scan examining nucleus accumbens (NAcc) connectivity. Individuals at CHR for psychosis showed greater dampening (but no differences in self/emotion-focus) in self-reported response to positive affect compared to healthy controls. In individuals at CHR, higher levels of dampening and lower levels of self-focus were associated with higher positive and lower negative symptoms. Dampening responses were related to decreased dorsal and rostral anterior cingulate cortex-NAcc resting-state connectivity in the CHR group but increased dorsal and rostral anterior cingulate cortex-NAcc resting-state connectivity in the healthy control group. Self-focused responses were related to increased dorsolateral prefrontal cortex-NAcc resting-state connectivity in the CHR group but decreased resting-state connectivity in the healthy control group. Self-reported dampening of positive affect was elevated in individuals at CHR for psychosis. Dampening and self-focused responses were associated with distinct resting-state connectivity compared to peers, suggesting unique mechanisms underlying these emotion regulation strategies. Responses to positive affect may be a useful target for cognitive treatment, but individuals at CHR show distinct neurocorrelates and may require a tailored approach.

Alterations in Emotional Diversity Correspond With Increased Severity of Attenuated Positive and Negative Symptoms in the Clinical High-Risk Syndrome

Background: Alterations in emotional functioning are a key feature of psychosis and are present in individuals with a clinical high-risk (CHR) syndrome. However, little is known about alterations in emotional diversity (i.e., the variety and relative abundance of emotions that humans experience) and clinical correlates in this population. Methods: Individuals meeting criteria for a CHR syndrome (N = 47) and matched healthy controls (HC) (N = 58) completed the modified Differential Emotions Scale (used to derive scores of total, positive, and negative emotional diversity) and clinical interviews (i.e., Structured Interview for Psychosis-Risk Syndromes). Results: Findings showed that the CHR group experienced lower levels of positive emotional diversity compared to HCs. Among the CHR individuals, lower levels of positive and higher levels of negative emotional diversity were associated with more severe attenuated positive and negative symptoms. Analyses controlled for mean levels of emotion and current antipsychotic medication use. Discussion: Results demonstrate that altered emotional diversity (in particular lower levels of positive and higher levels of negative emotional diversity) is a clinically relevant marker in CHR individuals, above and beyond alterations in mean levels of emotional experiences. Future studies may probe sources, downstream consequences, and potential modifiability of decreased emotional diversity in individuals at CHR.