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Isıklı S, Bektaş AB, Tamer Ş, Atabay M, Arkalı BD, Bağcı B, Bayrakcı A, Sebold M, Zorlu N. Effort-cost decision-making associated with negative symptoms in schizophrenia and bipolar disorder. Behav Brain Res 2024; 467:114996. [PMID: 38609021 DOI: 10.1016/j.bbr.2024.114996] [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: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024]
Abstract
Motivational deficits and reduced goal-directed behavior for external rewards have long been considered an important features of negative symptoms in patients with schizophrenia (SCZ). Negative symptoms have also a high prevalence in bipolar disorder (BP). We used a transdiagnostic approach in order to examine association between negative symptoms and effort allocation for monetary rewards. 41 patients with SCZ and 34 patients with BP were enrolled in the study along with 41 healthy controls (HC). Effort-Expenditure for Rewards Task (EEfRT) was used to measure subjects' effort allocation for monetary rewards. Generalized estimating equation models were used to analyze EEfRT choice behavior. Negative symptoms were assessed using the Brief Negative Symptom Scale (BNSS). SCZ and BP groups expended lower effort to obtain a monetary rewards compared to HC. Severity of negative symptoms was negatively correlated with EEfRT performance in both diagnostic groups. Each diagnostic group showed lower effort allocation for monetary rewards compared to HC suggesting reduced motivation for monetary rewards. In addition, our results suggest that abnormal effort-based decision-making might be a transdiagnostic factor underlying negative symptoms.
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Affiliation(s)
- Serhan Isıklı
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Aslıhan Bilge Bektaş
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Şule Tamer
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Murat Atabay
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Bilgesu Deniz Arkalı
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Başak Bağcı
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Adem Bayrakcı
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey
| | - Miriam Sebold
- Department of Business and Law, Aschaffenburg University of Applied Sciences, Aschaffenburg, Germany
| | - Nabi Zorlu
- Department of Psychiatry, Katip Celebi University Ataturk Education and Research Hospital, Izmir, Turkey.
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Bora E, Eyuboglu MS, Cesim E, Demir M, Yalincetin B, Ermis C, Özbek Uzman S, Sut E, Demirlek C, Verim B, Baykara B, İnal N, Akdede BB. Social cognition and neurocognition in first-episode bipolar disorder and psychosis: The effect of negative and attenuated positive symptoms. J Affect Disord 2024; 351:356-363. [PMID: 38290586 DOI: 10.1016/j.jad.2024.01.237] [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: 09/11/2023] [Revised: 01/13/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Schizophrenia and bipolar disorder are associated with neurocognitive and social-cognitive impairments. To date very few studies investigated social cognition in first-episode bipolar disorder (FEBD). Our main aim was to investigate the differences in social cognition and neurocognition between FEBD and first-episode psychosis (FEP). Another aim was to investigate neurocognitive correlates of negative symptoms and attenuated psychotic symptoms in FEBD. METHODS This study included 55 FEBD, 64 FEP and 43 healthy controls. A comprehensive neuropsychological battery assessing social cognition, processing speed, verbal and visual memory, working memory, sustained attention, and executive functions was administered to all participants. RESULTS Both FEBD and FEP were associated with widespread deficits in all neurocognitive domains and social cognition. Both FEP (d = -1.19) and FEBP (d = -0.88) were also impaired in social cognition. In FEP, effect sizes (Cohen's d) of neurocognitive deficits ranged from -0.71 to -1.56. FEBD was also associated with relatively milder but similar neurocognitive deficits (d = -0.61 to-1.17). FEBD group performed significantly better than FEP group in verbal and visual memory, processing speed, and executive function domains (d = -0.40 to-0.52). Negative symptoms and social functioning were associated with neuropsychological impairment in both groups. The severity of attenuated psychotic symptoms was associated with poorer verbal memory in FEBD (r = -0.39, p < 0.01). LIMITATIONS The cross-sectional nature of the current study is the main limitation. CONCLUSIONS Neurocognitive and social-cognitive deficits are evident in both FEBD and FEP. In FEBD, more severe memory deficits might be markers of clinical overlap and shared neurobiological vulnerability with psychotic disorders.
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Affiliation(s)
- E Bora
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia.
| | - M S Eyuboglu
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - E Cesim
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - M Demir
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - B Yalincetin
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - C Ermis
- Queen Silvia Children's Hospital, Department Child and Adolescent Psychiatry, Gothenburg, Sweden
| | - S Özbek Uzman
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - E Sut
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - C Demirlek
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - B Verim
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - B Baykara
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - N İnal
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - B B Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
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Whitton AE, Cooper JA, Merchant JT, Treadway MT, Lewandowski KE. Using Computational Phenotyping to Identify Divergent Strategies for Effort Allocation Across the Psychosis Spectrum. Schizophr Bull 2024:sbae024. [PMID: 38498838 DOI: 10.1093/schbul/sbae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances in effort-cost decision-making have been highlighted as a potential transdiagnostic process underpinning negative symptoms in individuals with schizophrenia. However, recent studies using computational phenotyping show that individuals employ a range of strategies to allocate effort, and use of different strategies is associated with unique clinical and cognitive characteristics. Building on prior work in schizophrenia, this study evaluated whether effort allocation strategies differed in individuals with distinct psychotic disorders. STUDY DESIGN We applied computational modeling to effort-cost decision-making data obtained from individuals with psychotic disorders (n = 190) who performed the Effort Expenditure for Rewards Task. The sample included 91 individuals with schizophrenia/schizoaffective disorder, 90 individuals with psychotic bipolar disorder, and 52 controls. STUDY RESULTS Different effort allocation strategies were observed both across and within different disorders. Relative to individuals with psychotic bipolar disorder, a greater proportion of individuals with schizophrenia/schizoaffective disorder did not use reward value or probability information to guide effort allocation. Furthermore, across disorders, different effort allocation strategies were associated with specific clinical and cognitive features. Those who did not use reward value or probability information to guide effort allocation had more severe positive and negative symptoms, and poorer cognitive and community functioning. In contrast, those who only used reward value information showed a trend toward more severe positive symptoms. CONCLUSIONS These findings indicate that similar deficits in effort-cost decision-making may arise from different computational mechanisms across the psychosis spectrum.
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Affiliation(s)
- Alexis E Whitton
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Jessica A Cooper
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jaisal T Merchant
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
| | - Michael T Treadway
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Kathryn E Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Luther L, Jarvis SA, Spilka MJ, Strauss GP. Global reward processing deficits predict negative symptoms transdiagnostically and transphasically in a severe mental illness-spectrum sample. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01714-7. [PMID: 38051397 DOI: 10.1007/s00406-023-01714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023]
Abstract
Reward processing impairments are a key factor associated with negative symptoms in those with severe mental illnesses. However, past findings are inconsistent regarding which reward processing components are impaired and most strongly linked to negative symptoms. The current study examined the hypothesis that these mixed findings may be the result of multiple reward processing pathways (i.e., equifinality) to negative symptoms that cut across diagnostic boundaries and phases of illness. Participants included healthy controls (n = 100) who served as a reference sample and a severe mental illness-spectrum sample (n = 92) that included psychotic-like experiences, clinical high-risk for psychosis, bipolar disorder, and schizophrenia participants. All participants completed tasks measuring four RDoC Positive Valence System constructs: value representation, reinforcement learning, effort-cost computation, and hedonic reactivity. A k-means cluster analysis of the severe mental illness-spectrum samples identified three clusters with differential reward processing profiles that were characterized by: (1) global reward processing deficits (22.8%), (2) selective impairments in hedonic reactivity alone (40.2%), and (3) preserved reward processing (37%). Elevated negative symptoms were only observed in the global reward processing cluster. All clusters contained participants from each clinical group, and the distribution of these groups did not significantly differ among the clusters. Findings identified one pathway contributing to negative symptoms that was transdiagnostic and transphasic. Future work further characterizing divergent pathways to negative symptoms may help to improve symptom trajectories and personalized treatments.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
| | - Sierra A Jarvis
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Michael J Spilka
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
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Wehr S, Weigel L, Davis J, Galderisi S, Mucci A, Leucht S. Clinical Assessment Interview for Negative Symptoms (CAINS): A Systematic Review of Measurement Properties. Schizophr Bull 2023:sbad137. [PMID: 37951838 DOI: 10.1093/schbul/sbad137] [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] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Negative symptoms are very important for the overall loss of functioning observed in patients with schizophrenia. There is a need for valid tools to assess these symptoms. STUDY DESIGN We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review guideline to evaluate the quality of the clinical assessment interview for negative symptoms (CAINS) as a clinician-rated outcome measurement (ClinROM). STUDY RESULTS The search strategy resulted in the retrieval of 13 articles, 11 of which were included in this evaluation. In terms of risk of bias, most articles reported on measures of internal consistency and construct validity, which were overall of good quality. Structural validity, reliability, measurement error, and cross-cultural validity were reported with less than optimum quality. There was a risk of bias in ClinROM development. According to the updated criteria of good measurement properties, structural validity, internal consistency, and reliability showed good results. In contrast, hypothesis testing was somewhat poorer. Results for cross-cultural validity were indeterminate. According to the updated GRADE approach from the COSMIN group the scale received a moderate grade. CONCLUSIONS The COSMIN standard allows a judgment of the CAINS as an instrument with the potential to be recommended for use, but which requires further research to assess its quality, in particular in the domains of content validity, internal consistency, and cross-cultural validity.
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Affiliation(s)
- Sophia Wehr
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lucia Weigel
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL
- Maryland Psychiatric Research Center, Baltimore, MD
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Weigel L, Wehr S, Galderisi S, Mucci A, Davis J, Giordano GM, Leucht S. The Brief negative Symptom Scale (BNSS): a systematic review of measurement properties. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:45. [PMID: 37500628 PMCID: PMC10374652 DOI: 10.1038/s41537-023-00380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Negative symptoms of schizophrenia are linked with poor functioning and quality of life. Therefore, appropriate measurement tools to assess negative symptoms are needed. The NIMH-MATRICS Consensus defined five domains for negative symptoms, which The Brief Negative Symptom Scale (BNSS) covers. METHODS We used the COSMIN guidelines for systematic reviews to evaluate the quality of psychometric data of the BNSS scale as a Clinician-Rated Outcome Measure (ClinROM). RESULTS The search strategy resulted in the inclusion of 17 articles. When using the risk of bias checklist, there was a generally good quality in reporting of structural validity and hypothesis testing. Internal consistency, reliability and cross-cultural validity were of poorer quality. ClinROM development and content validity showed inadequate results. According to the updated criteria of good measurement properties, structural validity, internal consistency and interrater reliability showed good results, while hypothesis testing showed poorer results. Cross-cultural validity and test-retest reliability were indeterminate. The updated GRADE approach resulted in a moderate grade. CONCLUSIONS We can potentially recommend the use of the BNSS as a concise tool to rate negative symptoms. Due to weaknesses in certain domains further validations are warranted.
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Affiliation(s)
- Lucia Weigel
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Sophia Wehr
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago (mc 912), 1601 W. Taylor St., Chicago, Il 60612, and Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Giulia Maria Giordano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany.
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Ihler HM, Lyngstad SH, Mørch-Johnsen LE, Lagerberg TV, Melle I, Romm KL. A transdiagnostic approach to negative symptoms: exploring factor structure and negative symptoms in bipolar disorders. Front Psychiatry 2023; 14:1136097. [PMID: 37398600 PMCID: PMC10313454 DOI: 10.3389/fpsyt.2023.1136097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Background Negative symptoms are increasingly recognized as transdiagnostic phenomena, linked to reduced quality of life and functioning, and often caused or worsened by amendable external factors such as depression, social deprivation, side-effects of antipsychotics or substance use. The structure of negative symptoms fits into two dimensions: diminished expression and apathy. These may differ in association with external factors that influence their severity and may thus require different treatment approaches. The dimensions are comprehensively established in non-affective psychotic disorders but are understudied in bipolar disorders. Methods We conducted exploratory and confirmatory factor analyses in a sample of 584 individuals with bipolar disorder to assess the latent factor structure of negative symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), and performed correlational analyses and multiple hierarchical regression analyses to investigate links between the two dimensions of negative symptoms and clinical and sociodemographic correlates. Results The latent factor structure of negative symptoms fits into two dimensions, i.e., diminished expression and apathy. A diagnosis of bipolar type I or a history of psychotic episodes predicted more severe levels of diminished expression. Depressive symptoms were associated with more severe negative symptoms across dimensions, yet 26.3% of euthymic individuals still displayed at least one mild or more severe negative symptom (PANSS score ≥ 3). Discussion The two-dimensional structure of negative symptoms seen in non-affective psychotic disorders reproduces in bipolar disorders indicating similarities in their phenomenology. Diminished expression was associated with a history of psychotic episodes and a diagnosis of BD-I, which may infer closer connections to psychosis liability. We found significantly less severe negative symptoms in euthymic than depressed participants. Nevertheless, more than a quarter of the euthymic individuals had at least one mild negative symptom, demonstrating some degree of persistence beyond depressed states.
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Affiliation(s)
- Henrik Myhre Ihler
- Norment, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Siv Hege Lyngstad
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Lynn Egeland Mørch-Johnsen
- Norment, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Department of Clinical Research, Østfold Hospital, Grålum, Norway
| | - Trine Vik Lagerberg
- Norment, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- Norment, Division of Mental Health and Addiction, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Santos HC, Rodrigues A, Ferreira S, Martins JM, Baptista T, Gama Marques J, Kirkpatrick B, Prata D. The European Portuguese Version of the Brief Negative Symptom Scale. Psychopathology 2023; 57:76-80. [PMID: 37276842 DOI: 10.1159/000530705] [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: 08/25/2022] [Accepted: 04/12/2023] [Indexed: 06/07/2023]
Abstract
Negative symptoms reflect a currently much-untreated loss of normal functioning and are frequently found in psychotic disorders. We present the first translation of the Brief Negative Symptom Scale (BNSS) to European Portuguese and evaluate its validity in a sample of Portuguese male patients with a psychotic spectrum disorder. The Portuguese BNSS showed excellent internal consistency, high convergent validity (i.e., strong correlation with the PANSS negative factor), and high discriminant validity (i.e., a lack of association with the PANSS positive factor). In sum, the present European Portuguese BNSS has shown to be reliable, thus extending this instrument's clinical availability worldwide.
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Affiliation(s)
- Henrique Castro Santos
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - Alexandra Rodrigues
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- Unidade de Neurorradiologia, Hospital Central Do Funchal, Funchal, Portugal
| | - Sara Ferreira
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - João Malhadas Martins
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Baptista
- Departamento de Imagiologia, Hospital CUF Tejo, Lisboa, Portugal
| | - João Gama Marques
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Brian Kirkpatrick
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Diana Prata
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Lisboa, Portugal
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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9
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Luther L, Raugh IM, Collins DE, Knippenberg AR, Strauss GP. Negative symptoms in schizophrenia differ across environmental contexts in daily life. J Psychiatr Res 2023; 161:10-18. [PMID: 36893666 PMCID: PMC10149609 DOI: 10.1016/j.jpsychires.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
A recent environmental theory of negative symptoms posits that environmental contexts (e.g., location, social partner) play a significant-yet often unaccounted for-role in negative symptoms of schizophrenia (SZ). "Gold-standard" clinical rating scales offer limited precision for evaluating how contexts impact symptoms. To overcome some of these limitations, Ecological Momentary Assessment (EMA) was used to determine whether there were state fluctuations in experiential negative symptoms (anhedonia, avolition, and asociality) in SZ across contexts (locations, activities, social interaction partner, social interaction method). Outpatients with SZ (n = 52) and healthy controls (CN: n = 55) completed 8 daily EMA surveys for 6 days assessing negative symptom domains (anhedonia, avolition, and asociality) and contexts. Multilevel modeling demonstrated that negative symptoms varied across location, activity, social interaction partner, and social interaction method. For the majority of contexts, SZ and CN did not report significantly different levels of negative symptoms, with SZ only reporting higher negative symptoms than CN while eating, resting, interacting with a significant other, or being at home. Further, there were several contexts where negative symptoms were similarly reduced (e.g., recreation, most social interactions) or elevated (e.g., using the computer, working, running errands) in each group. Results demonstrate that experiential negative symptoms dynamically change across contexts in SZ. Some contexts may "normalize" experiential negative symptoms in SZ, while other contexts, notably some used to promote functional recovery, may increase experiential negative symptoms.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
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Berglund AM, James SH, Raugh IM, Strauss GP. Beliefs About the Uncontrollability and Usefulness of Emotion in the Schizophrenia-Spectrum: Links to Emotion Regulation and Negative Symptoms. COGNITIVE THERAPY AND RESEARCH 2023; 47:282-294. [PMID: 36779179 PMCID: PMC9894745 DOI: 10.1007/s10608-023-10357-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
Background Beliefs about the usefulness and controllability of emotions are associated with emotion regulation and psychological distress in the general population. Although individuals with schizophrenia-spectrum disorders evidence emotion regulation abnormalities, it is unclear whether emotional beliefs contribute to these difficulties and their associated poor clinical outcomes. Methods Participants included 72 individuals with schizophrenia-spectrum diagnoses (outpatients with schizophrenia n = 38; youth at clinical high-risk for psychosis, n = 34) and healthy controls (CN: n = 61) who completed the Emotional Beliefs Questionnaire, Emotion Regulation Questionnaire, and measures of clinical symptom severity. Results Those with schizophrenia-spectrum diagnoses reported believing that emotions were less controllable than CN; however, groups did not differ regarding beliefs about the usefulness of emotion. Greater beliefs of the uncontrollability of emotion were associated with greater use of suppression, less use of reappraisal, and increased negative symptoms. Emotion regulation partially mediated the association between emotional beliefs and negative symptoms. Conclusions Individuals in the schizophrenia-spectrum display superordinate beliefs that emotions are uncontrollable. These beliefs may influence emotion regulation strategy selection and success, which contributes to negative symptoms. Findings suggest that beliefs of emotional uncontrollability reflect a novel process related to both emotion regulation and negative symptoms that could be targeted in psychosocial treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10357-w.
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Affiliation(s)
- Alysia M. Berglund
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Sydney H. James
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Ian M. Raugh
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
| | - Gregory P. Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St, Athens, GA USA
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Martinuzzi LJ, Strassnig MT, Depp CA, Moore RC, Ackerman R, Pinkham AE, Harvey PD. A closer look at avolition in schizophrenia and bipolar disorder: Persistence of different types of activities over time. Schizophr Res 2022; 250:188-195. [PMID: 36436498 PMCID: PMC9810384 DOI: 10.1016/j.schres.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/18/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Avolition is associated cross-diagnostically with extensive functional impairment. Participants with schizophrenia and bipolar disorder (BD) engage in fewer productive activities than healthy controls, with more sedentary activities such as sitting. We examined the temporal variability in activities of participants with schizophrenia and bipolar disorder, focusing on persistence of activities and the likelihood of performing more than one activity at a time. METHODS 101 participants with schizophrenia and 76 participants with BD were sampled 3 times per day for 30 days utilizing Ecological Momentary Assessment surveys. Each survey queried current activities along with questions about who they were with and if they were home or away and moods. We separated activities into productive, unproductive, or passive recreational categories. RESULTS Participants with schizophrenia and bipolar disorder reported one activity on most surveys, with that activity commonly being passive or unproductive. No participant reported engaging in more than one productive activity. Productive activities were more likely to occur away from home, with 17 % of surveys from home reporting productive activities. All three activities were persistent, but passive and unproductive activities were more likely than productive activities to be persistent at home. Negative mood states predicted unproductive and passive activities in BD participants only. DISCUSSION The low numbers of activities, combined with persistence of unproductive and passive activities highlights the impact of avolition. Most persistent activities reflected sedentary behavior. People with schizophrenia or bipolar disorder may benefit from interventions targeting leaving home more often to improve their general levels of functioning and overall health.
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Affiliation(s)
| | - Martin T Strassnig
- Department of Psychiatry, University of Miami Miller School of Medicine, USA
| | - Colin A Depp
- Department of Psychiatry UCSD Medical Center, USA; San Diego VA Healthcare System, USA
| | | | - Robert Ackerman
- Department of Psychology, University of Texas at Dallas, USA
| | - Amy E Pinkham
- Department of Psychology, University of Texas at Dallas, USA; Department of Psychiatry, UT Southwestern Medical Center, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, USA; Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA.
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12
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Perez MM, Tercero BA, Durand F, Gould F, Moore RC, Depp CA, Ackerman RA, Pinkham AE, Harvey PD. Revisiting how People with Schizophrenia Spend Their Days: Associations of lifetime milestone Achievements with Daily Activities examined with Ecological Momentary Assessment. PSYCHIATRY RESEARCH COMMUNICATIONS 2022; 2:100060. [PMID: 36118412 PMCID: PMC9477426 DOI: 10.1016/j.psycom.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Milestone achievements are reduced in people with schizophrenia and are lower in comparison to people with bipolar disorder. However, it is not clear what the implications are for engagement in momentary activities based on milestone achievements. Further, some recent research has suggested that psychotic symptoms are associated with challenges in self-assessment of activities, but there is less information about the correlations of milestone achievements and ongoing psychotic symptoms. We examined momentary activities and symptoms as a function of lifetime milestone achievement in 102 individuals with schizophrenia and 71 with bipolar disorder. Ecological Momentary Assessment (EMA) was used to sample daily activities and concurrent symptoms 3 times per day for 30 days. Each survey asked the participant where they were, who they were with, and what they were doing, as well as sampling the concurrent presence of psychotic symptoms. Not being financially responsible for their residence was associated with engaging in fewer productive activities. Participants who never had a relationship were more commonly home and alone and engaged in fewer social interactions. A lifetime history of employment was correlated with engaging in more productive activities, including at home. More common momentary psychosis was seen in participants who failed to achieve each of the functional milestones. Lifetime milestone achievements were associated with greater frequencies of productive behaviors and with fewer momentary experiences of psychosis, suggesting that psychotic symptoms may have importance for sustaining disability that would be challenging to detect without momentary information.
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Affiliation(s)
- Michelle M. Perez
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Bianca A. Tercero
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | | | - Felicia Gould
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Raeanne C. Moore
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Robert A. Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
- Research Service, Miami VA Healthcare System, Miami, FL, USA
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13
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Miller ML, Raugh IM, Strauss GP, Harvey PD. Remote digital phenotyping in serious mental illness: Focus on negative symptoms, mood symptoms, and self-awareness. Biomark Neuropsychiatry 2022. [DOI: 10.1016/j.bionps.2022.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Fendrich SJ, Koralnik LR, Bonner M, Goetz D, Joe P, Lee J, Mueller B, Robinson-Papp J, Gonen O, Clemente JC, Malaspina D. Patient-reported exposures and outcomes link the gut-brain axis and inflammatory pathways to specific symptoms of severe mental illness. Psychiatry Res 2022; 312:114526. [PMID: 35462090 DOI: 10.1016/j.psychres.2022.114526] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 02/08/2023]
Abstract
UNLABELLED We developed a "gut-brain-axis questionnaire" (GBAQ) to obtain standardized person-specific "review of systems" data for microbiome-gut-brain-axis studies. Individual items were compared to PANSS symptom measures using dimensional, transdiagnostic and traditional categorical approaches. METHOD Forty psychotic participants, independent of diagnoses, and 42 without psychosis (18 nonpsychotic affective disorders, 24 healthy controls) completed the GBAQ and underwent research diagnostic and symptom assessments. The PANSS scales and its dysphoric mood, autistic preoccupation and activation factors were computed. RESULTS Transdiagnostic analyses robustly linked psychosis severity to constipation (p<.001), and Negative (p=.045) and General Psychopathology scores (p=.016) with bowel hypomotility. Activation factor scores predicted numbers of psychiatric (p=.009) and medical conditions (p=.003), BMI (p=.003), skin (p<.001) and other conditions. Categorical analyses comparing psychotic, nonpsychotic and control groups revealed behavioral differences: cigarette smoking (p=.013), alcohol use (p=.007), diet (p's <.05), exercise (p<.001). All subjects accurately self-reported their diagnosis. CONCLUSIONS The GBAQ is a promising tool. Transdiagnostic analyses associated psychotic symptoms to gut hypomotility, indicative of low gut vagal tone, consistent with reduced cardiovagal activity in psychosis. Activation, similar to delirium symptoms, predicted medical comorbidity and systemic inflammatory conditions. Group level comparisons only showed behavioral differences. Underpinnings of psychiatric disorders may include reduced gut vagal function, producing psychosis, and systemic inflammation, impacting risks for psychotic and nonpsychotic conditions.
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Affiliation(s)
- Sarah J Fendrich
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lauren R Koralnik
- Department of Psychology, Barnard College of Columbia University, New York, New York, USA
| | - Mharisi Bonner
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deborah Goetz
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Joe
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jakleen Lee
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bridget Mueller
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica Robinson-Papp
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Oded Gonen
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dolores Malaspina
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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15
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Strauss GP, Raugh IM, Zhang L, Luther L, Chapman HC, Allen DN, Kirkpatrick B, Cohen AS. Validation of accelerometry as a digital phenotyping measure of negative symptoms in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:37. [PMID: 35853890 PMCID: PMC9261099 DOI: 10.1038/s41537-022-00241-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/24/2022] [Indexed: 05/05/2023]
Abstract
Negative symptoms are commonly assessed via clinical rating scales; however, these measures have several inherent limitations that impact validity and utility for their use in clinical trials. Objective digital phenotyping measures that overcome some of these limitations are now available. The current study evaluated the validity of accelerometry (ACL), a passive digital phenotyping method that involves collecting data on the presence, vigor, and variability of movement. Outpatients with schizophrenia (SZ: n = 50) and demographically matched healthy controls (CN: n = 70) had ACL continuously recorded from a smartphone and smartband for 6 days. Active digital phenotyping assessments, including surveys related to activity context, were also collected via 8 daily surveys throughout the 6 day period. SZ participants had lower scores on phone ACL variables reflecting vigor and variability of movement compared to CN. ACL variables demonstrated convergent validity as indicated by significant correlations with active digital phenotyping self-reports of time spent in goal-directed activities and clinical ratings of negative symptoms. The discriminant validity of ACL was demonstrated by low correlations with clinical rating scale measures of positive, disorganized, and total symptoms. Collectively, findings suggest that ACL is a valid objective measure of negative symptoms that may complement traditional approaches to assessing the construct using clinical rating scales.
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Affiliation(s)
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Luyu Zhang
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Hannah C Chapman
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Las Vegas, NV, USA
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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16
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The impact of the COVID-19 pandemic on negative symptoms in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:17-27. [PMID: 33881621 PMCID: PMC8057945 DOI: 10.1007/s00406-021-01260-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
Negative symptoms are core features of schizophrenia-spectrum disorders that are frequently observed across all phases of illness. By their nature, COVID-19 social isolation, physical distancing, and health precautions induce behavioural aspects of negative symptoms. However, it is unclear whether these prevention measures also lead to increases in experiential negative symptoms, whether such effects are equivalent across individual negative symptom domains, and if exacerbations occur equivalently across phases of illness. The current study compared negative symptom severity scores obtained during the pandemic to pre-pandemic assessments in two samples: (1) outpatients with chronic schizophrenia (SZ: n = 32) and matched healthy controls (CN: n = 31) and (2) individuals at clinical high risk for psychosis (CHR: n = 25) and matched CN (n = 30). Pre-pandemic ratings of negative symptoms were clinically elevated in SZ and CHR groups, which did not differ from each other in severity. In SZ, ratings obtained during the pandemic were significantly higher than pre-pandemic ratings for all 5 domains (alogia, blunted affect, anhedonia, avolition, and asociality) and item-level analyses indicated that exacerbations occurred on both experiential and behavioral symptoms of anhedonia, avolition, and asociality. In contrast, CHR only exhibited increases in anhedonia and avolition items during the pandemic compared to pre-ratings. Findings suggest that negative symptoms should be a critical treatment target during and after the pandemic in the schizophrenia spectrum given that they are worsening and critically related to risk for conversion, functional outcome, and recovery.
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17
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Zakharova K, Arkusha I, Akzigitov R, Avedisova A. Transdiagnostic approach to negative symptoms. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:23-30. [DOI: 10.17116/jnevro202212201123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Strassnig MT, Miller ML, Moore R, Depp CA, Pinkham AE, Harvey PD. Evidence for avolition in bipolar disorder? A 30-day ecological momentary assessment comparison of daily activities in bipolar disorder and schizophrenia. Psychiatry Res 2021; 300:113924. [PMID: 33848963 PMCID: PMC8141033 DOI: 10.1016/j.psychres.2021.113924] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Disability is common in bipolar disorder (BD) and predicted by persistent sadness. We used ecological momentary assessment (EMA) to examine daily activities in people with BD and schizophrenia. We classified activities as productive, unproductive, or passive recreation, relating them to momentary sadness, location, and social context. METHODS 71 people with BD and 102 people with schizophrenia were sampled 3 times/day for 30 days with an EMA survey. Each survey asked where they were, with whom, what they were doing, and if they were sad. RESULTS People with BD were home more than 50% of the time. There were no differences in prevalence of activity types across diagnoses. People with BD were less likely to report only one activity since the prior survey, but the most surveys still reported only one. For both groups, sadness and being home and alone since the last survey was associated with less productive activity and more passive recreation. CONCLUSIONS Participants with BD and schizophrenia manifested high levels of unproductive and passive activities, predicted by momentary sadness. These activity patterns are consistent with descriptions of avolition and they minimally differentiated people with BD and schizophrenia. Previous reports of negative symptoms in BD may have been identifying these behaviors.
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Affiliation(s)
| | - Michelle L Miller
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Raeanne Moore
- UCSD Health Sciences Center, La Jolla, CA, United States
| | - Colin A Depp
- UCSD Health Sciences Center, La Jolla, CA, United States; San Diego VA Medical Center La Jolla, CA, United States
| | - Amy E Pinkham
- University of Texas at Dallas, Richardson, TX, United States; University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, United States; Bruce W. Carter VA Medical Center, Miami, FL, United States.
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19
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Mallet J, Guessoum SB, Tebeka S, Le Strat Y, Dubertret C. Self-evaluation of negative symptoms in adolescent and young adult first psychiatric episodes. Prog Neuropsychopharmacol Biol Psychiatry 2020; 103:109988. [PMID: 32474008 DOI: 10.1016/j.pnpbp.2020.109988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Negative Symptoms (blunted affect, alogia, anhedonia, avolition, and asociality) are usually described in schizophrenia but they are also present in other psychiatric disorders. The diagnosis and prognosis relevance of negative symptoms (NS) self-assessment during a first psychiatric episode is still unknown. AIMS To determine (i) the rate of self-assessed NS in a first psychiatric episode among adolescents and young adults compared to control subjects; and (ii), whether there is a difference in the prevalence of NS between schizophrenia and major depressive disorder first episodes. METHODS The population included patients aged 15-25 years, with no psychiatric history and no history of medication. A dimensional evaluation was assessed during hospitalization, including depressive (Hamilton Depression Scale), psychotic symptoms (Prodromal Questionnaire, 16 items) and the self-evaluation of negative symptoms (SNS scale). Prospective categorical diagnoses were updated 6 months after hospitalization. The population included 117 individuals (58 patients and 59 healthy controls). RESULTS Among healthy individuals, 47.5% reported at least one NS, the most reported being amotivation. After binary logistic regression, Negative Symptoms (SNS score) were associated with a diagnostic of psychiatric disorder at the 6-months follow-up (OR = 1.163, p = .001), whereas depressive symptoms and psychotic experiences were not. A SNS threshold allowed to screen first episode patients and SZ patients in the general population (assessed with ROC curve). A high prevalence of self-reported NS was observed across diagnostic boundaries in first psychiatric episodes, with a mean SNS score of 19.3 ± 7.1 for schizophrenic disorders and 20.7 ± 8.6 for depressive disorders. The prevalence of NS was not significantly different between depressive disorders and schizophrenic disorders (p > .05). CONCLUSION NS are an important transnosographic dimension during first psychiatric episodes among adolescents and young adults. Negative symptoms self-assessment with the SNS scale is relevant during a first psychiatric episode.
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Affiliation(s)
- Jasmina Mallet
- AP-HP Greater Paris University Hospital, Psychiatry Department, University Hospital Louis Mourier, France; University of Paris, INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France.
| | - Sélim Benjamin Guessoum
- AP-HP Greater Paris University Hospital, Psychiatry Department, University Hospital Louis Mourier, France
| | - Sarah Tebeka
- AP-HP Greater Paris University Hospital, Psychiatry Department, University Hospital Louis Mourier, France; University of Paris, INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
| | - Yann Le Strat
- AP-HP Greater Paris University Hospital, Psychiatry Department, University Hospital Louis Mourier, France; University of Paris, INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
| | - Caroline Dubertret
- AP-HP Greater Paris University Hospital, Psychiatry Department, University Hospital Louis Mourier, France; University of Paris, INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
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20
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Metacognition Is Uniquely Related to Concurrent and Prospective Assessments of Negative Symptoms Independent of Verbal Memory in Serious Mental Illness. J Nerv Ment Dis 2020; 208:837-842. [PMID: 32740145 DOI: 10.1097/nmd.0000000000001219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The inability to synthesize information into experience of self and others could be one significant cause of negative symptoms. To explore this possibility, we examined the relationships between baseline metacognition and concurrent and prospective negative symptoms controlling for verbal memory. The participants were 62 adults diagnosed with serious mental illness enrolled in outpatient treatment. Metacognition was measured with the Metacognitive Assessment Scale-Abbreviated, symptoms were assessed using the Brief Psychiatric Rating Scale, and verbal memory was assessed using the California Verbal Learning Test. Significant correlations were found, indicating that poorer overall metacognition was associated with greater levels of negative symptoms assessed concurrently (r = 0.39) and 1 month later (r = 0.36). A significant relationship persisted after controlling for verbal memory and education. These findings support the idea that metacognitive deficits are related to negative symptoms and point to the potential of metacognitive interventions to positively influence negative symptoms.
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21
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Raugh IM, James SH, Gonzalez CM, Chapman HC, Cohen AS, Kirkpatrick B, Strauss GP. Geolocation as a Digital Phenotyping Measure of Negative Symptoms and Functional Outcome. Schizophr Bull 2020; 46:1596-1607. [PMID: 32851401 PMCID: PMC7751192 DOI: 10.1093/schbul/sbaa121] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Negative symptoms and functional outcome have traditionally been assessed using clinical rating scales, which rely on retrospective self-reports and have several inherent limitations that impact validity. These issues may be addressed with more objective digital phenotyping measures. In the current study, we evaluated the psychometric properties of a novel "passive" digital phenotyping method: geolocation. METHOD Participants included outpatients with schizophrenia or schizoaffective disorder (SZ: n = 44), outpatients with bipolar disorder (BD: n =19), and demographically matched healthy controls (CN: n = 42) who completed 6 days of "active" digital phenotyping assessments (eg, surveys) while geolocation was recorded. RESULTS Results indicated that SZ patients show less activity than CN and BD, particularly, in their travel from home. Geolocation variables demonstrated convergent validity by small to medium correlations with negative symptoms and functional outcome measured via clinical rating scales, as well as active digital phenotyping behavioral indices of avolition, asociality, and anhedonia. Discriminant validity was supported by low correlations with positive symptoms, depression, and anxiety. Reliability was supported by good internal consistency and moderate stability across days. CONCLUSIONS These findings provide preliminary support for the reliability and validity of geolocation as an objective measure of negative symptoms and functional outcome. Geolocation offers enhanced precision and the ability to take a "big data" approach that facilitates sophisticated computational models. Near-continuous recordings and large numbers of samples may make geolocation a novel outcome measure for clinical trials due to enhanced power to detect treatment effects.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA
| | - Sydney H James
- Department of Psychology, University of Georgia, Athens, GA
| | | | | | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA,To whom correspondence should be addressed; tel: +1-706-542-0307, fax: +1-706-542-3275, e-mail:
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22
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A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders. Neuropsychol Rev 2020; 30:407-424. [PMID: 32766940 DOI: 10.1007/s11065-020-09448-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
Abstract
Psychotic disorders are characterized by a generalized neurocognitive deficit (i.e., performance 1.5 SD below controls across neuropsychological domains with no specific profile of differential deficits). A motivational account of the generalized neurocognitive deficit has been proposed, which attributes poor neuropsychological testing performance to low effort. However, findings are inconsistent regarding effort test failure rate in individuals with psychotic disorders across studies (0-72%), and moderators are unclear, making it difficult to know whether the motivational explanation is viable. To address these issues, a meta-analysis was performed on data from 2205 individuals with psychotic disorders across 19 studies with 24 independent effects. Effort failure rate was examined along with moderators of effort test type, forensic status, IQ, positive symptoms, negative symptoms, diagnosis, age, gender, education, and antipsychotic use. The pooled weighted effort test failure rate was 18% across studies and there was a moderate pooled association between effort failure rate and global neurocognitive performance (r = .57). IQ and education significantly moderated failure rate. Collectively, these findings suggest that a nontrivial proportion of individuals with a psychotic disorder fail effort testing, and failure rate is associated with global neuropsychological impairment. However, given that effort tests are not immune to the effects of IQ in psychotic disorders, these results cannot attest to the viability of the motivational account of the generalized neurocognitive deficit. Furthermore, the significant moderating effect of IQ and education on effort test performance suggests that effort tests have questionable validity in this population and should be interpreted with caution.
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23
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Makowski C, Lewis JD, Khundrakpam B, Tardif CL, Palaniyappan L, Joober R, Malla A, Shah JL, Bodnar M, Chakravarty MM, Evans AC, Lepage M. Altered hippocampal centrality and dynamic anatomical covariance of intracortical microstructure in first episode psychosis. Hippocampus 2020; 30:1058-1072. [PMID: 32485018 DOI: 10.1002/hipo.23215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/23/2022]
Abstract
Hippocampal circuitry has been posited to be fundamental to positive symptoms in psychosis, but its contributions to other factors important for outcome remains unclear. We hypothesized that longitudinal changes in the hippocampal circuit and concomitant changes of intracortical microstructure are altered in first episode psychosis (FEP) patients and that such changes are associated with negative symptoms and verbal memory. Longitudinal brain scans (2-4 visits over 3-15 months) were acquired for 27 FEP and 29 age- and sex-matched healthy controls. Quantitative T1 maps, sensitive to myelin content, were used to sample the microstructure of the hippocampal subfields and output circuitry (fimbria, alveus, fornix, mammillary bodies), and intracortical regions. Dynamic anatomical covariance in pair-wise regional trajectories were assessed for each subject, and graph theory was used to calculate a participation coefficient metric that quantifies the similarity/divergence between hippocampal and intracortical microstructure. The mean participation coefficient of the hippocampus was significantly reduced in FEP patients compared with controls, reflecting differences in output hippocampal regions. Importantly, lower participation coefficient of the hippocampal circuit was associated with worse negative symptoms, a relationship that was mediated by changes in verbal memory. This study provides evidence for reduced hippocampal centrality in FEP and concomitant changes in intracortical anatomy. Myelin-rich output regions of the hippocampus may be an important biological trigger in early psychosis, with cascading effects on broader cortical networks and resultant clinical profiles.
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Affiliation(s)
- Carolina Makowski
- Department of Psychiatry, Douglas Mental Health University Institute, Verdun, Quebec, Canada.,McGill Centre for Integrative Neuroscience, McGill University, Montreal, Quebec, Canada.,Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - John D Lewis
- McGill Centre for Integrative Neuroscience, McGill University, Montreal, Quebec, Canada
| | | | - Christine L Tardif
- Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Lena Palaniyappan
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Ridha Joober
- Department of Psychiatry, Douglas Mental Health University Institute, Verdun, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ashok Malla
- Department of Psychiatry, Douglas Mental Health University Institute, Verdun, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jai L Shah
- Department of Psychiatry, Douglas Mental Health University Institute, Verdun, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Michael Bodnar
- Royal Ottawa Mental Health Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - M Mallar Chakravarty
- Department of Psychiatry, Douglas Mental Health University Institute, Verdun, Quebec, Canada.,Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alan C Evans
- McGill Centre for Integrative Neuroscience, McGill University, Montreal, Quebec, Canada.,Department of Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Department of Psychiatry, Douglas Mental Health University Institute, Verdun, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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24
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Ducrocq F, Walle R, Contini A, Oummadi A, Caraballo B, van der Veldt S, Boyer ML, Aby F, Tolentino-Cortez T, Helbling JC, Martine L, Grégoire S, Cabaret S, Vancassel S, Layé S, Kang JX, Fioramonti X, Berdeaux O, Barreda-Gómez G, Masson E, Ferreira G, Ma DWL, Bosch-Bouju C, De Smedt-Peyrusse V, Trifilieff P. Causal Link between n-3 Polyunsaturated Fatty Acid Deficiency and Motivation Deficits. Cell Metab 2020; 31:755-772.e7. [PMID: 32142670 DOI: 10.1016/j.cmet.2020.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 12/02/2019] [Accepted: 02/13/2020] [Indexed: 01/11/2023]
Abstract
Reward-processing impairment is a common symptomatic dimension of several psychiatric disorders. However, whether the underlying pathological mechanisms are common is unknown. Herein, we asked if the decrease in the n-3 polyunsaturated fatty acid (PUFA) lipid species, consistently described in these pathologies, could underlie reward-processing deficits. We show that reduced n-3 PUFA biostatus in mice leads to selective motivational impairments. Electrophysiological recordings revealed increased collateral inhibition of dopamine D2 receptor-expressing medium spiny neurons (D2-MSNs) onto dopamine D1 receptor-expressing MSNs in the nucleus accumbens, a main brain region for the modulation of motivation. Strikingly, transgenically preventing n-3 PUFA deficiency selectively in D2-expressing neurons normalizes MSN collateral inhibition and enhances motivation. These results constitute the first demonstration of a causal link between a behavioral deficit and n-3 PUFA decrease in a discrete neuronal population and suggest that lower n-3 PUFA biostatus in psychopathologies could participate in the etiology of reward-related symptoms.
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Affiliation(s)
- Fabien Ducrocq
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France.
| | - Roman Walle
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - Andrea Contini
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - Asma Oummadi
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - Baptiste Caraballo
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | | | - Marie-Lou Boyer
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - Frank Aby
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | | | | | - Lucy Martine
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000 Dijon, France
| | - Stéphane Grégoire
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000 Dijon, France
| | - Stéphanie Cabaret
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000 Dijon, France
| | - Sylvie Vancassel
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - Sophie Layé
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - Jing Xuan Kang
- Laboratory for Lipid Medicine and Technology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
| | - Xavier Fioramonti
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - Olivier Berdeaux
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000 Dijon, France
| | | | - Elodie Masson
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000 Dijon, France
| | - Guillaume Ferreira
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road E., Guelph, ON N1G2W1, Canada
| | | | | | - Pierre Trifilieff
- Université Bordeaux, INRAE, Bordeaux INP, NutriNeuro, 33000, Bordeaux, France.
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25
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The brief negative symptom scale in translation: A review of psychometric properties and beyond. Eur Neuropsychopharmacol 2020; 33:36-44. [PMID: 32081498 DOI: 10.1016/j.euroneuro.2020.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/20/2022]
Abstract
Negative symptoms are a core feature of schizophrenia and associated with social and occupational impairment. To encourage treatment development and address the limitations of existing rating instruments in this area across culture, the Brief Negative Symptoms Scale (BNSS) was developed. The authors reviewed studies published since the BNSS was published in 2010 that examined the psychometric properties of the instrument in translation and compared for consistency, psychometric performance and related features. Eleven published cross-cultural validation studies demonstrated the translated versions of the BNSS have strong psychometric properties, similar to the original English version. The internal consistency ranged from 0.88 to 0.98 and the inter-rater reliability ranged from 0.81 to 0.98 for the total score. The BNSS exhibited good convergent validity with existing measures of similar constructs and function, and good discriminant validity relative to other constructs. Recent research also reported that the BNSS is sensitive to drug effects, with effect sizes comparable to established scales. The results of confirmatory factor analyses revealed that the 5-factor structure of negative symptoms in schizophrenia (blunted affect, anhedonia, avolition, asociality, and alogia) crosses cultures. This psychometric evidence suggests that the BNSS is a valid and reliable instrument for assessing pathological mechanism underlying the negative symptoms of schizophrenia across cultures and can be a useful instrument in global clinical trials.
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26
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Kirschner M, Cathomas F, Manoliu A, Habermeyer B, Simon JJ, Seifritz E, Tobler PN, Kaiser S. Shared and dissociable features of apathy and reward system dysfunction in bipolar I disorder and schizophrenia. Psychol Med 2020; 50:936-947. [PMID: 30994080 DOI: 10.1017/s0033291719000801] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bipolar disorder I (BD-I) is defined by episodes of mania, depression and euthymic states. These episodes are among other symptoms characterized by altered reward processing and negative symptoms (NS), in particular apathy. However, the neural correlates of these deficits are not well understood. METHODS We first assessed the severity of NS in 25 euthymic BD-I patients compared with 25 healthy controls (HC) and 27 patients with schizophrenia (SZ). Then, we investigated ventral (VS) and dorsal striatal (DS) activation during reward anticipation in a Monetary Incentive Delayed Task and its association with NS. RESULTS In BD-I patients NS were clearly present and the severity of apathy was comparable to SZ patients. Apathy scores in the BD-I group but not in the SZ group correlated with sub-syndromal depression scores. At the neural level, we found significant VS and DS activation in BD-I patients and no group differences with HC or SZ patients. In contrast to patients with SZ, apathy did not correlate with striatal activation during reward anticipation. Explorative whole-brain analyses revealed reduced extra-striatal activation in BD-I patients compared with HC and an association between reduced activation of the inferior frontal gyrus and apathy. CONCLUSION This study found that in BD-I patients apathy is present to an extent comparable to SZ, but is more strongly related to sub-syndromal depressive symptoms. The findings support the view of different pathophysiological mechanisms underlying apathy in the two disorders and suggest that extra-striatal dysfunction may contribute to impaired reward processing and apathy in BD-I.
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Affiliation(s)
- Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Flurin Cathomas
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom
| | | | - Joe J Simon
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, Heidelberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, 8057Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8057Zurich, Switzerland
| | - Philippe N Tobler
- Neuroscience Center Zurich, University of Zurich, 8057Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, 8057Zurich, Switzerland
- Department of Economics, Laboratory for Social and Neural Systems Research, University of Zurich, 8006Zurich, Switzerland
| | - Stefan Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Chemin du Petit-Bel-Air, 1225 Chêne-Bourg, Switzerland
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27
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Strauss GP, Esfahlani FZ, Kirkpatrick B, Allen DN, Gold JM, Visser KF, Sayama H. Network Analysis Reveals Which Negative Symptom Domains Are Most Central in Schizophrenia vs Bipolar Disorder. Schizophr Bull 2019; 45:1319-1330. [PMID: 30649527 PMCID: PMC6811832 DOI: 10.1093/schbul/sby168] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Network analysis was used to examine how densely interconnected individual negative symptom domains are, whether some domains are more central than others, and whether sex influenced network structure. Participants included outpatients with schizophrenia (SZ; n = 201), a bipolar disorder (BD; n = 46) clinical comparison group, and healthy controls (CN; n = 27) who were rated on the Brief Negative Symptom Scale. The mutual information measure was used to construct negative symptom networks. Groups were compared on macroscopic network properties to evaluate overall network connectedness, and microscopic properties to determine which domains were most central. Macroscopic analyses indicated that patients with SZ had a less densely connected negative symptom network than BD or CN groups, and that males with SZ had less densely connected networks than females. Microscopic analyses indicated that alogia and avolition were most central in the SZ group, whereas anhedonia was most central in BD and CN groups. In addition, blunted affect, alogia, and asociality were most central in females with SZ, and alogia and avolition were most central in males with SZ. These findings suggest that negative symptoms may be highly treatment resistant in SZ because they are not very densely connected. Less densely connected networks may make treatments less likely to achieve global reductions in negative symptoms because individual domains function in isolation with little interaction. Sex differences in centralities suggest that the search for pathophysiological mechanisms and targeted treatment development should be focused on different sets of symptoms in males and females.
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Affiliation(s)
| | - Farnaz Zamani Esfahlani
- Department of Systems Science and Industrial Engineering and Center for Collective Dynamics of Complex Systems, Binghamton University, Binghamton, NY
| | - Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada, Reno School of Medicine, Reno, NV
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV
| | - James M Gold
- Department of Psychiatry and Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Hiroki Sayama
- Department of Systems Science and Industrial Engineering and Center for Collective Dynamics of Complex Systems, Binghamton University, Binghamton, NY
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28
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Kapila A, Fisher HL, Johnson S, Major B, Rahaman N, Joyce J, Chamberlain-Kent N, Lawrence J, Young AH, Stone JM. Clinical and demographic differences between patients with manic, depressive and schizophrenia-spectrum psychoses presenting to Early Intervention Services in London. Early Interv Psychiatry 2019; 13:509-516. [PMID: 29034588 DOI: 10.1111/eip.12511] [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: 12/21/2016] [Revised: 06/23/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
AIM To investigate the relationship between the presenting clinical and demographic characteristics in first-episode psychosis (FEP) patients with their clinical diagnostic grouping 1 year later. METHODS Data from 1014 first-presentation psychosis patients from seven London-based Early Intervention Services were extracted from the MiData audit database. Associations between clinical and demographic measures at presentation and clinical diagnosis made at 1 year were assessed with analysis of variance (ANOVA) and Chi-square tests. RESULTS The sample comprised 76% of patients with schizophrenia-spectrum diagnoses, 9% with manic psychoses (MP) and 6% with depressive psychoses. Compared to the other 2 groups, patients who were diagnosed as having MP were younger, with higher education and shorter duration of untreated psychosis, and had higher Young Mania Rating Scale scores at presentation and lower Positive and Negative Syndrome Scale (PANSS) negative scores. Patients diagnosed at 1 year as having depressive psychosis were older and more likely to be white, with the lowest PANSS positive scores at baseline. Patients diagnosed at 1 year as having schizophrenia spectrum diagnoses were more likely to be males. Patients in the 3 diagnostic subgroups of psychosis differed on both clinical and demographic characteristics at presentation. CONCLUSIONS There were significant clinical and demographic differences at presentation between FEP patients who received different clinical diagnoses at 1 year. Future work should determine the extent to which these differences can be used to guide clinical care.
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Affiliation(s)
- Adisha Kapila
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Helen L Fisher
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Barnaby Major
- EQUIP, Hackney, East London NHS Foundation Trust, London, UK.,Herefordshire Early Intervention Service, 2gether NHS Foundation Trust, Herefordshire, UK
| | - Nikola Rahaman
- Kensington, Chelsea, Westminster and Brent Early Intervention Service, Central & North West London NHS Foundation Trust, London, UK
| | - John Joyce
- Lewisham Early Intervention Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nick Chamberlain-Kent
- Wandsworth Early Intervention Service, South West London & St Georges' Mental Health NHS Trust, London, UK
| | - Jo Lawrence
- STEP, Southwark, South London and Maudsley NHS Foundation Trust, London, UK
| | - Allan H Young
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - James M Stone
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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29
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Labad J. The role of cortisol and prolactin in the pathogenesis and clinical expression of psychotic disorders. Psychoneuroendocrinology 2019; 102:24-36. [PMID: 30503781 DOI: 10.1016/j.psyneuen.2018.11.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 02/03/2023]
Abstract
For many years, the study of the psychotic phenotpe and approach to treatment of schizophrenia has been focused on positive psychotic symptoms, although the functional outcome is more clearly associated with negative and cognitive symptoms. Recently, there has been a growing interest in identifying biomarkers associated with these symptoms at early stages of the illness, including the risk of psychosis in vulnerable individuals (at-risk mental states [ARMS]). In this paper, the role of cortisol and prolactin in the clinical expression of psychosis will be reviewed. In examination of the role of these hormones and the risk of developing a psychotic disorder in ARMS individuals, previous studies have suggested potential roles for both cortisol and prolactin. The study of cognitive abilities in recent-onset psychotic patients has suggested that affected cognitive domains differ depending upon the studied hormones: cortisol (processing speed, verbal and working memory) and prolactin (processing speed), with several studies suggesting that there are sex-differences in these associations. All of these results suggest that both cortisol and prolactin contribute to the pathogenesis and clinical expression of psychotic disorders.
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Affiliation(s)
- Javier Labad
- Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Translational Neuroscience Unit, Universitat Autònoma de Barcelona (UAB), CIBERSAM. Sabadell, Barcelona, Spain.
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30
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Büchmann CB, Pedersen G, Aminoff SR, Laskemoen JF, Barrett EA, Melle I, Lagerberg TV. Validity of the Birchwood insight scale in patients with schizophrenia spectrum- and bipolar disorders. Psychiatry Res 2019; 272:715-722. [PMID: 30832191 DOI: 10.1016/j.psychres.2018.12.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022]
Abstract
The aim of this study is to investigate the validity of the Norwegian version of the Insight Scale (IS) in large and representative samples of patients with schizophrenia spectrum disorders, bipolar I disorder and bipolar II disorder. A total of 997 participants were included (schizophrenia spectrum disorders: 557; bipolar I disorder: 282; bipolar II disorder: 138). Confirmatory factor analysis was conducted to investigate the construct validity and bivariate correlational analysis was applied to investigate convergent validity. Confirmatory factor analyses indicated a reasonable model fit to the original three-factor subscale structure of the IS in all three diagnostic groups. The IS total score and its subscales correlated significantly with both the insight items in the Young Mania Rating Scale and the Positive and Negative Syndrome Scale in both schizophrenia spectrum disorders and bipolar I disorder. In the bipolar II disorder group, however, the IS subscales correlated poorly with both the observer-rated measures. Our study supports the construct validity of the IS in both schizophrenia spectrum disorder- and bipolar disorder populations. The study also demonstrates that patients' self-reports of insight correspond to observer-based single item ratings of insight in bipolar I disorder and schizophrenia spectrum disorders.
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Affiliation(s)
- Camilla Bakkalia Büchmann
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Geir Pedersen
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway; Oslo University Hospital, Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo, Norway
| | - Sofie Ragnhild Aminoff
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway; Oslo University Hospital, Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo, Norway
| | - Jannicke Fjæra Laskemoen
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - Elizabeth Ann Barrett
- Oslo University Hospital, Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo, Norway
| | - Ingrid Melle
- NORMENT and K.G. Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway; NORMENT and K.G. Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT and K.G. Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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31
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Wang YY, Wang Y, Zou YM, Ni K, Tian X, Sun HW, Lui SSY, Cheung EFC, Suckling J, Chan RCK. Theory of mind impairment and its clinical correlates in patients with schizophrenia, major depressive disorder and bipolar disorder. Schizophr Res 2018; 197:349-356. [PMID: 29122405 DOI: 10.1016/j.schres.2017.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although Theory of Mind (ToM) impairment has been observed in patients with a wide range of mental disorders, the similarity and uniqueness of these deficits across diagnostic groups has not been thoroughly investigated. METHODS We recruited 35 participants with schizophrenia (SCZ), 35 with bipolar disorder (BD), 35 with major depressive disorder (MDD), and 35 healthy controls in this study. All participants were matched in age, gender proportion and IQ estimates. The Yoni task, capturing both the cognitive and affective components of ToM at the first- and second-order level was administered. Repeated-measure ANOVA and MANOVA were conducted to compare the group differences in ToM performance. A network was then constructed with ToM performances, psychotic and depressive symptoms, and executive function as nodes exploring the clinical correlates of ToM. RESULTS Overall, ToM impairments were observed in all patient groups compared with healthy controls, with patients with SCZ performing worse than those with BD. In second-order conditions, patients with SCZ and MDD showed deficits in both cognitive and affective conditions, while patients with BD performed significantly poorer in cognitive conditions. Network analysis showed that second-order affective ToM performance was associated with psychotic and depressive symptoms as well as executive dysfunction, while second-order affective ToM performance and negative symptoms showed relatively high centrality in the network. CONCLUSIONS Patients with SCZ, MDD and BD exhibited different types and severity of impairments in ToM sub-components. Impairment in higher-order affective ToM appears to be closely related to clinical symptoms in both psychotic and affective disorders.
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Affiliation(s)
- Yan-Yu Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, Weifang Medical University, Shandong 261053, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China.
| | - Ying-Min Zou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China
| | - Ke Ni
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China; Mental Health Center of Qiqihar city, Heilongjiang 161006, China
| | - Xue Tian
- Department of Psychology, Weifang Medical University, Shandong 261053, China
| | - Hong-Wei Sun
- Department of Psychology, Weifang Medical University, Shandong 261053, China
| | - Simon S Y Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - John Suckling
- Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough NHS Trust, Cambridge CB2 0SZ, United Kingdom
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China.
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32
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Kirkpatrick B, Saoud JB, Strauss GP, Ahmed AO, Tatsumi K, Opler M, Luthringer R, Davidson M. The brief negative symptom scale (BNSS): Sensitivity to treatment effects. Schizophr Res 2018; 197:269-273. [PMID: 29275856 DOI: 10.1016/j.schres.2017.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/25/2017] [Accepted: 11/24/2017] [Indexed: 02/07/2023]
Abstract
The Brief Negative Symptom Scale (BNSS) grew out of a recommendation by the NIMH-sponsored Consensus Development Conference on Negative Symptoms that a scale based on contemporary concepts be developed. We assessed sensitivity to change of the BNSS in a trial of MIN-101, which showed efficacy for negative symptoms (PANSS pentagonal model) at daily doses of 32 and 64mg/day. Using mixed-effects model for repeated measures, we examined change in BNSS total score and in the BNSS factors of anhedonia/avolition/asociality (AAA), and expressivity (EXP). Compared to placebo, the 64mg group (N=83) showed a significant decrease in BNSS total score (effect size d [ES] 0.56, p<0.01) and both factor scores (AAA ES=0.48, EXP ES=0.46, p<0.02 for both). Patients in the trial had minimal depression and positive symptom scores; covarying for disorganization, positive symptoms, or anxiety/depression did not cause a meaningful change in the significance of the BNSS total or factor scores in this group. The 32mg group (N=78) did not differ significantly from placebo (N=83) on BNSS total score (ES=0.33, p<0.09), AAA (ES=0.25, p<0.20) or EXP (ES=0.30, p<0.12) scores. These results demonstrate the BNSS is sensitive to change.
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Affiliation(s)
| | | | | | - Anthony O Ahmed
- Department of Psychiatry, Weill Cornell School of Medicine, USA
| | | | - Mark Opler
- ProPhase LLC, New York City, New York, USA
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33
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Schafer M, Kim JW, Joseph J, Xu J, Frangou S, Doucet GE. Imaging Habenula Volume in Schizophrenia and Bipolar Disorder. Front Psychiatry 2018; 9:456. [PMID: 30319463 PMCID: PMC6165901 DOI: 10.3389/fpsyt.2018.00456] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/03/2018] [Indexed: 02/01/2023] Open
Abstract
The habenula (Hb), a bilateral nucleus located next to the dorsomedial thalamus, is of particular relevance to psychiatric disorders based on preclinical evidence linking the Hb to depressive and amotivational states. However, studies in clinical samples are scant because segmentation of the Hb in neuroimaging data is challenging due to its small size and low contrast from the surrounding tissues. Negative affective states dominate the clinical course of schizophrenia and bipolar disorder and represent a major cause of disability. Diagnosis-related alterations in the volume of Hb in these disorders have therefore been hypothesized but remain largely untested. To probe this question, we used a recently developed objective and reliable semi-automated Hb segmentation method based on myelin-sensitive magnetic resonance imaging (MRI) data. We ascertained case-control differences in Hb volume from high resolution structural MRI data obtained from patients with schizophrenia (n = 95), bipolar disorder (n = 44) and demographically matched healthy individuals (n = 52). Following strict quality control of the MRI data, the final sample comprised 68 patients with schizophrenia, 32 with bipolar disorder and 40 healthy individuals. Regardless of diagnosis, age, sex, and IQ were not correlated with Hb volume. This was also the case for age of illness onset and medication (i.e., antipsychotic dose and lithium-treatment status). Case-control differences in Hb volume did not reach statistical significance; their effect size (Cohen's d) was negligible on the left (schizophrenia: 0.14; bipolar disorder: -0.03) and small on the right (schizophrenia: 0.34; bipolar disorder: 0.26). Nevertheless, variability in the volume of the right Hb was associated with suicidality in the entire patient sample (ρ = 0.29, p = 0.004) as well as in each patient group (bipolar disorder: ρ = 0.34, p = 0.04; schizophrenia: ρ = 0.25, p = 0.04). These findings warrant replication in larger samples and longitudinal designs and encourage more comprehensive characterization of Hb connectivity and function in clinical populations.
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Affiliation(s)
- Matthew Schafer
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joo-Won Kim
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joshmi Joseph
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Junqian Xu
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gaelle E Doucet
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Saito S, Fujii K, Ozeki Y, Ohmori K, Honda G, Mori H, Kato K, Kuroda J, Aoki A, Asahi H, Sato H, Shimoda K, Akiyama K. Cognitive function, treatment response to lithium, and social functioning in Japanese patients with bipolar disorder. Bipolar Disord 2017; 19:552-562. [PMID: 28691278 DOI: 10.1111/bdi.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/07/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Patients with bipolar disorder often suffer from cognitive impairment that significantly influences their functional outcome. However, it remains unknown whether lithium has a central role in cognition and functional outcome. We examined whether cognition and functional outcome were predicted by demographic and clinical variables, including the response to lithium, in lithium-treated patients with bipolar disorder. METHODS We evaluated 96 lithium-treated euthymic patients with bipolar disorder and 196 age- and-gender-matched healthy controls, using the Brief Assessment of Cognition in Schizophrenia (BACS). The patients were also assessed using the Social Functioning Scale (SFS) and "The Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" (Alda) scale, which was evaluated as either a continuous measure of the total scale or a dichotomous criterion. RESULTS Multiple regression analysis revealed two key findings: first, that the premorbid intelligence quotient, age, and number of mood episodes were predictors of the BACS composite score; and, second, that the BACS composite score, negative symptoms, and continuous measure on the total Alda scale (but not its dichotomy) predicted the total SFS score. Structural equation modeling (SEM) was used to confirm these findings, and additionally revealed that the Alda scale was significantly associated with negative symptoms and also the number of mood episodes, regardless of how it was evaluated. CONCLUSIONS SEM delineated how demographic and clinical variables, cognitive performance, and response to lithium treatment were causally associated with, and converged on, social function. The putative role of the Alda scale for social function warrants further study.
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Affiliation(s)
- Satoshi Saito
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan.,Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kumiko Fujii
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Yuji Ozeki
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kenichi Ohmori
- Shiseikai, Takizawa Hospital, Utsunomiya, Tochigi, Japan
| | - Gyo Honda
- Seiseido Kohseikai, Mori Hospital, Utsunomiya, Tochigi, Japan
| | - Harunobu Mori
- Seiseido Kohseikai, Mori Hospital, Utsunomiya, Tochigi, Japan
| | - Kazuko Kato
- Sakura La Mental Clinic, Utsunomiya, Tochigi, Japan
| | | | - Akiko Aoki
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | | | | | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kazufumi Akiyama
- Department of Biological Psychiatry and Neuroscience, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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Popolo R, Smith E, Lysaker PH, Lestingi K, Cavallo F, Melchiorre L, Santone C, Dimaggio G. Metacognitive profiles in schizophrenia and bipolar disorder: Comparisons with healthy controls and correlations with negative symptoms. Psychiatry Res 2017; 257:45-50. [PMID: 28719831 DOI: 10.1016/j.psychres.2017.07.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
Abstract
While deficits in metacognition, or the ability to notice and reflect upon mental states has been observed in schizophrenia and linked with poorer concurrent and future function, it is unknown whether these deficits are unique to schizophrenia. Accordingly, this study assessed metacognition using the Metacognitive Assessment Scale-Abbreviated (MAS-A) and the Metacognitions Questionnaire- 30 (MCQ-30) among 26 adults with schizophrenia, 23 with bipolar disorder and 23 healthy controls. Symptom levels of the psychiatric groups were assessed with the Brief Psychiatric Rating Scale. ANCOVA controlling for age and education revealed that the schizophrenia group had lower scores on the MAS-A total and its subscales compared to the bipolar group and healthy controls. The bipolar disorder group also had lower MAS-A scores than the healthy control group. No group differences were found for the MCQ-30. Examination of symptom correlates revealed MAS-A scores were most commonly related to negative symptoms in both clinical groups. The total score and need for control subscale of MCQ-30 was related to total symptomatology and positive symptoms in patients with bipolar disorder. Correlations between the two measures of metacognition revealed that higher MAS-A scores were significantly related to lower scores on the Need to Control Thoughts MCQ-30 subscale.
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Affiliation(s)
- Raffaele Popolo
- Center for Metacognitive Psychotherapy, Rome, Italy; Studi Cognitivi, Modena, Italy
| | - Elizabeth Smith
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
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36
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Abstract
In the DSM5, negative symptoms are 1 of the 5 core dimensions of psychopathology evaluated for schizophrenia. However, negative symptoms are not pathognomonic-they are also part of the diagnostic criteria for other schizophrenia-spectrum disorders, disorders that sometimes have comorbid psychosis, diagnoses not in the schizophrenia-spectrum, and the general "nonclinical" population. Although etiological models of negative symptoms have been developed for chronic schizophrenia, there has been little attention given to whether these models have transdiagnostic applicability. In the current review, we examine areas of commonality and divergence in the clinical presentation and etiology of negative symptoms across diagnostic categories. It was concluded that negative symptoms are relatively frequent across diagnostic categories, but individual disorders may differ in whether their negative symptoms are persistent/transient or primary/secondary. Evidence for separate dimensions of volitional and expressive symptoms exists, and there may be multiple mechanistic pathways to the same symptom phenomenon among DSM-5 disorders within and outside the schizophrenia-spectrum (ie, equifinality). Evidence for a novel transdiagnostic etiological model is presented based on the Research Domain Criteria (RDoC) constructs, which proposes the existence of 2 such pathways-a hedonic pathway and a cognitive pathway-that can both lead to expressive or volitional symptoms. To facilitate treatment breakthroughs, future transdiagnostic studies on negative symptoms are warranted that explore mechanisms underlying volitional and expressive pathology.
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Affiliation(s)
- Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA
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Abstract
PURPOSE OF REVIEW To provide a review on studies published in the last year relevant to the categorization and assessment of negative symptoms. RECENT FINDINGS Recent research supported the validity of the 'deficit/non-deficit schizophrenia' categorization. Few studies confirmed the validity of the category 'persistent negative symptoms', whereas no recent study explored the validity of the category 'predominant negative symptoms'. The two-factor structure of the negative dimension is supported by studies reporting different correlates for the two subdomains: diminished expression and avolition/apathy. The need to further split avolition/apathy in two distinct components, that is anhedonia and amotivation, is confirmed in recent papers. Additional approaches to the assessment of negative symptoms have been proposed, including the self-assessment of negative symptoms, and the evaluation of negative symptoms in daily life and their assessment by means of computerized analyses. SUMMARY Negative symptoms represent an unmet need in the care of schizophrenia, as they are associated to poor response to available treatments and to poor functional outcome. Their accurate categorization and assessment represent a major challenge for research on neurobiological substrates and new treatment strategies.
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Polat Nazlı I, Ergül C, Aydemir Ö, Chandhoke S, Üçok A, Gönül AS. Validation of Turkish version of brief negative symptom scale. Int J Psychiatry Clin Pract 2016; 20:265-71. [PMID: 27409157 DOI: 10.1080/13651501.2016.1207086] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Negative symptoms in schizophrenia have been assessed by many instruments. However, a current consensus on these symptoms has been built and new tools, such as the Brief Negative Symptom Scale (BNSS), are generated. This study aimed to evaluate reliability and validity of the Turkish version of BNSS. METHODS The scale was translated to Turkish and backtranslated to English. After the approval of the translation, 75 schizophrenia patients were interviewed with BNSS, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) and Extrapyramidal Symptom Rating Scale (ESRS). Reliability and validity analyses were then calculated. RESULTS In the reliability analysis, the Cronbach's alpha coefficient was 0.96 and item-total score correlation coefficients were between 0.655-0.884. The intraclass correlation coefficient was 0.665. The inter-rater reliability was 0.982 (p < 0.0001). In the validity analysis, the total score of BNSS-TR was correlated with PANSS Total Score, Positive Symptoms Subscale, Negative Symptoms Subscale, and General Psychopathology Subscale. CDSS and ESRS were not correlated with BNSS-TR. The factor structure of the scale was consisting the same items as in the original version. CONCLUSIONS Our study confirms that the Turkish version of BNSS is an applicable tool for the evaluation of negative symptoms in schizophrenia.
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Affiliation(s)
- Irmak Polat Nazlı
- a Department of Psychiatry, School of Medicine , Ege University , Izmir , Turkey
| | - Ceylan Ergül
- b Department of Psychiatry, Istanbul School of Medicine , Istanbul University , Istanbul , Turkey
| | - Ömer Aydemir
- c Department of Psychiatry, School of Medicine , Celal Bayar University , Manisa , Turkey
| | - Swati Chandhoke
- d School of Medicine , Stony Brook University , Stony Brook , NY , USA
| | - Alp Üçok
- b Department of Psychiatry, Istanbul School of Medicine , Istanbul University , Istanbul , Turkey
| | - Ali Saffet Gönül
- a Department of Psychiatry, School of Medicine , Ege University , Izmir , Turkey ;,e Department of Psychiatry and Behavioural Sciences, School of Medicine , Mercer University , Macon , GA , USA
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Gu C, Zhang Y, Wei F, Cheng Y, Cao Y, Hou H. Magnetic resonance imaging DTI-FT study on schizophrenic patients with typical negative first symptoms. Exp Ther Med 2016; 12:1450-1454. [PMID: 27588066 PMCID: PMC4998077 DOI: 10.3892/etm.2016.3469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/17/2016] [Indexed: 01/03/2023] Open
Abstract
Magnetic resonance imaging (MRI) with diffusion-tensor imaging (DTI) together with a white matter fiber tracking (FT) technique was used to assess different brain white matter structures and functionalities in schizophrenic patients with typical first negative symptoms. In total, 30 schizophrenic patients with typical first negative symptoms, comprising an observation group were paired 1:1 according to gender, age, right-handedness, and education, with 30 healthy individuals in a control group. Individuals in each group underwent routine MRI and DTI examination of the brain, and diffusion-tensor tractography (DTT) data were obtained through whole brain analysis based on voxel and tractography. The results were expressed by fractional anisotropy (FA) values. The schizophrenic patients were evaluated using a positive and negative symptom scale (PANSS) as well as a Global Assessment Scale (GAS). The results of the study showed that routine MRIs identified no differences between the two groups. However, compared with the control group, the FA values obtained by DTT from the deep left prefrontal cortex, the right deep temporal lobe, the white matter of the inferior frontal gyrus and part of the corpus callosum were significantly lower in the observation group (P<0.05). The PANSS positive scale value in the observation group averaged 7.7±1.5, and the negative scale averaged 46.6±5.9, while the general psychopathology scale averaged 65.4±10.3, and GAS averaged 53.8±19.2. The Pearson statistical analysis, the left deep prefrontal cortex, the right deep temporal lobe, the white matter of the inferior frontal gyrus and the FA value of part of the corpus callosum in the observation group was negatively correlated with the negative scale (P<0.05), and positively correlated with GAS (P<0.05). In conclusion, a decrease in the FA values of the left deep prefrontal cortex, the right deep temporal lobe, the white matter of the inferior frontal gyrus and part of the corpus callosum may be associated with schizophrenia with typical first negative symptoms and the application of MRI DTI-FT can improve diagnostic accuracy.
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Affiliation(s)
- Chengyu Gu
- Department of Geriatric, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Ying Zhang
- Department of Geriatric, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Fuquan Wei
- Department of Geriatric, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Yougen Cheng
- Department of Geriatric, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Yulin Cao
- Department of Geriatric, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Hongtao Hou
- Department of Geriatric, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
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