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Kilicoglu MFV, Lundin NB, Angers K, Moe AM. Narrative-Derived Indices of Metacognition among People with Schizophrenia: Associations with Self-Reported and Performance-Based Social Functioning. Behav Sci (Basel) 2024; 14:265. [PMID: 38667061 PMCID: PMC11047350 DOI: 10.3390/bs14040265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
Metacognitive functioning-which broadly encompasses the mental processes involved in thinking about the thinking of one's self and the thinking of others-is often impaired among individuals living with schizophrenia and may contribute to difficulties in social and interpersonal functioning. Although the majority of studies assessing metacognition among individuals with schizophrenia use standardized, laboratory-based measurements, an increasing number of studies have measured metacognitive capacity using natural language produced by individuals living with mental illness. At the same time, less is known about how language-derived indices of metacognitive function relate to key social outcomes among people with schizophrenia. The primary objective of this study was to employ a validated language coding system (the Metacognition Assessment Scale, Abbreviated; MAS-A) to assess metacognitive functioning from the spoken life narratives of individuals with schizophrenia (n = 32) and community controls (n = 15). Among individuals with schizophrenia, we also examined the associations between language-derived metacognition and measures of self-reported and performance-based social functioning. Our results suggest that most aspects of metacognition in our sample were not significantly diminished in people with schizophrenia compared to community controls. Unexpectedly, the MAS-A subscale related to one's ability to master psychological difficulties was rated higher among individuals with schizophrenia. Further, our results suggest that among people with schizophrenia, higher metacognitive functioning in the domain of self-reflectivity was associated with poorer self-reported social functioning, while a greater metacognitive awareness of other individuals' minds was associated with better scores on aspects of performance-based social functioning. Collectively, these results underscore the utility of assessing metacognitive functioning via life-story narratives to understand social outcomes and highlight possible aspects of resiliency among individuals who have experienced a serious mental illness.
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Affiliation(s)
- Melissa F. V. Kilicoglu
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH 43210, USA; (M.F.V.K.); (N.B.L.)
| | - Nancy B. Lundin
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH 43210, USA; (M.F.V.K.); (N.B.L.)
| | - Kaley Angers
- Department of Psychiatry, Neuropsychology Section, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA;
| | - Aubrey M. Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH 43210, USA; (M.F.V.K.); (N.B.L.)
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McGuire N, Gumley A, Hasson-Ohayon I, Allan S, Aunjitsakul W, Aydin O, Bo S, Bonfils KA, Bröcker AL, de Jong S, Dimaggio G, Inchausti F, Jansen JE, Lecomte T, Luther L, MacBeth A, Montag C, Pedersen MB, Pijnenborg GHM, Popolo R, Schwannauer M, Trauelsen AM, van Donkersgoed R, Wu W, Wang K, Lysaker PH, McLeod H. Investigating the relationship between negative symptoms and metacognitive functioning in psychosis: An individual participant data meta-analysis. Psychol Psychother 2023; 96:918-933. [PMID: 37530433 DOI: 10.1111/papt.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/24/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Negative symptoms are a persistent, yet under-explored problem in psychosis. Disturbances in metacognition are a potential causal factor in negative symptom development and maintenance. This meta-analysis uses individual participant data (IPD) from existing research to assess the relationship between negative symptoms and metacognition treated as summed scores and domains. METHODS Data sets containing individuals with negative symptoms and metacognition data, aged 16+ with psychosis, were identified according to pre-specific parameters. IPD integrity and completeness were checked and data were synthesized in two-stage meta-analyses of each negative symptoms cluster compared with metacognition in seemingly unrelated regression using restricted maximum likelihood estimation. Planned and exploratory sensitivity analyses were also conducted. RESULTS Thirty-three eligible data sets were identified with 21 with sufficient similarity and availability to be included in meta-analyses, corresponding to 1301 participants. The strongest relationships observed were between summed scores of negative symptoms and metacognition. Metacognitive domains of self-reflectivity and understanding others' minds, and expressive negative symptoms emerged as significant in some meta-analyses. The uncertainty of several effect estimates increased significantly when controlling for covariates. CONCLUSIONS This robust meta-analysis highlights the impact of using summed versus domain-specific scores of metacognition and negative symptoms, and relationships are not as clear-cut as once believed. Findings support arguments for further differentiation of negative symptom profiles and continued granular exploration of the relationship between metacognition and negative symptoms.
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Affiliation(s)
| | | | | | | | | | - Orkun Aydin
- International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Steven de Jong
- Lentis Psychiatric Institute, Groningen, The Netherlands
| | | | - Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | | | | | | | | | | | - Marlene Buch Pedersen
- Early Psychosis Intervention Centre, Psychiatry East, Region Zealand, Roskilde, Denmark
| | | | | | | | - Anne-Marie Trauelsen
- Assessment and Brief Treatment Team (Newham), East London Foundation Trust, London, UK
| | | | | | - Kai Wang
- Anhui Medical University, Hefei, China
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Amoretti S, Mezquida G, Verdolini N, Bioque M, Sánchez-Torres AM, Pina-Camacho L, Zorrilla I, Trabsa A, Rodriguez-Jimenez R, Corripio I, Sarró S, Ibañez A, Usall J, Segarra R, Vieta E, Roberto N, Ramos-Quiroga JA, Tortorella A, Menculini G, Cuesta MJ, Parellada M, González-Pinto A, Berrocoso E, Bernardo M. Negative symptoms and sex differences in first episode schizophrenia: What's their role in the functional outcome? A longitudinal study. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00010-8. [PMID: 38591832 DOI: 10.1016/j.sjpmh.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Negative symptoms (NS) include asociality, avolition, anhedonia, alogia, and blunted affect and are linked to poor prognosis. It has been suggested that they reflect two different factors: diminished expression (EXP) (blunted affect and alogia) and amotivation/pleasure (MAP) (anhedonia, avolition, asociality). The aim of this article was to examine potential sex differences among first-episode schizophrenia (FES) patients and analyze sex-related predictors of two NS symptoms factors (EXP and MAP) and functional outcome. MATERIAL AND METHODS Two hundred and twenty-three FES (71 females and 152 males) were included and evaluated at baseline, six-months and one-year. Repeated measures ANOVA was used to examine the effects of time and sex on NS and a multiple linear regression backward elimination was performed to predict NS factors (MAP-EXP) and functioning. RESULTS Females showed fewer NS (p=0.031; Cohen's d=-0.312), especially those related to EXP (p=0.024; Cohen's d=-0.326) rather than MAP (p=0.086), than males. In both male and female group, worse premorbid adjustment and higher depressive symptoms made a significant contribution to the presence of higher deficits in EXP at one-year follow-up, while positive and depressive symptoms predicted alterations in MAP. Finally, in females, lower deficits in MAP and better premorbid adjustment predicted better functioning at one-year follow-up (R2=0.494; p<0.001), while only higher deficits in MAP predicted worse functioning in males (R2=0.088; p=0.012). CONCLUSIONS Slightly sex differences have been found in this study. Our results lead us to consider that early interventions of NS, especially those focusing on motivation and pleasure symptoms, could improve functional outcomes.
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Affiliation(s)
- Silvia Amoretti
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, University of Perugia, Perugia, Italy
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Serra Húnter Fellow, Department of Basic Clinical Practice, University of Barcelona
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Miquel Bioque
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Laura Pina-Camacho
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Iñaki Zorrilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Universidad del País Vasco/Euskal Herriko Unibertsitatea, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria-Gasteiz, Spain
| | - Amira Trabsa
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; CogPsy Group, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Salvador Sarró
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Angela Ibañez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Rafael Segarra
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Cruces University Hospital, BioCruces Health Research Institute, University of the Basque Country (UPV/EHU), Vizcaya, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Natalia Roberto
- Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain; Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Institute of Neurosciences (UBNeuro), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Alfonso Tortorella
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Giulia Menculini
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Universidad del País Vasco/Euskal Herriko Unibertsitatea, Spain; Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria-Gasteiz, Spain
| | - Esther Berrocoso
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Neuropsychopharmacology and Psychobiology Research Group, Department of Psychology, University of Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic, Departament de Medicina, Institut de Neurociències (UBNeuro), Universitat de Barcelona (UB), Institut d'Investigacions Biomèdiques, August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Lundin NB, Cowan HR, Singh DK, Moe AM. Lower cohesion and altered first-person pronoun usage in the spoken life narratives of individuals with schizophrenia. Schizophr Res 2023; 259:140-149. [PMID: 37127466 PMCID: PMC10524354 DOI: 10.1016/j.schres.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/17/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Usage of computational tools to quantify language disturbances among individuals with psychosis is increasing, improving measurement efficiency and access to fine-grained constructs. However, few studies apply automated linguistic analysis to life narratives in this population. Such research could facilitate the measurement of psychosis-relevant constructs such as sense of agency, capacity to organize one's personal history, narrative richness, and perceptions of the roles that others play in one's life. Furthermore, research is needed to understand how narrative linguistic features relate to cognitive and social functioning. In the present study, individuals with schizophrenia (n = 32) and individuals without a psychotic disorder (n = 15) produced personal life narratives within the Indiana Psychiatric Illness Interview. Narratives were analyzed using the Coh-Metrix computational tool. Linguistic variables analyzed were indices of connections within causal and goal-driven speech (deep cohesion), unique word usage (lexical diversity), and pronoun usage. Individuals with schizophrenia compared to control participants produced narratives that were lower in deep cohesion, contained more first-person singular pronouns, and contained fewer first-person plural pronouns. Narratives did not significantly differ between groups in lexical diversity, third-person pronoun usage, or total word count. Cognitive-linguistic relationships emerged in the full sample, including significant correlations between greater working memory capacity and greater deep cohesion and lexical diversity. In the schizophrenia group, social problem-solving abilities did not correlate with linguistic variables but were associated with cognition. Findings highlight the relevance of psychotherapies which aim to promote recovery among individuals with psychosis through the construction of coherent life narratives and increasing agency and social connectedness.
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Affiliation(s)
- Nancy B Lundin
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA.
| | - Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA.
| | - Divnoor K Singh
- Department of Neuroscience, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA; Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA.
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Minor KS, Lundin NB, Myers EJ, Fernández-Villardón A, Lysaker PH. Automated measures of speech content and speech organization in schizophrenia: Test-retest reliability and generalizability across demographic variables. Psychiatry Res 2023; 320:115048. [PMID: 36645988 DOI: 10.1016/j.psychres.2023.115048] [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: 09/13/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
Technological advances in artificial intelligence and natural language processing have increased efficiency of assessing speech content and speech organization in schizophrenia. Despite these developments, there has been little focus on the psychometrics of these approaches. Using two common assessments, the current study addressed this gap by: 1) measuring test-retest reliability; and 2) assessing whether speech content and/or speech organization generalize across demographics. To test these aims, we examined psychometric properties of the Linguistic Inquiry Word Count (LIWC), a speech content measure, and the Coh-Metrix, a speech organization measure. Across baseline to six month (n = 101) and baseline to one year (n = 47) narrative speech samples, we generally observed fair reliability for speech content measures and fair to good reliability for speech organization measures. Regarding demographics, multiple speech indices varied by race, income, and education. The lack of excellent reliability scores for speech indices holds important implications for examining speech variables in clinical trials and highlights the dynamic nature of speech. This work illustrates the importance of designing speech content and speech organization measures with external validity across demographic factors. Future studies examining speech in schizophrenia should account for potential biases against demographic groups introduced by linguistic analysis tools.
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Affiliation(s)
- Kyle S Minor
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States.
| | - Nancy B Lundin
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - Evan J Myers
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States
| | | | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, United States; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
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Zhou Q, Pu CC, Huang BJ, Miao Q, Zhou TH, Cheng Z, Gao TQ, Shi C, Yu X. Optimal cutoff scores of the Chinese version of 15-item negative symptom assessment that indicate prominent negative symptoms of schizophrenia. Front Psychiatry 2023; 14:1154459. [PMID: 37139322 PMCID: PMC10149848 DOI: 10.3389/fpsyt.2023.1154459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Objective The Chinese version of 15-item negative symptom assessment (NSA-15) is an instrument with a three-factor structure specifically validated for assessing negative symptoms of schizophrenia. To provide a reference for future practical applications in the recognition of schizophrenia patients with negative symptoms, this study aimed to determine an appropriate NSA-15 cutoff score regarding negative symptoms to identify prominent negative symptoms (PNS). Methods A total of 199 participants with schizophrenia were recruited and divided into the PNS group (n = 79) and non-PNS group (n = 120) according to scale for assessment of negative symptoms (SANS) scores. Receiver-operating characteristic (ROC) curve analysis was used to determine the optimal NSA-15 cutoff score for identifying PNS. Results The optimal cutoff NSA-15 score for identifying PNS was 40. Communication, emotion and motivation factors in the NSA-15 had cutoffs of 13, 6, and 16, respectively. The communication factor score had slightly better discrimination than scores on the other two factors. The discriminant ability of the global rating of the NSA-15 was not as good as that of the NSA-15 total score (area under the curve (AUC): 0.873 vs. 0.944). Conclusion The optimal NSA-15 cutoff scores for identifying PNS in schizophrenia were determined in this study. The NSA-15 provides a convenient and easy-to-use assessment for identifying patients with PNS in Chinese clinical situations. The communication factor of the NSA-15 also has excellent discrimination.
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Affiliation(s)
- Qi 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
| | - Cheng-cheng 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
| | - Bing-jie 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
| | - Qi Miao
- Shandong Mental Health Center, Shandong University, Jinan, China
| | - Tian-hang 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
| | - Zhang Cheng
- 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
| | - Tian-Qi 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
| | - 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
- *Correspondence: Chuan Shi, ; Xin Yu,
| | - 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
- *Correspondence: Chuan Shi, ; Xin Yu,
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Lysaker PH, Holm T, Kukla M, Wiesepape C, Faith L, Musselman A, Lysaker JT. Psychosis and the challenges to narrative identity and the good life: Advances from research on the integrated model of metacognition. JOURNAL OF RESEARCH IN PERSONALITY 2022. [DOI: 10.1016/j.jrp.2022.104267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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8
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Larsen EM, Donaldson KR, Jonas KG, Lian W, Bromet EJ, Kotov R, Mohanty A. Pleasant and unpleasant odor identification ability is associated with distinct dimensions of negative symptoms transdiagnostically in psychotic disorders. Schizophr Res 2022; 248:183-193. [PMID: 36084492 PMCID: PMC10774004 DOI: 10.1016/j.schres.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/12/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
Negative symptoms are among the greatest sources of functional impairment for individuals with schizophrenia, yet their mechanisms remain poorly understood. Olfactory impairment is associated with negative symptoms. The processing of pleasant olfactory stimuli is subserved by reward-related neural circuitry while unpleasant olfactory processing is subserved by emotion-related neural circuitry, suggesting that these two odor dimensions may offer a window into differential mechanisms of negative symptoms. We examined whether pleasant and unpleasant odor identification bears differential relationships with avolition and inexpressivity dimensions of negative symptoms, whether these relationships are transdiagnostic, and whether pleasant and unpleasant odor processing also relate differently to other domains of functioning in a sample of individuals diagnosed with schizophrenia (N = 54), other psychotic disorders (N = 65), and never-psychotic adults (N = 160). Hierarchical regressions showed that pleasant odor identification was uniquely associated with avolition, while unpleasant odor identification was uniquely associated with inexpressivity. These relationships were largely transdiagnostic across groups. Additionally, pleasant and unpleasant odor identification displayed signs of specificity with other functional and cognitive measures. These results align with past work suggesting dissociable pathomechanisms of negative symptoms and provide a potential avenue for future work using valence-specific olfactory dysfunction as a semi-objective and low-cost marker for understanding and predicting the severity of specific negative symptom profiles.
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Affiliation(s)
- Emmett M. Larsen
- Department of Psychology, Stony Brook University, Stony Brook, NY
| | | | - Katherine G. Jonas
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY
| | - Wenxuan Lian
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY
| | - Aprajita Mohanty
- Department of Psychology, Stony Brook University, Stony Brook, NY
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Pillny M, Krkovic K, Buck L, Lincoln TM. From Memories of Past Experiences to Present Motivation? A Meta-analysis on the Association Between Episodic Memory and Negative Symptoms in People With Psychosis. Schizophr Bull 2022; 48:307-324. [PMID: 34635918 PMCID: PMC8886596 DOI: 10.1093/schbul/sbab120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Based on findings from cognitive science, it has been theorized that the reductions in motivation and goal-directed behavior in people with psychosis could stem from impaired episodic memory. In the current meta-analysis, we investigated this putative functional link between episodic memory deficits and negative symptoms. We hypothesized that episodic memory deficits in psychosis would be related to negative symptoms in general but would be more strongly related to amotivation than to reduced expressivity. We included 103 eligible studies (13,622 participants) in the analyses. Results revealed significant, moderate negative associations of episodic memory with negative symptoms in general (k = 103; r = -.23; z = -13.40; P ≤ .001; 95% CI [-.26; -.20]), with amotivation (k = 16; r = -.18; z = -6.6; P ≤ .001; 95% CI [-.23; -.13]) and with reduced expressivity (k = 15; r = -.18; z = -3.30; P ≤.001; 95% CI[-.29; -.07]). These associations were not moderated by sociodemographic characteristics, positive symptoms, depression, antipsychotic medication or type of negative symptom scale. Although these findings provide sound evidence for the association between episodic memory deficits and amotivation, the rather small magnitude and the unspecific pattern of this relationship also indicate that episodic memory deficits are unlikely to be the only factor relevant to amotivation. This implicates that future research should investigate episodic memory in conjunction with other factors that could account for the association of episodic memory deficits and amotivation in psychosis.
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Affiliation(s)
- Matthias Pillny
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Laura Buck
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Universität Hamburg, Hamburg, Germany
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10
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Swanson L, Schwannauer M, Bird T, Eliasson E, Millar A, Moritz S, Griffiths H. Metacognitive Training Modified for Negative Symptoms (MCT-N): A Feasibility study. Clin Psychol Psychother 2021; 29:1068-1079. [PMID: 34792834 DOI: 10.1002/cpp.2692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although patients often prioritise the treatment of negative symptoms, few psychological interventions targeting negative symptoms exist. This study attempts to fill this gap by piloting a modified Metacognitive training programme, specifically targeted at negative symptoms (MCT-N), with a group of patients with prominent negative symptoms. METHOD We adopted a mixed methods case series design, providing detailed quantitative data on changes over time, to focus on potential mechanisms underlying the intervention, in combination with qualitative interviews. RESULTS The intervention showed good feasibility as demonstrated by the attendance rate, the positive feedback from participants and the multidisciplinary team, and the improvements on negative symptoms observed following the intervention. Multilevel modelling showed that depression, internalised stigma, and reflective functioning explained the variance in negative symptoms. DISCUSSION The pilot study indicated that the intervention has high feasibility and that improvements in negative symptoms can be partially explained by improvements on depression, stigma, and reflective functioning.
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Affiliation(s)
- Linda Swanson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh.,NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh.,Region Sörmland, Sweden, Centre for Clinical Research Sörmland, Eskilstuna
| | - Matthias Schwannauer
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Tim Bird
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Emma Eliasson
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
| | - Audrey Millar
- NHS Lothian, UK, Psychology Department, Royal Edinburgh Hospital, Edinburgh
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Germany, Department of Psychiatry and Psychotherapy, Hamburg
| | - Helen Griffiths
- University of Edinburgh, UK, Section of Clinical and Health Psychology, School of Health in Social Science, Edinburgh
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11
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Deficits in access consciousness, integrative function, and consequent autonoetic thinking in schizophrenia. Med Hypotheses 2021; 155:110664. [PMID: 34425452 DOI: 10.1016/j.mehy.2021.110664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/09/2021] [Accepted: 08/10/2021] [Indexed: 11/23/2022]
Abstract
Alterations within consciousness in schizophrenia can be evidenced by impediments in self-awareness and loss of agency. Ned Block's definition of access consciousness is applied in order to further delineate cognitive deficits involving reflective thought and autonoetic thinking in persons with schizophrenia. Current theories on the nature and functioning of consciousness are discussed, which include Global Workspace Theory and metarepresentational characterizations. These describe a recursive, integrative quality to consciousness, contributed to by the functions of access consciousness, that is relevant in examining cognitive deficits in schizophrenia. The integrative deficit that is described as operating in conscious process involves a failure to incorporate prior outputs from a separate cognitive task and integrate these into a novel working schema. The alterations in access consciousness in persons with schizophrenia appear to be a consequence of disrupted integrative cognitive functions. An anteceding problem with cortical circuits involving integrative functions related to access consciousness is therefore hypothesized to manifest as subsequent cognitive dysfunction that leads to symptoms of schizophrenia. Constitutive failures to integrate information in schizophrenia could lead to an inability to create experiential unity and manage content in autonoetic consciousness. Some of the aberrant reasoning manifested by persons with schizophrenia, including problems with hierarchical relational reasoning, model-based-learning, J-con, ipseity, and source monitoring, could also reflect alterations in access consciousness, and their investigation offers additional approaches for scientific inquiry.
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12
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Lysaker PH, Chernov N, Moiseeva T, Sozinova M, Dmitryeva N, Alyoshin V, Luther L, Karpenko O, Kostyuk G. Clinical insight, cognitive insight and metacognition in psychosis: Evidence of mediation. J Psychiatr Res 2021; 140:1-6. [PMID: 34087750 DOI: 10.1016/j.jpsychires.2021.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/18/2021] [Accepted: 05/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Schizophrenia is increasingly understood as an interactive network of disturbances in different elements of self-awareness. In this study we have examined the relationship between disturbances in two forms of awareness: cognitive insight and clinical insight by exploring whether their relationship is mediated by a third form of larger awareness: metacognition. METHODS Participants were 41 outpatients with schizophrenia and 37 outpatients with early episode psychosis gathered in Moscow, Russia. Metacognition was assessed with the Metacognition Assessment Scale - Abbreviated. Verbal memory and positive symptoms were assessed for use as additional mediators. RESULTS Mediation analyses revealed that after accounting for the effects of positive symptoms and verbal memory, the relationship between the self-reflection domain of cognitive insight and clinical insight was significantly mediated by overall metacognitive capacity. Further, positive symptoms were a significant mediator between the cognitive insight self-reflection domain and clinical insight. Neither metacognition nor positive symptoms or verbal memory were found to mediate the relationship of the cognitive insight domain of self-certainty with clinical insight. CONCLUSIONS Decrements in some forms of ability to reflect upon one's thinking may reduce the ability to form complex and integrated ideas of oneself and others, leading to less coherent and complete accounts of the experience of schizophrenia.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, 116A, 1481 W. 10th Street, Indianapolis, IN, 46202, United States.
| | - Nikita Chernov
- Psychotherapy and Social Rehabilitation Department, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia; Mental-Health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Tatyana Moiseeva
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Marta Sozinova
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Nadezhda Dmitryeva
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia
| | - Vitaliy Alyoshin
- Medical Psychologist Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Lauren Luther
- Psychologist Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street Boston, MA, 02115, USA.
| | - Olga Karpenko
- Deputy Director of Education Center Mental-health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
| | - Georgiy Kostyuk
- Mental-Health Clinic, No1 Named After N.A. Alexeev, Zagorodnoye Shosse 2, Moscow, Russia.
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13
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Lysaker PH, Cheli S, Dimaggio G, Buck B, Bonfils KA, Huling K, Wiesepape C, Lysaker JT. Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs? BMC Psychiatry 2021; 21:329. [PMID: 34215225 PMCID: PMC8254212 DOI: 10.1186/s12888-021-03338-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/21/2021] [Indexed: 02/01/2023] Open
Abstract
Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised - as often occurs in psychosis - results in the loss of persons' sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.
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Affiliation(s)
- P H Lysaker
- Richard L Roudebush VA Medical Center, Department of Psychiatry, 1481 W. 10th St., Indianapolis, IN, 46202, USA. .,Department of Psychiatry, Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, USA.
| | - S Cheli
- University of Florence, School of Human Health Sciences, Piazza di San Marco, 4, 50121, Florence, FI, Italy
| | - G Dimaggio
- Terzocentro di Psicoterapia Cognitiva, Associazione di Psicologia Cognitiva, Via Ravenna, 9, 00161, Rome, RM, Italy
| | - B Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Behavioral Research in Technology and Engineering (BRiTE) Center, 1851 NE Grant Ln., Seattle, WA, 98185, USA
| | - K A Bonfils
- University of Southern Mississippi, School of Psychology, 118 College Dr., Hattiesbury, MS, 39406, USA
| | - K Huling
- University of Indianapolis, School of Psychological Sciences, 1400 E. Hanna Ave., Indianapolis, IN, 46277, USA
| | - C Wiesepape
- Indiana State University, Department of Psychology, 200 N. 7th St., Terre Haute, IN, 47809, USA
| | - J T Lysaker
- Department of Philosophy, Emory University, 201 Dowman Dr., Atlanta, GA, 30322, USA
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14
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Bonfils KA, Luther L, Lysaker PH. Metacognition & social cognition differentially influence experiential & expressive negative symptoms in schizophrenia. Schizophr Res 2021; 233:13-15. [PMID: 34216940 DOI: 10.1016/j.schres.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/14/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Kelsey A Bonfils
- The University of Southern Mississippi, School of Psychology, 118 College Dr., #5025, Hattiesburg, MS 39406, USA.
| | - Lauren Luther
- Massachusetts General Hospital, Department of Psychiatry, 149 13th Street, Room 2603, Charlestown, MA 02129, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Day Hospital 116H, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Suite 4800, Indianapolis, IN 46202, USA
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15
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Mørch-Johnsen L, Smelror RE, Andreou D, Barth C, Johannessen C, Wedervang-Resell K, Wortinger LA, Díaz R, Victoria G, Ueland T, Andreassen OA, Myhre AM, Rund BR, Ulloa RE, Agartz I. Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis. Front Psychiatry 2021; 12:825681. [PMID: 35069300 PMCID: PMC8777217 DOI: 10.3389/fpsyt.2021.825681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Early-onset psychosis (EOP) is among the leading causes of disease burden in adolescents. Negative symptoms and cognitive deficits predicts poorer functional outcome. A better understanding of the association between negative symptoms and cognitive impairment may inform theories on underlying mechanisms and elucidate targets for development of new treatments. Two domains of negative symptoms have been described in adult patients with schizophrenia: apathy and diminished expression, however, the factorial structure of negative symptoms has not been investigated in EOP. We aimed to explore the factorial structure of negative symptoms and investigate associations between cognitive performance and negative symptom domains in adolescents with EOP. We hypothesized that (1) two negative symptom factors would be identifiable, and that (2) diminished expression would be more strongly associated with cognitive performance, similar to adult psychosis patients. Methods: Adolescent patients with non-affective EOP (n = 169) were included from three cohorts: Youth-TOP, Norway (n = 45), Early-Onset Study, Norway (n = 27) and Adolescent Schizophrenia Study, Mexico (n = 97). An exploratory factor analysis was performed to investigate the underlying structure of negative symptoms (measured with the Positive and Negative Syndrome Scale (PANSS)). Factor-models were further assessed using confirmatory factor analyses. Associations between negative symptom domains and six cognitive domains were assessed using multiple linear regression models controlling for age, sex and cohort. The neurocognitive domains from the MATRICS Consensus Cognitive Battery included: speed of processing, attention, working memory, verbal learning, visual learning, and reasoning and problem solving. Results: The exploratory factor analysis of PANSS negative symptoms suggested retaining only a single factor, but a forced two factor solution corroborated previously described factors of apathy and diminished expression in adult-onset schizophrenia. Results from confirmatory factor analysis indicated a better fit for the two-factor model than for the one-factor model. For both negative symptom domains, negative symptom scores were inversely associated with verbal learning scores. Conclusion: The results support the presence of two domains of negative symptoms in EOP; apathy and diminished expression. Future studies on negative symptoms in EOP should examine putative differential effects of these symptom domains. For both domains, negative symptom scores were significantly inversely associated with verbal learning.
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Affiliation(s)
- Lynn Mørch-Johnsen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry and Department of Clinical Research, Østfold Hospital, Grålum, Norway
| | - Runar Elle Smelror
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Claudia Barth
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Cecilie Johannessen
- Department of Neurohabilitation, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kirsten Wedervang-Resell
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura A Wortinger
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ricardo Díaz
- Research Department, Arete Proyectos y Administración, Mexico City, Mexico
| | - Gamaliel Victoria
- Planning of Prevention Programs in the Directorate of Integral Attention to Girls, Boys and Adolescents, System for the Integral Development of the Family, Mexico City, Mexico
| | - Torill Ueland
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway
| | - Anne M Myhre
- Division of Mental Health and Addiction, Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway.,Research Department, Vestre Viken Hospital Trust, Drammen, Norway
| | - Rosa Elena Ulloa
- Developmental Psychopharmacology at the Research Division, Child Psychiatric Hospital, Mexico City, Mexico
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Institute of Clinical Medicine, K.G. Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
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