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Jagtap S, Best MW. Examining the influence of self-referential thinking on aberrant salience and jumping to conclusions bias in individuals with schizophrenia-spectrum disorders. J Behav Ther Exp Psychiatry 2024; 83:101935. [PMID: 38064876 DOI: 10.1016/j.jbtep.2023.101935] [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: 06/09/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Cognitive processes such as aberrant salience and the jumping to conclusions (JTC) bias are implicated in the development of delusions. Self-referential thinking is implicated in this process; however, it is unknown how it may interact with aberrant salience and JTC bias in individuals with schizophrenia-spectrum disorders (SSDs). This study examined associations of self-referential thinking with aberrant salience, JTC bias, and delusion severity, and whether self-referential stimuli led to an increase in aberrant salience and JTC bias in SSDs (n = 20) relative to psychiatrically healthy controls (n = 20). METHODS To assess aberrant salience and JTC bias, participants were asked to complete both self-referential and neutral versions of the Salience Attribution Test (SAT) and the Beads Task, as well as self-report measures of aberrant salience and JTC bias. RESULTS Self-referential task condition interacted with clinical group to predict JTC beads task scores, such that participants with SSDs exhibited greater levels of JTC bias than psychiatrically healthy controls during the neutral task condition, when controlling for levels of motivation, cognitive insight, and functioning. Self-referential thinking was significantly associated with aberrant salience, JTC bias, and delusion severity. LIMITATIONS This experiment examined trait-level relationships between variables, so does not provide information about state-level interrelationships and would benefit from replication using more dynamic methods such as ecological momentary assessment. CONCLUSIONS These findings highlight the interrelationships between self-referential thinking, JTC bias, aberrant salience, and delusion severity, in individuals with SSDs, and support the interactive role of self-referential thinking in predicting JTC bias.
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Affiliation(s)
- Shreya Jagtap
- Department of Psychological Clinical Science, University of Toronto Scarborough, Canada; Centre for Addiction and Mental Health, Canada
| | - Michael W Best
- Department of Psychological Clinical Science, University of Toronto Scarborough, Canada; Centre for Addiction and Mental Health, Canada; Ontario Shores Centre for Mental Health Sciences, Canada.
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2
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Martinelli A, Moncalieri G, Zamparini M, Alessandri G, Vittorio Caprara G, Castelnuovo G, Rocchetti M, Starace F, Zarbo C, de Girolamo G. Positivity, daily time use, mood, and functioning in patients with schizophrenia spectrum disorders: Results from the diapason multicentric study. Int J Soc Psychiatry 2024; 70:319-329. [PMID: 38054430 PMCID: PMC10913309 DOI: 10.1177/00207640231212868] [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] [Indexed: 12/07/2023]
Abstract
BACKGROUND Positivity (POS) indicates the proclivity to see life and experiences in a positive light. There is limited research on its effects on individuals with Schizophrenia Spectrum Disorders (SSD). Very little is known about the relationship between POS and daily activities in people with SSD. AIM The study aims to compare the POS rated by patients with SSD with those obtained in an Italian normative sample matched by age and sex and to use the Ecological Momentary Assessment (EMA) to investigate the association between POS and daily time use (i.e. productive activities, leisure activities), functioning and mood in individuals with SSD. METHOD 620 SSD patients were recruited from mental health services in Italy as part of the DiAPAson project. POS, symptom severity, functioning, and quality of life (QoL) were assessed. POS scores were compared to a normative sample of 5,002 Italian citizens. Additionally, a subset of 102 patients underwent 7-day assessments using mobile EMA. RESULTS People with SSD did not significantly differ from the Italian normative sample in POS levels (0.035, p = .190). POS showed a significant inverse association with support network (-0.586, p = .036) and symptomatology (BPRS -0.101; 95% p < .001; BNSS B = -0.113, p < .001). A significant direct association was found between POS and QoL (B = 0.310, p < .001) and functioning (B = 0.058, p < .001). In the subsample using EMA, POS ratings showed significant associations with Positive Emotions (B = 0.167, p < .001) and Negative Emotions (B = -0.201, p < .001). CONCLUSION People with SSD exhibited comparable levels of POS to the normative sample. Higher POS was linked to better functioning, QoL, fewer severe symptoms, and increased positive emotions. However, it did not relate to increased productivity or engagement in leisure activities. Further research is needed to understand the relationship between POS and time use in individuals with SSD.
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Affiliation(s)
- Alessandra Martinelli
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giulia Moncalieri
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | | | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Cristina Zarbo
- Department of Psychology, University of Milan Bicocca, Milan, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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3
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Dlagnekova A, Van Staden W. The validity of a therapeutic invigoration task in avolitional schizophrenia outpatients. J Clin Psychol 2024; 80:7-22. [PMID: 37367206 DOI: 10.1002/jclp.23562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/01/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Avolition is associated with much morbidity and functional impairment in schizophrenia patients. Vigor may be taken as, in part, the inverse of avolition, but it has not been investigated as a therapeutic pursuit before. To this end, a therapeutic invigoration task was developed drawing on cognitive-behavioral and guided imagery therapies. This study investigated the validity and reliability of a therapeutic invigoration task in avolitional residual phase schizophrenia outpatients. METHODS In a proof-of-concept quasi-experimental one-group sequentially repeated pretest/posttest study design, patients (n = 76) participated in a structured invigoration task that was repeated after 1 month (n = 70). RESULTS Patients' vigor during the preceding 7 days measured on the Vigor Assessment Scale increased highly significantly in anticipation of the subsequent 7 days on both occasions with respectively very large (Cohen's δ with Hedges' correction [δ] = 1.46) and large (δ = 1.04) effect sizes. The anticipated vigor after the first occasion was partially consummated during the subsequent month in that vigor during the 7 days preceding the second occasion was lower than participants had anticipated but still significantly higher than at baseline (p < 0.001; δ = 0.70). Repeating the task a month later, together with homework, had a cumulative effect as indicated by a very large effect size (δ = 1.61). CONCLUSION Results suggest that the invigoration task did what it was supposed do, and did so consistently, in patients with avolitional residual schizophrenia. These results warrant a subsequent randomized controlled trial to establish the efficacy of the invigoration task.
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Affiliation(s)
- Antonia Dlagnekova
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
- Centre for Ethics and Philosophy of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Werdie Van Staden
- Centre for Ethics and Philosophy of Health Sciences, University of Pretoria, Pretoria, South Africa
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4
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Saperia S, Felsky D, Da Silva S, Siddiqui I, Rector N, Remington G, Zakzanis KK, Foussias G. Modeling Effort-Based Decision Making: Individual Differences in Schizophrenia and Major Depressive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1041-1049. [PMID: 37290745 DOI: 10.1016/j.bpsc.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND A critical facet of motivation is effort-based decision making, which refers to the mental processes involved in deciding whether a potential reward is worth the effort. To advance understanding of how individuals with schizophrenia and major depressive disorder utilize cost-benefit information to guide choice behavior, this study aimed to characterize individual differences in the computations associated with effort-based decision making. METHODS One hundred forty-five participants (51 with schizophrenia, 43 with depression, and 51 healthy control participants) completed the Effort Expenditure for Rewards Task, with mixed effects modeling conducted to estimate the predictors of decision making. These model-derived, subject-specific coefficients were then clustered using k-means to test for the presence of discrete transdiagnostic subgroups with different profiles of reward, probability, and cost information utilization during effort-based decision making. RESULTS An optimal 2-cluster solution was identified, with no significant differences in the distribution of diagnostic groups between clusters. Cluster 1 (n = 76) was characterized by overall lower information utilization during decision making than cluster 2 (n = 61). Participants in this low information utilization cluster were also significantly older and more cognitively impaired, and their utilization of reward, probability, and cost was significantly correlated with clinical amotivation, depressive symptoms, and cognitive functioning. CONCLUSIONS Our findings revealed meaningful individual differences among participants with schizophrenia, depression, and healthy control participants in their utilization of cost-benefit information in the context of effortful decision making. These findings may provide insight into different processes associated with aberrant choice behavior and may potentially guide the identification of more individualized treatment targets for effort-based motivation deficits across disorders.
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Affiliation(s)
- Sarah Saperia
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada; Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel Felsky
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Centre for Neuroinformatics and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Susana Da Silva
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ishraq Siddiqui
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Neil Rector
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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5
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Strauss GP, Walker EF, Pelletier-Baldelli A, Carter NT, Ellman LM, Schiffman J, Luther L, James SH, Berglund AM, Gupta T, Ristanovic I, Mittal VA. Development and Validation of the Negative Symptom Inventory-Psychosis Risk. Schizophr Bull 2023; 49:1205-1216. [PMID: 37186040 PMCID: PMC10483448 DOI: 10.1093/schbul/sbad038] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND HYPOTHESES Early identification and prevention of psychosis is limited by the availability of tools designed to assess negative symptoms in those at clinical high-risk for psychosis (CHR). To address this critical need, a multi-site study was established to develop and validate a clinical rating scale designed specifically for individuals at CHR: The Negative Symptom Inventory-Psychosis Risk (NSI-PR). STUDY DESIGN The measure was developed according to guidelines recommended by the NIMH Consensus Conference on Negative Symptoms using a transparent, iterative, and data-driven process. A 16-item version of the NSI-PR was designed to have an overly inclusive set of items and lengthier interview to support the ultimate intention of creating a new briefer measure. Psychometric properties of the 16-item NSI-PR were evaluated in a sample of 218 CHR participants. STUDY RESULTS Item-level analyses indicated that men had higher scores than women. Reliability analyses supported internal consistency, inter-rater agreement, and temporal stability. Associations with measures of negative symptoms and functioning supported convergent validity. Small correlations with positive, disorganized, and general symptoms supported discriminant validity. Structural analyses indicated a 5-factor structure (anhedonia, avolition, asociality, alogia, and blunted affect). Item response theory identified items for removal and indicated that the anchor range could be reduced. Factor loadings, item-level correlations, item-total correlations, and skew further supported removal of certain items. CONCLUSIONS These findings support the psychometric properties of the NSI-PR and guided the creation of a new 11-item NSI-PR that will be validated in the next phase of this multi-site scale development project.
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Affiliation(s)
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | | | - Nathan T Carter
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Lauren M Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California- Irvine, Irvine, CA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Sydney H James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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6
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Moses DG, Palaniappan P, Ponraj PC. Residual experiential symptoms mediate the effect of expressive symptoms over the social functioning in remitted schizophrenia. Ind Psychiatry J 2023; 32:309-316. [PMID: 38161473 PMCID: PMC10756619 DOI: 10.4103/ipj.ipj_30_23] [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: 02/09/2023] [Accepted: 02/23/2023] [Indexed: 01/03/2024] Open
Abstract
Context Impairment in social functioning had been consistently found in remitted schizophrenia; yet, predictors of social dysfunction had been hardly explored and intervention trials had rarely included remitted schizophrenia. Methods 60 subjects with schizophrenia (diagnosed based on DSM5), currently in remission (SAPS and SANS global rating ≤2, for a minimum period of 12 weeks) and 46 age and gender-matched healthy controls were recruited after obtaining informed consent. The socio-demographic details, illness characteristics, depressive symptoms, positive and negative symptoms [using Scale for assessment of positive symptoms (SAPS), and scale for assessment of negative symptoms (SANS)] were assessed. The Theory of Mind (ToM) score was derived from the ToM tasks of a culturally validated tool, Social Cognition Rating Tools in Indian Setting. The social functioning was assessed using Groningen social disabilities schedule II (GSDSSII). Results The mean SAPS summary and SANS summary scores were 3.01 ± 2.99 and 4.32 ± 2.94, respectively. The social functioning was significantly impaired in remitted schizophrenia when compared to healthy controls. In the hierarchical regression, experiential dimension (β =1.941, t = 6.097, P < 0.001), followed by expressive dimension predicted social functioning (explained 70.5% of variance) after controlling for confounders. On mediation analysis, the effect of expressive dimension over the social functioning was significantly mediated by experiential dimension (E = 1.1821, Boot SE = 0.2895, C.I: 0.6934 to 1.7862). Conclusion The experiential dimension mediates the effect of expressive dimension over the social dysfunction in remitted schizophrenia. Future studies should focus on targeting the experiential dimension and thereby social functioning.
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Affiliation(s)
- Dinesh G. Moses
- Department of Psychiatry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Pradeep Palaniappan
- Department of Psychiatry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Pratap Chander Ponraj
- Department of Psychiatry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
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7
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Ramos-Mastache D, Mondragón-Maya A, Liemburg EJ, Enriquez-Geppert S, Goerlich KS, Rosel-Vales M, Pérez-Ferrara D, Jansari AS, Aleman A. Understanding the relationship between apathy, cognition and functional outcome in schizophrenia: The significance of an ecological assessment. PLoS One 2022; 17:e0277047. [PMID: 36327293 PMCID: PMC9632867 DOI: 10.1371/journal.pone.0277047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
In recent years there has been an increasing interest in understanding the role apathy plays in mediating the relationship between cognitive impairment and functional outcome. In general, most studies measure cognition with traditional cognitive tests that give explicit instructions and guide the participants toward generating a response. However, given that apathy is defined by a decrease in self-initiated behavior, it is crucial to evaluate cognition with ecological tasks that do not explicitly direct the patient´s motivation to generate behaviors to assess the actual effect. This study investigated whether an ecological cognitive assessment (the Jansari Executive Function Assessment, JEF©) would uniquely contribute to the relationship between cognition, apathy, and functional outcome in schizophrenia. The Apathy Evaluation Scale (AES), neuropsychological tests and the JEF© were administered to 20 patients with schizophrenia. Hierarchical multiple regression and mediation analysis were performed to test the associations between the variables of interest. Results showed that JEF© explained a significant portion of the variance in AES (25%). In addition, apathy explained 36% of the variance in functional outcome. However, AES did not mediate between cognition and functional outcome. Our results highlight the importance of assessing cognition with tasks that require integration of cognitive functions needed for real life demands.
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Affiliation(s)
- Daniela Ramos-Mastache
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlanepantla de Baz, Estado de México, México
| | - Alejandra Mondragón-Maya
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlanepantla de Baz, Estado de México, México
- * E-mail:
| | - Edith J. Liemburg
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Stefanie Enriquez-Geppert
- Department of Developmental and Clinical Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Katharina S. Goerlich
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - Mauricio Rosel-Vales
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - David Pérez-Ferrara
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlanepantla de Baz, Estado de México, México
| | - Ashok S. Jansari
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Andre Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- Shenzhen Key Laboratory of Affective and Social Neuroscience, Center for Brain Disorders and Cognitive Sciences, Shenzhen University, Shenzhen, China
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Siddiqui I, Remington G, Saperia S, Da Silva S, Fletcher PJ, Voineskos AN, Zakzanis KK, Foussias G. Behavioural phenotypes of intrinsic motivation in schizophrenia determined by cluster analysis of objectively quantified real-world performance. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:85. [PMID: 36271094 PMCID: PMC9587030 DOI: 10.1038/s41537-022-00294-0] [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] [Received: 10/07/2021] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
Intrinsic motivation deficits are a prominent feature of schizophrenia that substantially impacts functional outcome. This study used cluster analysis of innate real-world behaviours captured during two open-field tasks to dimensionally examine heterogeneity in intrinsic motivation in schizophrenia patients (SZ) and healthy controls (HC). Wireless motion capture quantified participants' behaviours aligning with distinct aspects of intrinsic motivation: exploratory behaviour and effortful activity in the absence of external incentive. Cluster analysis of task-derived measures identified behaviourally differentiable subgroups, which were compared across standard clinical measures of general amotivation, cognition, and community functioning. Among 45 SZ and 47 HC participants, three clusters with characteristically different behavioural phenotypes emerged: low exploration (20 SZ, 19 HC), low activity (15 SZ, 8 HC), and high exploration/activity (10 SZ, 20 HC). Low performance in either dimension corresponded with similar increased amotivation. Within-cluster discrepancies emerged for amotivation (SZ > HC) within the low exploration and high performance clusters, and for functioning (SZ < HC) within all clusters, increasing from high performance to low activity to low exploration. Objective multidimensional characterization thus revealed divergent behavioural expression of intrinsic motivation deficits that may be conflated by summary clinical measures of motivation and overlooked by unidimensional evaluation. Deficits in either aspect may hinder general motivation and functioning particularly in SZ. Multidimensional phenotyping may help guide personalized remediation by discriminating between intrinsic motivation impairments that require amelioration versus unimpaired tendencies that may facilitate remediation.
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Affiliation(s)
- Ishraq Siddiqui
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Gary Remington
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Sarah Saperia
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto Scarborough, Toronto, ON Canada
| | - Susana Da Silva
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Paul J. Fletcher
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto, Toronto, ON Canada
| | - Aristotle N. Voineskos
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Konstantine K. Zakzanis
- grid.17063.330000 0001 2157 2938Department of Psychology, University of Toronto Scarborough, Toronto, ON Canada
| | - George Foussias
- grid.155956.b0000 0000 8793 5925Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
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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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10
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Moe AM, Weiss DM, Pine JG, Wastler HM, Breitborde NJK. Social motivation and behavior in first-episode psychosis: Unique contributions to social quality of life and social functioning. J Psychiatr Res 2021; 144:441-447. [PMID: 34749220 PMCID: PMC8667854 DOI: 10.1016/j.jpsychires.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Social functioning is diminished among people early in the course of psychotic illnesses, and is likely influenced by the negative symptoms that accompany these disorders, including changes in motivation and experience of pleasure. Though social impairments have a deleterious impact on functioning, socialization is a multifaceted behavior and little is known about how the various aspects may influence social functioning and social quality of life among people with first-episode psychosis. In the present study, we investigated the associations of specific aspects of social motivation and behavior with social functioning and social quality of life in a group of 54 young people (aged 15 to 35) with first-episode psychosis. Though different aspects of social motivation and behavior correlated positively with one another, social motivation for peer interactions was uniquely associated with social functioning and social quality of life - including when a broad measure of negative symptoms was considered within the same model. When these same associations were examined longitudinally, social motivation for peer interactions again emerged as a unique predictor of change in social functioning over 6 months. Our results suggest that the unique contribution of aspects of social motivation has implications for treatment, including the importance of developmentally-informed interventions to improve peer socialization in youth and young adults with psychosis.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychology, The Ohio State University, USA.
| | - David M Weiss
- Department of Psychology, The Ohio State University, USA
| | - Jacob G Pine
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Heather M Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychology, The Ohio State University, USA
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11
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Wong SCY, Chang WC, Hui CLM, Chan SKW, Lee EHM, Suen YN, Chen EYH. Relationship of subjective quality of life with symptomatology, neurocognition and psychosocial functioning in first-episode psychosis: a structural equation modelling approach. Eur Arch Psychiatry Clin Neurosci 2021; 271:1561-1569. [PMID: 34304302 DOI: 10.1007/s00406-021-01309-0] [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] [Received: 08/09/2020] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Subjective quality of life (SQoL) represents an important outcome of psychotic disorders. However, determinants of SQoL and their complex inter-relationships in the early course of illness remain to be clarified. Association between neurocognitive impairment and SQoL in first-episode psychosis (FEP) is understudied. This study employed structural equation modeling (SEM) to examine relationships among SQoL, depressive, positive and negative symptoms, neurocognition, and psychosocial functioning in FEP patients. Three hundred and forty-seven patients aged 25-55 years presenting with FEP to early intervention program in Hong Kong were recruited. Assessment encompassing symptom profiles, psychosocial functioning and a battery of neurocognitive tests were conducted. SF-12 mental component summary scores were computed as the primary measure of SQoL. Our correlation analyses revealed differential relationships between negative symptom subdomains and SQoL, with amotivation, but not diminished expression, being related to SQoL. Final SEM model yielded a good model fit (comparative fix index = 0.94; root mean square error of approximation = 0.05; standardized root mean square residuals = 0.07) and demonstrated that depression, positive symptoms and psychosocial functioning were directly associated with SQoL, with depression showing the strongest effect. Amotivation, neurocognition and positive symptoms had an indirect effect on SQoL via the mediation of psychosocial functioning. This study affirms depression as a critical determinant of subjective mental wellbeing, and underscores an intermediary role of psychosocial functioning in linking amotivation, neurocognitive impairment and positive symptoms to SQoL in FEP patients. Depression and functional impairment thus constitute as crucial therapeutic targets for improvement of SQoL in the early illness stage.
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Affiliation(s)
- Sandra Chi Yiu Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong. .,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Christy Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
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12
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Büki A, Bohár Z, Kekesi G, Vécsei L, Horvath G. Wisket rat model of schizophrenia: Impaired motivation and, altered brain structure, but no anhedonia. Physiol Behav 2021; 244:113651. [PMID: 34800492 DOI: 10.1016/j.physbeh.2021.113651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 01/17/2023]
Abstract
It is well-known that the poor cognition in schizophrenia is strongly linked to negative symptoms, including motivational deficit, which due to, at least partially, anhedonia. The goal of this study was to explore whether the schizophrenia-like Wisket animals with impaired motivation (obtained in the reward-based hole-board test), also show decreased hedonic behavior (investigated with the sucrose preference test). While neurochemical alterations of different neurotransmitter systems have been detected in the Wisket rats, no research has been performed on structural changes. Therefore, our additional aim was to reveal potential neuroanatomical and structural alterations in different brain regions in these rats. The rats showed decreased general motor activity (locomotion, rearing and exploration) and impaired task performance in the hole-board test compared to the controls, whereas no significant difference was observed in the sucrose preference test between the groups. The Wisket rats exhibited a significant decrease in the frontal cortical thickness and the hippocampal area, and moderate increases in the lateral ventricles and cell disarray in the CA3 subfield of hippocampus. To our knowledge, this is the first study to investigate the hedonic behavior and neuroanatomical alterations in a multi-hit animal model of schizophrenia. The results obtained in the sucrose preference test suggest that anhedonic behavior might not be involved in the impaired motivation obtained in the hole-board test. The neuropathological changes agree with findings obtained in patients with schizophrenia, which refine the high face validity of the Wisket model.
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Affiliation(s)
- Alexandra Büki
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., Szeged, H-6720, Hungary.
| | - Zsuzsanna Bohár
- MTA-SZTE Neuroscience Research Group, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Gabriella Kekesi
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., Szeged, H-6720, Hungary
| | - László Vécsei
- MTA-SZTE Neuroscience Research Group, Semmelweis u. 6, Szeged, H-6725, Hungary; Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., Szeged, H-6725, Hungary; Interdisciplinary Excellence Center, Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., Szeged, H-6725 Hungary
| | - Gyongyi Horvath
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., Szeged, H-6720, Hungary
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13
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Dlagnekova A, van Staden W, Masenge A. Validity and reliability of the Vigour Assessment Scale in avolitional schizophrenia outpatients. Schizophr Res 2021; 235:36-43. [PMID: 34304145 DOI: 10.1016/j.schres.2021.07.018] [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] [Received: 03/30/2020] [Revised: 02/22/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
A few items of existing schizophrenia scales measure avolition, but no research has been reported on vigour in schizophrenia, including whether avolition would be more or less the inverse of vigour. Such research requires a valid and reliable measure of vigour. In the absence of this, this study developed and examined the validity and the reliability of the Vigour Assessment Scale (VAS) among 242 avolitional schizophrenia outpatients in relation to measures of workplace vigour, behavioral inhibition and activation, procrastination, fatigue, anxiety, depressive features, and active involvement in personal growth. Convergent validity was found in moderate to strong correlations (r = 0.5 to 0.714) between the VAS and measures approximate to vigour. Discriminant validity was found in lower and/or inverse correlations with depression (r = -0.423), anxiety (r = -0.279), behaviour inhibition (r = -0.045), procrastination (r = -0.656), and fatigue (r = -0.684). Internal consistency was good with Cronbach's alpha coefficients above 0.8, and strong correlations for split-half (r = 0.71) and test-retest (r = 0.77) reliability. The standard error of measurement was seven on a scale of 145 points. An exploratory factor analysis yielded a 27-item version with a six-factor structure accounting for 61.9% of the cumulative variance. These results suggest that the VAS is a valid and reliable instrument in avolitional schizophrenia outpatients, suitable for use in further research on vigour and when vigour is pursued therapeutically or in efficacy studies. Subject to further validation, the VAS may be used in other clinical populations (e.g., in depression) and healthy populations where vigour may be pursued as a desirable attribute.
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Affiliation(s)
| | - Werdie van Staden
- Department of Psychiatry, University of Pretoria, South Africa; Centre for Ethics and Philosophy of Health Sciences, University of Pretoria, South Africa.
| | - Andries Masenge
- Department of Statistics, University of Pretoria, South Africa
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14
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Remington G, Hahn MK, Agarwal SM, Chintoh A, Agid O. Schizophrenia: Antipsychotics and drug development. Behav Brain Res 2021; 414:113507. [PMID: 34352293 DOI: 10.1016/j.bbr.2021.113507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 12/21/2022]
Abstract
The introduction of chlorpromazine and the work that ensued provided the foundation to reposition schizophrenia as a biological illness. The present paper follows the evolution of antipsychotics and their shift from 'typical' to 'atypical'. Atypicality is reviewed in reference to its original definition, clozapine's role, and developments that now leave the concept's utility in question. In a similar fashion, drug development is reviewed in the context of the illness' multiple symptom domains, as well as differences captured by clinical staging and phenotyping. Collectively, the evidence argues for a more nuanced approach to drug development that aligns with the illness' heterogeneity and complexity. Just as 'atypical' as a descriptor for antipsychotics may be outdated, it may be time to set aside the notion of developing drugs that treat 'schizophrenia'.
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Affiliation(s)
- Gary Remington
- University of Toronto, Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
| | - Margaret K Hahn
- University of Toronto, Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Sri Mahavir Agarwal
- University of Toronto, Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Araba Chintoh
- University of Toronto, Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Ofer Agid
- University of Toronto, Department of Psychiatry, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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15
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Strauss GP, Bartolomeo LA, Harvey PD. Avolition as the core negative symptom in schizophrenia: relevance to pharmacological treatment development. NPJ SCHIZOPHRENIA 2021; 7:16. [PMID: 33637748 PMCID: PMC7910596 DOI: 10.1038/s41537-021-00145-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
Negative symptoms have long been considered a core component of schizophrenia. Modern conceptualizations of the structure of negative symptoms posit that there are at least two broad dimensions (motivation and pleasure and diminished expression) or perhaps five separable domains (avolition, anhedonia, asociality, blunted affect, alogia). The current review synthesizes a body of emerging research indicating that avolition may have a special place among these dimensions, as it is generally associated with poorer outcomes and may have distinct neurobiological mechanisms. Network analytic findings also indicate that avolition is highly central and interconnected with the other negative symptom domains in schizophrenia, and successfully remediating avolition results in global improvement in the entire constellation of negative symptoms. Avolition may therefore reflect the most critical treatment target within the negative symptom construct. Implications for targeted treatment development and clinical trial design are discussed.
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Affiliation(s)
| | | | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Khan WU, Ghazala Z, Brooks HJ, Subramaniam P, Mulsant BH, Kumar S, Voineskos AN, Blumberger DM, Kern RS, Rajji TK. The Impact of Anticholinergic Burden on Functional Capacity in Persons With Schizophrenia Across the Adult Life Span. Schizophr Bull 2021; 47:249-257. [PMID: 32619225 PMCID: PMC7825090 DOI: 10.1093/schbul/sbaa093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Anticholinergic burden (ACB) from medications impairs cognition in schizophrenia. Cognition is a predictor of functional capacity; however, little is known about ACB effect on functional capacity in this population. This study assesses the relationship between ACB and functional capacity across the life span in individuals with schizophrenia after controlling for ACB effect on cognition. A cross-sectional analysis was performed with data collected from 6 academic tertiary health centers. Two hundred and twenty-three community-dwelling participants with schizophrenia or schizoaffective disorder were included in this study. Main variables were ACB, antipsychotic olanzapine equivalents, functional capacity, cognition, and negative symptoms. Simultaneous linear regression analyses were performed to assess the association between ACB, functional capacity, and cognition and then between ACB and cognition. A mediation analysis was then performed to examine whether cognition mediated ACB effect on functional capacity if there was an association between ACB and cognition. Mean age of participants was 49.0 years (SD = 13.1, range 19-79), and 63.7% of participants had severe ACB, ie, a total score of 3 or above. Regression analyses revealed that ACB, age, education, and cognition independently predicted functional capacity and that ACB predicted cognition among those aged 55 years and older. Mediation analysis showed that cognition did partially mediate the effect of ACB on functional capacity in this older cohort. In conclusion, people with schizophrenia are exposed to severe ACB that can have a direct negative impact on functional capacity after controlling for its impact on cognition. Reducing ACB could improve functional capacity and potentially real-world function in schizophrenia.
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Affiliation(s)
- Waqas Ullah Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zaid Ghazala
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Ponnusamy Subramaniam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert S Kern
- Department of Psychiatry, University of California–Los Angeles, Los Angeles, CA
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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17
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Relationship Between Symptomatic Dimensions and Global Functioning of Non-Help-Seeking Individuals at Risk for Psychosis. J Nerv Ment Dis 2020; 208:953-957. [PMID: 32925694 DOI: 10.1097/nmd.0000000000001237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aims to analyze the relationship between the symptomatic dimensions of psychosis and functioning of individuals at risk for psychosis (ultrahigh risk [UHR]) in a non-help-seeking UHR sample from the general population. The sample is the same as the one used in the Brazilian Subclinical Symptoms and Prodromal Psychosis cohort study. We applied questionnaires of functioning (Global Assessment of Functioning Scale) and symptomatic dimensions (Scale of Prodromal Symptoms). Next, we correlated the symptomatic dimensions with functioning. We found a significant relationship between avolition and uncommon thought content with poor functioning, whereas the remaining symptoms were not as relevant. Poor functioning was most related to avolition, a negative symptom, followed by unusual thought content, a positive symptom.
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18
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Chang WC, Wong CSM, Or PCF, Chu AOK, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: a network analysis approach. Psychol Med 2020; 50:2019-2027. [PMID: 31451127 DOI: 10.1017/s0033291719002113] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP. METHOD This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses. RESULTS Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength. CONCLUSION Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - C S M Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - P C F Or
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - A O K Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - E M H Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Y N Suen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
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19
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Executive dysfunctions differentially predict amotivation in first-episode schizophrenia-spectrum disorder: a prospective 1-year follow-up study. Eur Arch Psychiatry Clin Neurosci 2019; 269:887-896. [PMID: 29934845 DOI: 10.1007/s00406-018-0918-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
Amotivation is a major determinant of functional outcome in schizophrenia but it is understudied in the early course of illness. There is a paucity of longitudinal research investigating predictors of amotivation. In this study, we aimed to examine baseline cognitive and clinical predictors of amotivation at 6 and 12 months of follow-up in patients aged 18-55 years presenting with first-episode DSM-IV schizophrenia-spectrum disorder (FES). Of 145 patients recruited at intake, 116 and 113 completed assessments at 6- and 12-month follow-up, respectively. Amotivation was measured by avolition-apathy and anhedonia-asociality subscale scores of the Scale of the Assessment of Negative Symptoms. Cognitive assessment was administered at baseline. As executive dysfunction has been more consistently found to be associated with negative symptoms and amotivation in prior literature, we adopted fractionated approach to subdivide executive function into distinct components encompassing switching and flexibility, response initiation, response inhibition, planning and strategy allocation, sustained attention and working memory. Our results showed that baseline amotivation (p = 0.01) and switching and flexibility (p = 0.01) were found to independently predict amotivation at 6 months follow-up. Baseline amotivation (p < 0.01) and switching and flexibility (albeit with trend-wise significance, p = 0.06) were also retained in final multivariate regression model for 12-month amotivation prediction. No other executive components or cognitive domains predicted amotivation at follow-up. Findings of our study thus indicate amotivation at initial presentation as a critical determinant of subsequent motivational deficits over 1 year of treatment for FES patients. Cognitive flexibility might be specifically related to the development of amotivation in the early stage of illness.
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20
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Siddiqui I, Saperia S, Fervaha G, Da Silva S, Jeffay E, Zakzanis KK, Agid O, Remington G, Foussias G. Goal-directed planning and action impairments in schizophrenia evaluated in a virtual environment. Schizophr Res 2019; 206:400-406. [PMID: 30471980 DOI: 10.1016/j.schres.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/07/2018] [Accepted: 10/18/2018] [Indexed: 11/24/2022]
Abstract
Planning and executing goal-directed behaviours are critical final steps in translating motivation into action. Amotivation is a key feature of schizophrenia, but its impact on goal-directed functioning has not been extensively studied in an objective and ecologically valid manner. To address this, we investigated goal-directed planning and action in schizophrenia using a virtual reality task, the Multitasking in the City Test (MCT). The MCT was administered to 49 outpatients with schizophrenia and 55 healthy controls, and required participants to complete a series of errands in a virtual city. Ability to complete the task as directed was assessed by a performance score based on errands completed and errors committed. Task efficiency was evaluated by the total distance travelled, and an index of path efficiency comparing an optimal route with the traversed route. Schizophrenia participants had lower performance scores, travelled farther, and had reduced path efficiency compared to healthy controls. Greater distance travelled and lower path efficiency in schizophrenia were related to amotivation. Path efficiency in schizophrenia was also related to neurocognition, including planning ability; notably, this relationship appeared to be independent of the relationship with amotivation. Individuals with schizophrenia demonstrated impaired goal-directed planning and action in the context of a simulated everyday errands task, both in terms of reduced capacity to complete errands and reduced efficiency in doing so. The latter may manifest as diminished real-world motivated and functional behaviour in patients with schizophrenia and indicates a specific deficit in the execution of planned behaviour.
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Affiliation(s)
- Ishraq Siddiqui
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.
| | - Sarah Saperia
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Susana Da Silva
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Eliyas Jeffay
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Ofer Agid
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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21
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Saperia S, Da Silva S, Siddiqui I, Agid O, Daskalakis ZJ, Ravindran A, Voineskos AN, Zakzanis KK, Remington G, Foussias G. Reward-driven decision-making impairments in schizophrenia. Schizophr Res 2019; 206:277-283. [PMID: 30442476 DOI: 10.1016/j.schres.2018.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/25/2022]
Abstract
The ability to use feedback to guide optimal decision-making is essential for goal-directed behaviour. While impairments in feedback-driven decision-making have been associated with schizophrenia and depression, this has been examined primarily in the context of binary probabilistic choice paradigms. In real-world decision-making, however, individuals must make choices when there are more than two competing options that vary in the frequency and magnitude of potential rewards and losses. Thus, the current study examined win-stay/lose-shift (WSLS) behaviour on the Iowa Gambling Task (IGT) in order to evaluate the influence of immediate rewards and losses in guiding real-world decision-making in patients with schizophrenia and major depressive disorder. Fifty-one patients with schizophrenia, 43 patients with major depressive disorder, and 51 healthy controls completed the IGT, as well as a series of clinical and cognitive measures. WSLS was assessed by quantifying trial-by-trial behaviour following rewards and losses on the IGT. Multivariate analyses of variance revealed that patients with schizophrenia demonstrated intact lose-shift behaviour, but significantly reduced win-stay rates compared to healthy controls. In contrast, no WSLS impairments emerged in the depressed group. Win-stay impairments in the schizophrenia group were significantly related to deficits in motivation and cognition. Patients with schizophrenia exhibit impaired reward-driven decision-making in the context of multiple choices with concurrent rewards and losses, and this appears to be driven by a reduced propensity for advantageous win-stay behaviour. With the importance of reward learning and decision-making in generating goal-directed behaviour, these findings suggest a potential mechanism contributing to the motivation deficits seen in schizophrenia.
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Affiliation(s)
- Sarah Saperia
- Centre for Addiction and Mental Health, Toronto, Canada.
| | - Susana Da Silva
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ishraq Siddiqui
- Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ofer Agid
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Z Jeff Daskalakis
- 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
| | - Arun Ravindran
- 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
| | - Aristotle N Voineskos
- 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
- 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
| | - George Foussias
- 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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22
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DeRosse P, Barber AD, Fales CL, Malhotra AK. Deconstructing Avolition: Initiation vs persistence of reward-directed effort. Psychiatry Res 2019; 273:647-652. [PMID: 31207847 PMCID: PMC7864548 DOI: 10.1016/j.psychres.2019.01.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
Avolition, a decrease in the initiation and persistence of goal-directed behavior, is a critical determinant of disability in patients with schizophrenia. Recent studies have demonstrated that avolition can be modeled using reward-based, behavioral paradigms. These studies suggest that avolition represents a motivational deficit, accounted for by a diminished ability to anticipate pleasurable experiences. Notably, although data suggest that "initiation" and "persistence" of goal-directed behavior may depend on different processes, few studies have sought to distinguish between these two components of avolitional symptoms. Such distinctions could have real consequences for the development and evaluation of interventions designed to ameliorate avolitional symptoms. Thus, the present study examined the relationship between anticipatory pleasure, a key driver of avolition, and both the initiation and persistence of reward-directed, effortful responding during the Effort Expenditures for Rewards Task in 103 healthy participants. We found that anticipatory pleasure was not significantly predictive of the initiation of effortful responding but was significantly predictive of the persistence of effortful responding; most notably when the probabilities of reward and non-reward were equivalent. These data suggest that although deficits in reward processes contribute to the likelihood of persisting in reward-driven behavior, they contribute little to the initiation of such behavior.
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Affiliation(s)
- Pamela DeRosse
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA.
| | - Anita D Barber
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
| | - Christina L Fales
- The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
| | - Anil K Malhotra
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
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23
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Siddiqui I, Remington G, Fervaha G, Fletcher PJ, Voineskos AN, Saperia S, Zakzanis KK, Foussias G. Objective investigation of activity preference in schizophrenia: A pilot study. Psychiatry Res 2018; 267:551-559. [PMID: 29980136 DOI: 10.1016/j.psychres.2018.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/23/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
Amotivation and reduced goal-directed activity engagement are prominent features of schizophrenia. Previous investigations of patients' activities have relied on accounts of daily living activities, rather than objective measures. This study used wireless motion capture to objectively evaluate activity preference when individuals are provided an explicit choice between an active versus passive engagement option. Twenty outpatients with schizophrenia and twenty matched healthy controls completed the Activity Preference Task, in which participants play a motion-based game (active) or watch a film (passive), and were administered clinical and cognitive assessments. Schizophrenia participants' duration, intensity, and persistence of active engagement were associated with apathy and community functioning. No group differences emerged from comparisons of task measures; however, exploratory cluster analysis identified a distinct subgroup of schizophrenia patients with reduced engagement and increased apathy compared to other patients and controls. The Task provides a means of quantifying activity engagement, which may be particularly valuable given the lack of objective measures for intrinsically motivated behaviours. Our initial findings suggest that schizophrenia patients as a group are equally inclined as healthy individuals towards actively engaging activities when presented an explicit choice, but such provision may be insufficient for initiation and maintenance of functional behaviours among amotivated patients.
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Affiliation(s)
- Ishraq Siddiqui
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada..
| | - Gary Remington
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Gagan Fervaha
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Paul J Fletcher
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada; Preclinical Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada; Department of Psychology, University of Toronto, Sidney Smith Hall, 100 St. George St., Toronto, Ontario M5S 3G3, Canada
| | - Aristotle N Voineskos
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Sarah Saperia
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada
| | - Konstantine K Zakzanis
- Department of Psychology, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - George Foussias
- Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario M5T 1R8, Canada.; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada.; Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8, Canada
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24
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DeRosse P, Nitzburg GC, Blair M, Malhotra AK. Dimensional symptom severity and global cognitive function predict subjective quality of life in patients with schizophrenia and healthy adults. Schizophr Res 2018; 195:385-390. [PMID: 29056491 PMCID: PMC5908765 DOI: 10.1016/j.schres.2017.10.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/23/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022]
Abstract
Over the last several decades Quality of Life (QoL) has become increasingly important as an indicator of treatment outcomes; particularly in schizophrenia spectrum disorders because of its close association with functional disability. Numerous studies seeking to elucidate the factors that contribute to QoL in this population have implicated both symptom severity and cognition in determining QoL but the findings have been mixed. The critical factors that appear to impede the lack of consensus in the extant literature examining determinants of QoL include the heterogeneity of the samples and measures examined as well as medication effects across different studies. Thus, the present study sought to address some of these issues by examining the relationship between subjective QoL and both symptom severity and cognitive function in a relatively homogeneous patient sample of patients and a community control sample assessed for dimensional symptom severity. Our results suggest that both global cognitive function and psychiatric symptoms have a significant impact on the subjective QoL of both people with schizophrenia spectrum disorders and psychiatrically healthy adults. Specifically, we found that a global index of cognition as well as self-reported avolitional and depressive symptoms were significantly predictive of QoL in both samples. These findings highlight the importance of addressing cognitive, depressive and avolitional symptoms in the treatment of patients with schizophrenia spectrum disorders and suggest that improvements in these domains may have a meaningful impact on their overall QoL.
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Affiliation(s)
- Pamela DeRosse
- Hofstra-Northwell School of Medicine, Department of Psychiatry, Hempstead, NY, USA; Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA.
| | - George C. Nitzburg
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA,Teachers College, Columbia University, New York, NY, USA
| | - Melanie Blair
- Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA,Graduate Center, City University of New York, New York, NY, USA
| | - Anil K. Malhotra
- Hofstra-Northwell School of Medicine, Department of Psychiatry, Hempstead, NY, USA,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA,Division of Psychiatry Research, The Zucker Hillside Hospital, Division of Northwell Health, Glen Oaks, NY, USA
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25
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Objective assessment of exploratory behaviour in schizophrenia using wireless motion capture. Schizophr Res 2018; 195:122-129. [PMID: 28954705 DOI: 10.1016/j.schres.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/09/2017] [Accepted: 09/10/2017] [Indexed: 11/22/2022]
Abstract
Motivation deficits are a prominent feature of schizophrenia and have substantial consequences for functional outcome. The impact of amotivation on exploratory behaviour has not been extensively assessed by entirely objective means. This study evaluated deficits in exploratory behaviour in an open-field setting using wireless motion capture. Twenty-one stable adult outpatients with schizophrenia and twenty matched healthy controls completed the Novelty Exploration Task, in which participants explored a novel environment containing familiar and uncommon objects. Objective motion data were used to index participants' locomotor activity and tendency for visual and tactile object exploration. Clinical assessments of positive and negative symptoms, apathy, cognition, depression, medication side-effects, and community functioning were also administered. Relationships between task performance and clinical measures were evaluated using Spearman correlations, and group differences were evaluated using multivariate analysis of covariance tests. Although locomotor activity and tactile exploration were similar between the schizophrenia and healthy control groups, schizophrenia participants exhibited reduced visual object exploration (F(2,35)=3.40, p=0.045). Further, schizophrenia participants' geometric pattern of locomotion, visual exploration, and tactile exploration were correlated with overall negative symptoms (|ρ|=0.46-0.64, p<=0.039) and apathy (|ρ|=0.49-0.62, p<=0.028), and both visual and tactile exploration were also correlated with community functioning (|ρ|=0.46-0.48, p<=0.043). The Novelty Exploration Task may be a valuable tool to quantify exploratory behaviour beyond what is captured through standard clinical instruments and human observer ratings. Findings from this initial study suggest that locomotor activity and object interaction tendencies are impacted by motivation, and reveal deficits specifically in visual exploration in schizophrenia.
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26
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Giordano GM, Stanziano M, Papa M, Mucci A, Prinster A, Soricelli A, Galderisi S. Functional connectivity of the ventral tegmental area and avolition in subjects with schizophrenia: a resting state functional MRI study. Eur Neuropsychopharmacol 2018; 28:589-602. [PMID: 29653743 DOI: 10.1016/j.euroneuro.2018.03.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/17/2018] [Accepted: 03/22/2018] [Indexed: 12/12/2022]
Abstract
Avolition, a deficit in goal-directed behavior, is a key aspect of negative symptoms. It is highly prevalent in schizophrenia and is associated to poor functional outcome and to measures of real life motivation, indicating that central to the concept is the lack of interest and motivation. In this study we tested the hypothesis that avolition is related to altered connectivity within dopaminergic cortico-striatal circuits involved in motivation processes. Since dopamine input to these circuits derives mostly from the ventro-tegmental area (VTA), we investigated the relationships between the resting-state functional connectivity (RS-FC) of the VTA and avolition in twenty-six subjects with schizophrenia (SCZ), treated with second-generation antipsychotics only, compared to twenty-two healthy controls (HC). SCZ, in comparison to HC, showed significantly reduced RS-FC of the VTA with bilateral ventro-lateral prefrontal cortex (VLPFC), bilateral insular cortex (IC) and right (R) lateral occipital complex (LOC) and increased RS-FC of the VTA with bilateral dorso-lateral prefrontal cortex (DLPFC). Significant negative correlations were found between avolition and RS-FC of the VTA with the bilateral IC, R VLPFC and R LOC. According to our findings, avolition is linked to a disconnectivity of the VTA from several key cortical regions involved in the integration of value information with action selection. These findings are in line with translational animal models of "auto-activation apathy".
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Affiliation(s)
- Giulia Maria Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Mario Stanziano
- Laboratory of Neuronal Networks, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138 Naples, Italy
| | - Michele Papa
- Laboratory of Neuronal Networks, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138 Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy.
| | - Anna Prinster
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis 95, 80145 Naples, Italy
| | - Andrea Soricelli
- Department of Motor Sciences & Healthiness, University of Naples "Parthenope", Via Medina 40, 80133 Naples, Italy; I.R.C.C.S. Research Institute SDN, Via Gianturco 113, 80143 Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138 Naples, Italy
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27
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Psychometric evaluation of the Temporal Experience of Pleasure Scale (TEPS) in a German sample. Psychiatry Res 2018; 260:138-143. [PMID: 29195165 DOI: 10.1016/j.psychres.2017.11.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 10/12/2017] [Accepted: 11/18/2017] [Indexed: 11/20/2022]
Abstract
Anhedonia, or the inability to experience pleasure, is commonly observed in schizophrenia. It has been suggested that patients with schizophrenia are unable to predict future pleasurable events, but show intact experience of in-the-moment pleasure. Therefore, the Temporal Experience of Pleasure Scale (TEPS), a self-report measure allowing the assessment of anticipatory and consummatory pleasure, has been developed. To validate the German version of the TEPS, we recruited 59 healthy control participants and 51 patients with schizophrenia or schizoaffective disorder who completed the TEPS as well as a battery of psychometric tests to assess psychopathology, in particular self-rated anhedonia and clinician-rated apathy as well as overall measures of negative symptoms. We found acceptable to good internal consistency and a factor structure comparable to the original version. Scores of the TEPS were related to measures of anhedonia and apathy, but not with other measures of psychopathology. The present results suggest that the German version of the TEPS shows adequate reliability and validity to assess the construct of anhedonia. However, differential aspects of anticipatory and consummatory pleasure should be further investigated in clinical samples.
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28
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Da Silva S, Apatsidou A, Saperia S, Siddiqui I, Jeffay E, Voineskos AN, Daskalakis ZJ, Remington G, Zakzanis KK, Foussias G. An Examination of the Multi-Faceted Motivation System in Healthy Young Adults. Front Psychiatry 2018; 9:191. [PMID: 29867611 PMCID: PMC5958204 DOI: 10.3389/fpsyt.2018.00191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Amotivation is a prevalent symptom in schizophrenia (SZ) and depression (MDD), and is linked to poor functional outcomes in affected individuals. Conceptualizations of motivation have outlined a multi-faceted construct comprised of reward responsiveness, reward expectancy, reward valuation, effort valuation, and action selection/preference-based decision making. To date, findings from studies utilizing variable-centered approaches to examining isolated facets of motivation in SZ and MDD have been inconsistent. Thus, the present study adopted a person-centered approach, and comprehensively examined the reward system in a non-clinical sample in an attempt to explore potential subtypes of motivation impairments, while minimizing the effects of illness-related confounds. Methods: Ninety-six healthy undergraduate students were evaluated for amotivation, schizotypal traits, depressive symptoms, and cognition, and administered objective computerized tasks to measure the different facets of motivation. Cluster analysis was performed to explore subgroups of individuals based on similar motivation task performance. Additionally, correlational analyses were conducted in order to examine inter-relationships between motivation facets, and relations between clinical measures and facets of motivation. Results: Cluster analysis identified two subgroups of individuals with differential motivation performance profiles. Correlational analyses revealed that reward responsiveness was associated with amotivation, depressive symptoms, and negative schizotypy. Further, significant inter-correlations were found between reward responsiveness and reward expectancy, as well as between reward valuation and effort valuation. Conclusions: Our results mark important steps forward in understanding motivation in a non-clinical sample, and guide future dimensional and comprehensive analyses of the multi-faceted reward system. It remains to be seen whether these patterns of results will be similar in clinical populations such as SZ and MDD.
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Affiliation(s)
- Susana Da Silva
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Areti Apatsidou
- Department of Psychology, University of Toronto Scarborough, Scarborough, ON, Canada
| | - Sarah Saperia
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ishraq Siddiqui
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Eliyas Jeffay
- Department of Psychology, University of Toronto Scarborough, Scarborough, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gary Remington
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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29
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Vignapiano A, Mucci A, Merlotti E, Giordano GM, Amodio A, Palumbo D, Galderisi S. Impact of Reward and Loss Anticipation on Cognitive Control: An Event-Related Potential Study in Subjects With Schizophrenia and Healthy Controls. Clin EEG Neurosci 2018; 49:46-54. [PMID: 29243531 DOI: 10.1177/1550059417745935] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Deficits of cognitive functions and motivation are core aspects of schizophrenia. The interaction of these deficits might contribute to impair the ability to flexibly adjust behavior in accordance with one's intentions and goals. Many studies have focused on the anterior N2 as a correlate of cognitive control based on motivational value. AIMS Given the key role of motivation impairment in schizophrenia as a predictor of functional outcome, we aimed to study the impact of reward- and avoidance-based motivation on cognitive control using N2. METHOD Event-related potentials were recorded during the execution of the "Monetary Incentive Delay (MID)" task in 34 patients with schizophrenia (SCZ) stabilized on second-generation antipsychotics and 22 healthy controls (HC). Cognitive domains were assessed using the MATRICS Consensus Cognitive Battery. Negative symptom domains (Avolition/apathy and Expressive deficit), as well as positive and disorganization dimensions were also assessed in SCZ. RESULTS We did not observe any group difference in N2 amplitude or latency. In HC, N2 amplitude was significantly larger for anticipation of large loss with regard to all reward conditions and for all incentive versus neutral conditions. In SCZ, N2 amplitude did not discriminate between large loss and reward or between incentive and neutral conditions. N2 amplitude was not correlated with psychopathological dimensions or MCCB-assessed cognitive deficits in SCZ. CONCLUSION Our data in HC are in line with the hypothesis that N2 amplitude reflects the impact of motivational salience on cognitive control. Our results in SCZ indicate a deficit in the discrimination of motivational salience to the service of cognitive control, independently of psychopathology and other cognitive deficits.
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Affiliation(s)
- Annarita Vignapiano
- 1 Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Armida Mucci
- 1 Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eleonora Merlotti
- 1 Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia Maria Giordano
- 1 Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonella Amodio
- 1 Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Palumbo
- 1 Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Silvana Galderisi
- 1 Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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30
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Metacognition Is Necessary for the Emergence of Motivation in People With Schizophrenia Spectrum Disorders: A Necessary Condition Analysis. J Nerv Ment Dis 2017; 205:960-966. [PMID: 29064949 PMCID: PMC5718965 DOI: 10.1097/nmd.0000000000000753] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Metacognition deficits are a putative cause of reduced motivation in people with schizophrenia spectrum disorders. However, it is unclear whether certain levels of metacognition are necessary for motivation to emerge. This study used a Necessary Condition Analysis to test whether metacognition was necessary for the presence of motivation and to identify the minimum level of metacognition necessary for high motivation to be possible in people with schizophrenia spectrum disorders (N = 175). Participants completed clinician-rated measures of metacognition and motivation. Necessary Condition Analysis revealed that metacognition is a necessary condition for motivation and that high levels of motivation were only possible, although not guaranteed, when at least a basic level of metacognition was present. The findings suggest that metacognition is a necessary building block for the development of motivation. Results suggest that targeting metacognition may be essential for improving motivation among people with schizophrenia spectrum disorders who do not meet this metacognition threshold.
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31
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Leidenfrost CM, Schoelerman RM, Maher M, Antonius D. The development and efficacy of a group intervention program for individuals with serious mental illness in jail. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 54:98-106. [PMID: 28655427 DOI: 10.1016/j.ijlp.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/10/2017] [Accepted: 06/07/2017] [Indexed: 06/07/2023]
Abstract
Providing cost-effective means to treat the influx of individuals with serious mental illness entering the correctional system is a major challenge. Failure to provide appropriate mental health treatment may lead to poor outcomes, including recidivism and suicide. Group intervention is an effective and cost efficient way to provide mental health treatment. However, it has been understudied in jail settings. To meet the needs of jail-inmates with serious mental illness, an eight-week group-based module curriculum was developed and studied through analyses of perceived usefulness, retention of key material, and associations with cognitive ability, improvement in psychiatric symptoms, and level of motivation. One week after the completion of a group session, the participants remembered the group topic and at least one key point from the group the majority of the time. Better recall of group material was associated with better overall cognitive ability and motivation at discharge. Participants found the groups to be somewhat to extremely useful 88.4% of the time. Higher levels of usefulness were associated with reduced psychopathology and psychiatric improvement, as well as higher motivation at discharge. The findings provide support for the group intervention and implementation in a jail setting. Further implications are discussed.
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Affiliation(s)
- Corey M Leidenfrost
- University at Buffalo, State University of New York, Buffalo, NY, USA; Erie County Forensic Mental Health Services, Buffalo, NY, USA.
| | | | - Michael Maher
- Erie County Forensic Mental Health Services, Buffalo, NY, USA
| | - Daniel Antonius
- University at Buffalo, State University of New York, Buffalo, NY, USA; Erie County Forensic Mental Health Services, Buffalo, NY, USA; New York University School of Medicine, New York, NY, USA
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Grimes KM, Zanjani A, Zakzanis KK. Memory impairment and the mediating role of task difficulty in patients with schizophrenia. Psychiatry Clin Neurosci 2017; 71:600-611. [PMID: 28294468 DOI: 10.1111/pcn.12520] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/08/2017] [Accepted: 03/07/2017] [Indexed: 02/04/2023]
Abstract
Using meta-analytic methods, we sought to synthesize the research literature on memory impairment in schizophrenia. Additionally, we compared performances across memory measures to determine if task difficulty (e.g., effortful encoding and retrieval vs non-effortful encoding and retrieval) could account for variance across studies. Our primary measures of interest included the California Verbal Learning Test, Wechsler Memory Scale, Rey Auditory Verbal Learning Test, Hopkins Verbal Learning Test, Rey-Osterrieth Complex Figure Test, and the Benton Visual Retention Test. We searched for all studies that met inclusion criteria using PubMed, PsycINFO, Scholars Portal Search, and Google Scholar. Studies were included if: (i) they were published after 1980; (ii) healthy controls were compared to patients with schizophrenia; (iii) at least one of the noted measures of interest was employed in the primary study; and (iv) the primary study included data that could be transformed to point estimate effect sizes (i.e., Cohen's d). Cohen's d was calculated between patients and healthy controls, along with overall 95% confidence intervals. A two-tailed independent samples t-test was conducted to assess if performance differed on various paired subtests of the same domain. Large effect sizes were found for all memory tests. No significant differences were found between subtests. In conclusion, patients with schizophrenia experience significant verbal and visual memory impairments, which are not explained by task difficulty. Patients were unable to learn or retrieve more reliably despite repetition and cuing strategies, suggesting that memory impairment in the illness is not a function of task difficulty.
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Affiliation(s)
- Kyrsten M Grimes
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Canada
| | - Anosha Zanjani
- Graduate School of Architecture, Columbia University, New York, USA
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Investigating consummatory and anticipatory pleasure across motivation deficits in schizophrenia and healthy controls. Psychiatry Res 2017; 254:112-117. [PMID: 28460280 DOI: 10.1016/j.psychres.2017.04.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/19/2017] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
Abstract
Anhedonia has traditionally been considered a characteristic feature of schizophrenia, but the true nature of this deficit remains elusive. This study sought to investigate consummatory and anticipatory pleasure as it relates to motivation deficits. Eighty-four outpatients with schizophrenia and 81 healthy controls were administered the Temporal Experience of Pleasure Scale (TEPS), as well as a battery of clinical and cognitive assessments. Multivariate analyses of variance were used to examine the experience of pleasure as a function of diagnosis, and across levels of motivation deficits (i.e. low vs. moderate. vs. high) in schizophrenia. Hierarchical regression analyses were also conducted to evaluate the predictive value of amotivation in relation to the TEPS. There were no significant differences between schizophrenia and healthy control groups for either consummatory or anticipatory pleasure. Within the schizophrenia patients, only those with high levels of amotivation were significantly impaired in consummatory and anticipatory pleasure compared to low and moderate groups, and compared to healthy controls. Further, our results revealed that amotivation significantly predicts both consummatory and anticipatory pleasure, with no independent contribution of group. Utilizing study samples with a wide range of motivation deficits and incorporating objective paradigms may provide a more comprehensive understanding of hedonic deficits.
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Costa R, Probst M, Bastos T, Vilhena E, Seabra A, Corredeira R. Behavioural Regulation in Exercise Questionnaire in people with schizophrenia: construct validity of the Portuguese versions. Disabil Rehabil 2017. [PMID: 28641494 DOI: 10.1080/09638288.2017.1342277] [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: 10/19/2022]
Abstract
PURPOSE People with schizophrenia have low physical activity levels that can be explained by the restriction in motivation. The Behavioural Regulation in Exercise Questionnaire-2 is a 19-item scale commonly used to assess five different motivational subtypes for physical activity. However, there are limited psychometric analyses of this version in the schizophrenia context. Moreover, there is a lack of information related to the psychometric properties of version 3 of this questionnaire, with 24 items and six different motivational subtypes. The aim of this study was to examine the construct validity of both Portuguese versions in people with schizophrenia. METHODS A total of 118 persons with schizophrenia were included (30 women). Cronbach's alpha was used for internal consistency, Pearson's correlation for the retained motivation-types, confirmatory factor analysis for the structural validity of version 2 and exploratory factor analysis for the factor structure of version 3. RESULTS AND CONCLUSIONS Analyses of version 2 provided an adequate fit index for the structure of the five factors. Exploratory analyses suggested retaining 2 factors of version 3. The results of this study suggest that version 3 was an appropriate measure to assess controlled and autonomous motivation for physical activity in people with schizophrenia and support its use in clinical practice and research. Implications for Rehabilitation This study supports the need to identify the reasons why people with schizophrenia practice physical activity. For that purpose, it is important to use valid and cost-effective instruments. The Portuguese version of BREQ-2 confirmed a 5-factor model and showed adequate fit for the application in people with schizophrenia. However, the incremental indices values were lower than expected. The Portuguese version of BREQ-3 showed acceptable psychometric properties to assess controlled and autonomous motivation for physical activity in people with schizophrenia.
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Affiliation(s)
- Raquel Costa
- a Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal
| | - Michel Probst
- b Faculty of Kinesiology and Rehabilitation Sciences , Research Group for Adapted Physical Activity and Psychomotor Rehabilitation , KU Leuven Leuven , Belgium
| | - Tânia Bastos
- c Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport , University of Porto , Porto , Portugal.,d Research Center in Sports Sciences, Health Sciences and Human Development , CIDESD, University Institute of Maia, ISMAI , Maia , Portugal
| | - Estela Vilhena
- e Technology School, Polytechnic Institute of Cavado and Ave , EPIUnit-ISPUP, University of Porto , Porto , Portugal
| | - André Seabra
- a Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal
| | - Rui Corredeira
- a Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport , University of Porto , Porto , Portugal
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Chang WC, Kwong VWY, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach. Psychol Med 2017; 47:755-765. [PMID: 27869058 DOI: 10.1017/s0033291716003044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Better understanding of the complex interplay among key determinants of functional outcome is crucial to promoting recovery in psychotic disorders. However, this is understudied in the early course of illness. We aimed to examine the relationships among negative symptoms, neurocognition, general self-efficacy and global functioning in first-episode psychosis (FEP) patients using structural equation modeling (SEM). METHOD Three hundred and twenty-one Chinese patients aged 26-55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing symptom profiles, functioning, perceived general self-efficacy and a battery of neurocognitive tests were conducted. Negative symptom measurement was subdivided into amotivation and diminished expression (DE) domain scores based on the ratings in the Scale for the Assessment of Negative Symptoms. RESULTS An initial SEM model showed no significant association between functioning and DE which was removed from further analysis. A final trimmed model yielded very good model fit (χ2 = 15.48, p = 0.63; comparative fit index = 1.00; root mean square error of approximation <0.001) and demonstrated that amotivation, neurocognition and general self-efficacy had a direct effect on global functioning. Amotivation was also found to mediate a significant indirect effect of neurocognition and general self-efficacy on functioning. Neurocognition was not significantly related to general self-efficacy. CONCLUSION Our results indicate a critical intermediary role of amotivation in linking neurocognitive impairment to functioning in FEP. General self-efficacy may represent a promising treatment target for improvement of motivational deficits and functional outcome in the early illness stage.
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Affiliation(s)
- W C Chang
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - V W Y Kwong
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - C L M Hui
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - S K W Chan
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - E H M Lee
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - E Y H Chen
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
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Chang WC, Kwong VWY, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis. Eur Psychiatry 2017; 41:37-41. [PMID: 28049079 DOI: 10.1016/j.eurpsy.2016.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments. RESULTS Amotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation. CONCLUSION Our findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong.
| | - V W Y Kwong
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - G H K Chan
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - O T T Jim
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E S K Lau
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - C L M Hui
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - S K W Chan
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
| | - E H M Lee
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
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Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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38
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Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. WORLD PSYCHIATRY : OFFICIAL JOURNAL OF THE WORLD PSYCHIATRIC ASSOCIATION (WPA) 2017. [PMID: 28127915 DOI: 10.1002/wps.20385.] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.
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Affiliation(s)
- Stephen R Marder
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Semel Institute for Neuroscience at UCLA, Los Angeles, CA, USA
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39
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Farholm A, Sørensen M, Halvari H. Motivational factors associated with physical activity and quality of life in people with severe mental illness. Scand J Caring Sci 2016; 31:914-921. [PMID: 27910118 DOI: 10.1111/scs.12413] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND There has been increasing interest for investigating the role of motivation in physical activity among people with severe mental illness (SMI). Autonomous motivation has been suggested to have a potentially important role in adoption and maintenance of physical activity. However, the knowledge about factors that facilitate autonomous motivation among people with SMI is scarce. AIM The aim of this study was to examine factors associated with motivation for physical activity as well as the relationships between motivation, physical activity and health-related quality of life in individuals with SMI that were currently physically active. METHODS A cross-sectional design was used, and 88 participants were recruited from a public health network promoting physical activity for people with SMI. They answered a questionnaire package consisting of scales measuring psychological need support - psychological need satisfaction - and motivation for physical activity, physical activity and health-related quality of life. RESULTS The majority of participants reported to be in regular physical activity. Associations between variables were tested according to the self-determination theory process model. Structural equation modelling yielded good fit of the process model to the data. Specifically, a need-supportive environment was positively associated with psychological need satisfaction, while psychological need satisfaction was positively associated with autonomous motivation and mental health-related quality of life, and negatively associated with controlled motivation and amotivation. Physical activity was positively associated with autonomous motivation and physical health-related quality of life, and negatively associated with amotivation. CONCLUSION This study indicates that individuals with SMI can be regularly physically active when provided with suitable opportunities. Furthermore, the present results suggest that it is vital for health-care practitioners to emphasise creating a need-supportive environment when organising physical activity because such an environment is associated with both increased autonomous motivation for physical activity and mental health-related quality of life.
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Affiliation(s)
- Anders Farholm
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - Marit Sørensen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hallgeir Halvari
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway.,School of Business and Social Sciences, University College of Southeast Norway, Hønefoss, Norway
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40
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Luther L, Firmin RL, Minor KS, Vohs JL, Buck B, Buck KD, Lysaker PH. Metacognition deficits as a risk factor for prospective motivation deficits in schizophrenia spectrum disorders. Psychiatry Res 2016; 245:172-178. [PMID: 27543831 DOI: 10.1016/j.psychres.2016.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 01/19/2023]
Abstract
Although motivation deficits are key determinants of functional outcomes, little is known about factors that contribute to prospective motivation in people with schizophrenia. One candidate factor is metacognition, or the ability to form complex representations about oneself, others, and the world. This study aimed to assess whether metacognition deficits were a significant predictor of reduced prospective motivation, after controlling for the effects of baseline motivation, anticipatory pleasure, and antipsychotic medication dose. Fifty-one participants with a schizophrenia spectrum disorder completed measures of metacognition and anticipatory pleasure at baseline; participants also completed a measure of motivation at baseline and six months after the initial assessment. Baseline antipsychotic dose was obtained from medical charts. Hierarchical regression analysis revealed that lower levels of baseline metacognition significantly predicted reduced levels of motivation assessed six months later, after controlling for baseline levels of motivation, anticipatory pleasure, and antipsychotic dose. Higher baseline antipsychotic dose was also a significant predictor of reduced six month motivation. Results suggest that metacognition deficits and higher antipsychotic dose may be risk factors for the development of motivation deficits in schizophrenia. Implications include utilizing interventions to improve metacognition in conjunction with evaluating and possibly lowering antipsychotic dose for people struggling with motivation deficits.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States.
| | - Ruth L Firmin
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Kyle S Minor
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, United States; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Eskenazi Hospital, Indianapolis, IN, United States; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, United States
| | - Benjamin Buck
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kelly D Buck
- Richard L. Roudebush Veteran's Affairs Medical Center, Indianapolis, IN, United States
| | - Paul H Lysaker
- Indiana University School of Medicine, Indianapolis, IN, United States; Richard L. Roudebush Veteran's Affairs Medical Center, Indianapolis, IN, United States
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41
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Vignapiano A, Mucci A, Ford J, Montefusco V, Plescia G, Bucci P, Galderisi S. Reward anticipation and trait anhedonia: An electrophysiological investigation in subjects with schizophrenia. Clin Neurophysiol 2016; 127:2149-60. [DOI: 10.1016/j.clinph.2016.01.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 01/03/2016] [Accepted: 01/11/2016] [Indexed: 11/29/2022]
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Chang WC, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Impact of avolition and cognitive impairment on functional outcome in first-episode schizophrenia-spectrum disorder: a prospective one-year follow-up study. Schizophr Res 2016; 170:318-21. [PMID: 26778673 DOI: 10.1016/j.schres.2016.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/30/2015] [Accepted: 01/01/2016] [Indexed: 02/04/2023]
Abstract
Previous research investigating the relationships between avolition, cognition and functioning in schizophrenia mostly focused on chronic samples and were cross-sectional in design. Impacts of avolition and cognition on longitudinal functional outcome in first-episode patients are under-studied. We assessed 114 Chinese aged 18-55 years presenting with first-episode schizophrenia-spectrum disorder aiming to identify baseline predictors of 1-year functional outcome. Results showed that both avolition and global cognition independently predicted functioning, with avolition being the strongest predictor above and beyond cognition and other symptom dimensions. Our findings indicate the central role of in determining longitudinal functional status in the early illness stage.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
| | - Christy Lai Ming Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
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Luther L, Firmin RL, Vohs JL, Buck KD, Rand KL, Lysaker PH. Intrinsic motivation as a mediator between metacognition deficits and impaired functioning in psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2016; 55:332-47. [PMID: 26756621 DOI: 10.1111/bjc.12104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/21/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Poor functioning has long been observed in individuals with psychosis. Recent studies have identified metacognition - one's ability to form complex ideas about oneself and others and to use that information to respond to psychological and social challenges-as being an important determinant of functioning. However, the exact process by which deficits in metacognition lead to impaired functioning remains unclear. This study first examined whether low intrinsic motivation, or the tendency to pursue novel experiences and to engage in self-improvement, mediates the relationship between deficits in metacognition and impaired functioning. We then examined whether intrinsic motivation significantly mediated the relationship when controlling for age, education, symptoms, executive functioning, and social cognition. DESIGN Mediation models were examined in a cross-sectional data set. METHODS One hundred and seventy-five individuals with a psychotic disorder completed interview-based measures of metacognition, intrinsic motivation, symptoms, and functioning and performance-based measures of executive functioning and social cognition. RESULTS Analyses revealed that intrinsic motivation mediated the relationship between metacognition deficits and impaired functioning (95% CI of indirect effect [0.12-0.43]), even after controlling for the aforesaid variables (95% CI of indirect effect [0.04-0.29]). CONCLUSIONS Results suggest that intrinsic motivation may be a mechanism that underlies the link between deficits in metacognition and impaired functioning and indicate that metacognition and intrinsic motivation may be important treatment targets to improve functioning in individuals with psychosis. PRACTITIONER POINTS The findings of this study suggest that deficits in metacognition may indirectly lead to impaired functioning through their effect on intrinsic motivation in individuals with psychosis. Psychological treatments that target deficits in both metacognition and intrinsic motivation may help to alleviate impaired functioning in individuals with psychosis. LIMITATIONS The cross-sectional design of this study is a limitation, and additional longitudinal studies are needed to confirm the direction of the findings and rule out rival hypotheses. Generalization of the findings may be limited by the sample composition. It may be that different relationships exist between metacognition, intrinsic motivation, and functioning in those with early psychosis or among those in an acute phase or who decline treatment.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Ruth L Firmin
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Eskenazi Hospital, Indianapolis, Indiana, USA.,Larue D. Carter Memorial Hospital, Indiana University Psychotic Disorders Research Program, Indianapolis, Indiana, USA
| | - Kelly D Buck
- Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
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Saperstein AM, Medalia A. The Role of Motivation in Cognitive Remediation for People with Schizophrenia. Curr Top Behav Neurosci 2016; 27:533-546. [PMID: 25772266 DOI: 10.1007/7854_2015_373] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Motivation impairment is an often prominent component of schizophrenia symptomatology that impacts treatment engagement and reduces the functional benefit from psychosocial interventions. Intrinsic motivation in particular has been shown to be impaired in schizophrenia. Nowhere is the role of intrinsic motivation impairment more evident than in cognitive remediation for schizophrenia. This chapter describes the theoretical determinants of motivation to learn and illustrates how those determinants have been translated into therapeutic techniques that enhance intrinsic motivation in a clinical context. We review the extant research that indicates how motivation enhancing techniques yield treatment-related improvements within cognitive remediation therapy and, more broadly, in other behavioral skills-based interventions for schizophrenia.
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Affiliation(s)
- Alice M Saperstein
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Mailbox 104, New York, USA.
| | - Alice Medalia
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Mailbox 104, New York, USA
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45
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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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Luther L, Lysaker PH, Firmin RL, Breier A, Vohs JL. Intrinsic motivation and amotivation in first episode and prolonged psychosis. Schizophr Res 2015; 169:418-422. [PMID: 26386901 DOI: 10.1016/j.schres.2015.08.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
Abstract
The deleterious functional implications of motivation deficits in psychosis have generated interest in examining dimensions of the construct. However, there remains a paucity of data regarding whether dimensions of motivation differ over the course of psychosis. Therefore, this study examined two motivation dimensions, trait-like intrinsic motivation, and the negative symptom of amotivation, and tested the impact of illness phase on the 1) levels of these dimensions and 2) relationship between these dimensions. Participants with first episode psychosis (FEP; n=40) and prolonged psychosis (n=66) completed clinician-rated measures of intrinsic motivation and amotivation. Analyses revealed that when controlling for group differences in gender and education, the FEP group had significantly more intrinsic motivation and lower amotivation than the prolonged psychosis group. Moreover, intrinsic motivation was negatively correlated with amotivation in both FEP and prolonged psychosis, but the magnitude of the relationship did not statistically differ between groups. These findings suggest that motivation deficits are more severe later in the course of psychosis and that low intrinsic motivation may be partially independent of amotivation in both first episode and prolonged psychosis. Clinically, these results highlight the importance of targeting motivation in early intervention services.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N., Blackford St., LD 124, Indianapolis, IN 46202, USA.
| | - Paul H Lysaker
- Roudebush VA Medical Center, Research Dept. Mail code (151), 1481 W. 10th St., Indianapolis, IN 46219, USA; Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN 46202, USA.
| | - Ruth L Firmin
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N., Blackford St., LD 124, Indianapolis, IN 46202, USA.
| | - Alan Breier
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Wishard Hospital, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, 2601 Cold Spring Rd, Indianapolis, IN 46222,USA
| | - Jenifer L Vohs
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN 46202, USA; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Wishard Hospital, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, 2601 Cold Spring Rd, Indianapolis, IN 46222,USA.
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47
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Gerritsen CJ, Goldberg JO, Eastwood JD. Boredom proneness predicts quality of life in outpatients diagnosed with schizophrenia-spectrum disorders. Int J Soc Psychiatry 2015; 61:781-7. [PMID: 25964448 DOI: 10.1177/0020764015584647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is increasing recognition of the clinical significance of boredom associated with functional impairments in schizophrenia. Previous work has highlighted the importance of motivational deficits more broadly, although no study has yet explored the unique effects of boredom on community outcomes. AIMS This study aims to measure boredom proneness among outpatients diagnosed with schizophrenia to determine whether it is elevated in this population and to determine its relation to quality-of-life outcomes. METHODS A self-report measure of boredom proneness along with standard measures of symptoms and functional status was administered to a community-dwelling sample of schizophrenia outpatients. RESULTS Boredom proneness was found to be elevated in this population and was associated with reduced quality of life, specifically with leisure activity dissatisfaction and reduced sense of financial well-being. Negative symptoms were determined to be associated with reduced work and school functioning. CONCLUSION This pattern of unique effects on quality of life highlights the clinical relevance of identifying a subjective state of boredom and has theoretical importance in distinguishing boredom proneness specifically from more general avolitional and amotivational conditions that have tended to be the focus of clinical observation and previous research.
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Affiliation(s)
| | - Joel O Goldberg
- Department of Psychology, York University, Toronto, ON, Canada
| | - John D Eastwood
- Department of Psychology, York University, Toronto, ON, Canada
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Behdinan T, Foussias G, Wheeler AL, Stefanik L, Felsky D, Remington G, Rajji TK, Mallar Chakravarty M, Voineskos AN. Neuroimaging predictors of functional outcomes in schizophrenia at baseline and 6-month follow-up. Schizophr Res 2015; 169:69-75. [PMID: 26603060 PMCID: PMC4681643 DOI: 10.1016/j.schres.2015.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Studies show that deficit syndrome schizophrenia patients, characterized by primary negative symptoms and poor functional outcome, have impairment in specific neural circuits. We assessed whether these same neural circuits are directly linked to functional outcomes across schizophrenia patients. METHODS T1- and diffusion-weighted MR images were obtained for schizophrenia (n=30) and matched healthy control participants (n=30). Negative symptoms and functional outcome were assessed at baseline and 6-month follow-up. Cortical thickness and tract-wise fractional anisotropy (FA) were compared between groups. To assess relationships of neuroimaging measures with functional outcome, principal component analysis (PCA) was performed on tract-wise FA values and components were entered into a multiple regression model for schizophrenia participants. RESULTS Consistent with the literature, schizophrenia participants showed frontotemporal reductions in cortical thickness and tract-wise FA compared to controls. The top two components from PCA explained 71% of the variance in tract-wise FA values. The second component (associated with inferior longitudinal and arcuate fasciculus FA) was significantly correlated with functional outcome (baseline: β=0.54, p=0.03; follow-up: β=0.74, p=0.047); further analysis revealed this effect was mediated by negative symptoms. Post-hoc network analysis revealed increased cortical coupling between right inferior frontal and supramarginal gyri (connected by the arcuate fasciculus) in schizophrenia participants with poorer functional outcome. CONCLUSIONS Our findings indicate that impairment in the same neural circuitry susceptible in deficit syndrome schizophrenia predicts functional outcome in a continuous manner in schizophrenia participants. This relationship was mediated by negative symptom burden. Our findings provide novel evidence for brain-based biomarkers of longitudinal functional outcome in people with schizophrenia.
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Affiliation(s)
- Tina Behdinan
- Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 27 King's College Circle, Toronto, ON M5S, Canada
| | - George Foussias
- Institute of Medical Science, University of Toronto, 27 King's College Circle, Toronto, ON M5S, Canada; Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 27 King's College Circle, Toronto, ON, M5S, Canada
| | - Anne L Wheeler
- Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Laura Stefanik
- Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Daniel Felsky
- Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 27 King's College Circle, Toronto, ON M5S, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, 27 King's College Circle, Toronto, ON M5S, Canada; Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 27 King's College Circle, Toronto, ON, M5S, Canada
| | - Tarek K Rajji
- Institute of Medical Science, University of Toronto, 27 King's College Circle, Toronto, ON M5S, Canada; Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 27 King's College Circle, Toronto, ON, M5S, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Aristotle N Voineskos
- Kimel Family Translational Imaging-Genetics Research Lab, Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Institute of Medical Science, University of Toronto, 27 King's College Circle, Toronto, ON M5S, Canada; Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 27 King's College Circle, Toronto, ON, M5S, Canada.
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49
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Wallace TL, Bertrand D. Neuronal α7 Nicotinic Receptors as a Target for the Treatment of Schizophrenia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 124:79-111. [PMID: 26472526 DOI: 10.1016/bs.irn.2015.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Schizophrenia is a lifelong disease, the burden of which is often underestimated. Characterized by positive (e.g., hallucinations) and negative (e.g., avolition, amotivation) symptoms, schizophrenia is also accompanied with profound impairments in cognitive function that progress throughout the development of the disease. Although treatment with antipsychotic medications can effectively dampen some of the positive symptoms, these medications largely fail to reverse cognitive deficits or to mitigate negative symptoms. With a worldwide prevalence of approximately 1%, schizophrenia remains a large unmet medical need that stands to benefit greatly from (1) continued research to better understand the biological underpinnings of the disease and (2) the targeted development of novel therapeutics to improve the lives of those affected individuals. Improvements in our understanding of the neuronal networks associated with schizophrenia as well as progress in identifying genetic risk factors and environmental conditions that may predispose individuals to developing the disease are advancing new strategies to study and treat it. Herein, we review the evidence that supports the role of α7 nicotinic acetylcholine receptors in the central nervous system and why these receptors constitute a promising target to treat some of the prominent symptoms of schizophrenia.
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50
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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: 30] [Impact Index Per Article: 3.3] [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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