Metamotivation in people diagnosed with schizophrenia: A conceptual introduction and qualitative study

Negative symptoms in psychosis: A scoping review of qualitative studies

INTRODUCTION

Negative symptoms in schizophrenia, characterised by the absence or reduction of normal processes, are understudied and effective treatments remain elusive. Qualitative research can provide novel and patient-centred insights into these complex phenomena. This scoping review synthesizes findings from previously published qualitative studies aiming to explore previous results and identify gaps in the published literature.

METHODS

A systematic search was conducted on MEDLINE, CINAHL, and PsycINFO databases between April and June 2023. Qualitative studies on negative symptoms in psychotic illnesses were eligible for inclusion. Screening and data extraction procedures were performed by two reviewers working independently. Extracted findings were summarised using narrative synthesis based on consensus meetings with the research team.

RESULTS

A comprehensive search yielded 4753 articles, with six studies deemed eligible for inclusion. The included studies collectively delved into the experiences, causes, and consequences of negative symptoms. Participants reported a spectrum of negative symptom experiences influenced by social dynamics, societal stigma, and childhood trauma. There was a noticeable interaction between different symptom domains, including negative symptoms, such as motivation and sociability, being influenced by positive symptoms, such as hallucinations and delusions. Studies have also highlighted the impact of prescribed medication and substance use on negative symptoms. Areas needing further qualitative research were identified, including exploring the differentiation between primary and secondary negative symptoms, and gaining a deeper understanding of negative symptom evolution over time.

CONCLUSIONS

This scoping review provides valuable insights into the subjective experience of negative symptoms and the multifactorial contributory factors to negative symptoms in schizophrenia. The findings, such as the interplay between negative and positive symptoms, emphasise the importance of a holistic understanding of these complex symptoms, which can be informed by qualitative exploration. Furthermore, the qualitative perspectives can enhance future research avenues, and have potential for assisting the development of more effective approaches for treating negative symptoms.

IUPHAR Review on muscarinic M1 and M4 receptors as drug treatment targets relevant to the molecular pathology of schizophrenia

Cobenfy, a co-formulation of xanomeline and trospium, is the first drug not acting on the dopaminergic system of the CNS approved for the treatment of schizophrenia by the FDA. Xanomeline is a muscarinic M1 and M4 receptor (CHRM1 and CHRM4) agonist whilst trospium is a peripherally active CHRM antagonist that reduces the unwanted peripheral side-effects of xanomeline. Relevant to this exciting development, this review details the human CNS cholinergic systems and how those systems are affected by the molecular pathology of schizophrenia in a way suggesting activating the CHRM1 and 4 would be beneficial in treating the disorder. The CNS distribution of CHRMs is presented along with findings using CHRM knockout mice and mice treated with drugs that activate the CHRM1 and / or M4, these data explain why these CHRMs could be involved in the genesis of the symptoms of schizophrenia. Next, the process leading to the formulation of Cobenfy and the preclinical data on xanomeline are reviewed showing why Cobenfy was expected to be useful in treating schizophrenia. The pipeline of drugs targeting CHRM1 and /or M4 receptors to treat schizophrenia are discussed. Finally, the molecular pathology of two sub-groups within schizophrenia, separated based on the presence or absence of a deficit of cortical CHRM1, are reviewed to show how such approaches could identify new drug targets. In conclusion, the history of the development of Cobenfy highlights how a growing understanding the pathophysiology of schizophrenia will suggest new treatment targets for the disorder and that pharmacologists can synthesise drugs to target these sites.

Integrative Neuro-social cognitive Strategy Programme for Instilling REcovery (INSPIRE): a community-based cognitive remediation trial-study procotol

BACKGROUND

Adults with schizophrenia experience a range of neurocognitive problems that affect their daily functioning. Evidence for the efficacy of cognitive remediation in schizophrenia has been established, but its implementation in under-resourced community-based settings is less well-studied. In recent years, interventions have also focused on the strategy-learning approach in favor of drill-and-practice. Moreover, there is an increasing recognition to address social cognition and negative symptoms alongside neurocognition. This study attempts to carry out cognitive remediation in a community mental health setting. The Neuropsychological and Educational Approach to Remediation (NEAR) is used as the cognitive remediation intervention. Neurocognitive and social cognitive games will be introduced during the computer-assisted cognitive exercises sessions. In addition, the instructional technique will foster the use of metacognition and cognitive strategies. Moreover, metamotivation training will be the focus of some bridging sessions to enhance motivation to engage in goal-directed learning behaviors. The aims of the study are to 1) investigate the effects of cognitive remediation on neurocognition, social cognition and functional outcomes of participants with schizophrenia/schizoaffective disorders in community mental health settings; and 2) explore the mediators for change (eg: metamotivation, metacognition and negative symptoms) in cognitive performance and functional outcomes.

METHODS

This randomized controlled trial will be conducted in three Singapore Anglican Community Services (SACS) centers, where standard psychiatric rehabilitation is delivered. Participants who are randomized to the experimental arm will receive cognitive remediation and psychiatric rehabilitation, while those randomized to the control arm will receive standard psychiatric rehabilitation only. Cognitive remediation is carried out three times a week for 12 weeks. It consists of computer-assisted cognitive exercises, as well as bridging groups to aid transfer of learning to daily living. Baseline, post-intervention and eight-week follow-up measurements will be collected. Group by time differences in cognitive performance, negative symptoms, metamotivation, metacognition, functioning and recovery will be analyzed across the three time points. Mediators for improvement in cognitive performance and functioning will also be explored.

DISCUSSION

Findings of this research will add to the body of knowledge about the key therapeutic ingredients within a strategy-based cognitive remediation program and improve its implementation within under-resourced community settings.

TRIAL REGISTRATION

This study has been registered with ClinicalTrials.gov (ID: NCT06286202). Date of registration: 29 February 2024. Date of last update: 21 May 2024.

Challenges faced when living with schizophrenia in the community: A narrative inquiry

BACKGROUND

Schizophrenia is a chronic and severe mental disorder. People with schizophrenia have transferred from hospital-based care to community-based care with the support of mental health legal policies. Challenges faced in the community should be emphasized. Limited qualitative studies have explored the challenges of living with schizophrenia.

AIMS

To explore the challenges of people living with schizophrenia in the community.

METHODS

A narrative method was used, including semi-structured, face-to-face interviews. Thematic analysis approach was used to analyze data.

RESULTS

Ten clients and their family members participated in the study. Analysis revealed three main themes related to their challenges in the community: deficits in self-management of illness; insufficient community mental health care; and the influence of policy. These challenges prevent those with schizophrenia from effectively managing their illness, returning to a productive role in society, and improving their quality of life.

CONCLUSIONS

There are challenges in mental health rehabilitation and social reintegration of individuals with schizophrenia. There is a need for continuous community mental rehabilitation services, appropriate policy support, and the need to educate the public to reduce social bias and discrimination which allows individuals with schizophrenia to assume a productive role in the community.

A study of the impacts of motivational regulation and self-regulated second-language writing strategies on college students' proximal and distal writing enjoyment and anxiety

Motivational regulation is crucial to explaining autonomous self-regulated learning, yet has received relatively little empirical attention. This study therefore examined how 230 college students' motivational-regulation strategies affected their proximal and distal second-language writing-achievement emotions (i.e., enjoyment and anxiety), and sought evidence of interactive effects of such strategies and self-regulated learning strategies on each of these two types of emotions. All the studied types of motivational-regulation strategy were found to directly predict both proximal and distal writing enjoyment, under a "the more the happier" principle, but only a performance-oriented motivational regulation strategy predicted proximal or distal writing anxiety. A social-behavior learning strategy was found to counteract the high proximal anxiety caused by heavy use of the performance self-talk motivational regulation strategy; and motivational-regulation predictors also emerged as stable predictors of both proximal and distal writing well-being. These findings are expected to be both theoretically valuable to the study of motivational regulation under the self-regulated learning framework, and of practical value to educators, learners, and curriculum designers.