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Shi S, Cui S, Yao Y, Ge M, Yang M, Sheng X, Luo B, Yang Y, Yuan X, Zhou X, Liu H, Zhang K. Smartphone video games improve cognitive function in patients with chronic schizophrenia: a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2024; 274:929-939. [PMID: 37594510 DOI: 10.1007/s00406-023-01660-4] [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: 03/27/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
This study aimed to examine the efficacy of video games in improving cognitive function in chronic patients with schizophrenia and to evaluate the biomarker of video games for cognitive function. The patients in the game group were requested to play single-player video games on their smartphones for 1 h per day, five times a week for 6 weeks. Those in the control group watched television for 1 h per day, five times a week for 6 weeks. Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Stroop Color and Word Test (SCWT). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), General Self-Efficacy Scale (GSE), Problematic Mobile Gaming Questionnaire (PMGQ), and Patient Health Questionnaire-9 (PHQ-9). The game group demonstrated improved RBANS total score during the trial. There were no significant group effects among all SCWT scores. The game group demonstrated greater improvement on the PANSS Negative Scale, and global function (GAF score). The PMGQ scores were lower than the cutoff score at all time points in both groups. There were no significant group differences in the PHQ-9 and GSE scores. The serum BDNF levels were significantly higher in the game group following 6 weeks of video game intervention. The BDNF serum levels of all participants were positively associated with the RBANS total scores. This preliminary study suggested that video games can improve cognitive function in schizophrenia patients. Serum BDNF levels may be a suitable biomarker for predicting an improvement in cognitive function in schizophrenia patients.Trial registration: This study was registered on March 11, 2021 (ChiCTR2100044113).Clinical trials: Smartphone video games improve cognitive function in patients with chronic schizophrenia; https://www.chictr.org.cn/hvshowproject.aspx?id=95623 ; ChiCTR2100044113.
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Affiliation(s)
- Shengya Shi
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Shu Cui
- Department of Psychiatry, Fuyang Third People's Hospital, Fuyang, China
| | - Yitan Yao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Menglin Ge
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Meng Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Xuanlian Sheng
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Bei Luo
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Yating Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Xiaoping Yuan
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Xiaoqin Zhou
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China
| | - Kai Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Hefei, 238000, China.
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Wang HR, Liu ZQ, Nakua H, Hegarty CE, Thies MB, Patel PK, Schleifer CH, Boeck TP, McKinney RA, Currin D, Leathem L, DeRosse P, Bearden CE, Misic B, Karlsgodt KH. Decoding Early Psychoses: Unraveling Stable Microstructural Features Associated with Psychopathology Across Independent Cohorts. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.10.593636. [PMID: 38766080 PMCID: PMC11100779 DOI: 10.1101/2024.05.10.593636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Early Psychosis patients (EP, within 3 years after psychosis onset) show significant variability, making outcome predictions challenging. Currently, little evidence exists for stable relationships between neural microstructural properties and symptom profiles across EP diagnoses, limiting the development of early interventions. Methods A data-driven approach, Partial Least Squares (PLS) correlation, was used across two independent datasets to examine multivariate relationships between white matter (WM) properties and symptomatology, to identify stable and generalizable signatures in EP. The primary cohort included EP patients from the Human Connectome Project-Early Psychosis (n=124). The replication cohort included EP patients from the Feinstein Institute for Medical Research (n=78). Both samples included individuals with schizophrenia, schizoaffective disorder, and psychotic mood disorders. Results In both cohorts, a significant latent component (LC) corresponded to a symptom profile combining negative symptoms, primarily diminished expression, with specific somatic symptoms. Both LCs captured comprehensive features of WM disruption, primarily a combination of subcortical and frontal association fibers. Strikingly, the PLS model trained on the primary cohort accurately predicted microstructural features and symptoms in the replication cohort. Findings were not driven by diagnosis, medication, or substance use. Conclusions This data-driven transdiagnostic approach revealed a stable and replicable neurobiological signature of microstructural WM alterations in EP, across diagnoses and datasets, showing a strong covariance of these alterations with a unique profile of negative and somatic symptoms. This finding suggests the clinical utility of applying data-driven approaches to reveal symptom domains that share neurobiological underpinnings.
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Buchwald K, Narayanan A, Siegert RJ, Vignes M, Arrowsmith K, Sandham M. Centrality statistics of symptom networks of schizophrenia: a systematic review. Psychol Med 2024; 54:1061-1073. [PMID: 38174555 DOI: 10.1017/s003329172300363x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The network theory of psychological disorders posits that systems of symptoms cause, or are associated with, the expression of other symptoms. Substantial literature on symptom networks has been published to date, although no systematic review has been conducted exclusively on symptom networks of schizophrenia, schizoaffective disorder, and schizophreniform (people diagnosed with schizophrenia; PDS). This study aims to compare statistics of the symptom network publications on PDS in the last 21 years and identify congruences and discrepancies in the literature. More specifically, we will focus on centrality statistics. Thirty-two studies met the inclusion criteria. The results suggest that cognition, and social, and occupational functioning are central to the network of symptoms. Positive symptoms, particularly delusions were central among participants in many studies that did not include cognitive assessment. Nodes representing cognition were most central in those studies that did. Nodes representing negative symptoms were not as central as items measuring positive symptoms. Some studies that included measures of mood and affect found items or subscales measuring depression were central nodes in the networks. Cognition, and social, and occupational functioning appear to be core symptoms of schizophrenia as they are more central in the networks, compared to variables assessing positive symptoms. This seems consistent despite heterogeneity in the design of the studies.
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Affiliation(s)
- Khan Buchwald
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Ajit Narayanan
- Engineering, Computer, and Mathematical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Richard John Siegert
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Matthieu Vignes
- School of Mathematical and Computational Sciences, Massey University, Tennent Drive, Palmerston North, New Zealand
| | - Kim Arrowsmith
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
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Fritze S, Brandt GA, Volkmer S, Daub J, Krayem M, Kukovic J, Schwarz E, Braun U, Northoff G, Wolf RC, Kubera KM, Meyer-Lindenberg A, Hirjak D. Deciphering the interplay between psychopathological symptoms, sensorimotor, cognitive and global functioning: a transdiagnostic network analysis. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01782-3. [PMID: 38509230 DOI: 10.1007/s00406-024-01782-3] [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: 11/14/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Understanding the relationship between psychopathology and major domains of human neurobehavioral functioning may identify new transdiagnostic treatment targets. However, studies examining the interrelationship between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample are lacking. We hypothesized a close relationship between sensorimotor and cognitive functioning in a transdiagnostic patient sample. METHODS We applied network analysis and community detection methods to examine the interplay and centrality [expected influence (EI) and strength] between psychopathological symptoms, sensorimotor, cognitive, and global functioning in a transdiagnostic sample consisting of 174 schizophrenia spectrum (SSD) and 38 mood disorder (MOD) patients. All patients (n = 212) were examined with the Positive and Negative Syndrome Scale (PANSS), the Heidelberg Neurological Soft Signs Scale (NSS), the Global Assessment of Functioning (GAF), and the Brief Cognitive Assessment Tool for Schizophrenia consisted of trail making test B (TMT-B), category fluency (CF) and digit symbol substitution test (DSST). RESULTS NSS showed closer connections with TMT-B, CF, and DSST than with GAF and PANSS. DSST, PANSS general, and NSS motor coordination scores showed the highest EI. Sensory integration, DSST, and CF showed the highest strength. CONCLUSIONS The close connection between sensorimotor and cognitive impairment as well as the high centrality of sensorimotor symptoms suggests that both domains share aspects of SSD and MOD pathophysiology. But, because the majority of the study population was diagnosed with SSD, the question as to whether sensorimotor symptoms are really a transdiagnostic therapeutic target needs to be examined in future studies including more balanced diagnostic groups.
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Affiliation(s)
- Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
| | - Geva A Brandt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
| | - Sebastian Volkmer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jonas Daub
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
| | - Maria Krayem
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
| | - Jacqueline Kukovic
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
| | - Emanuel Schwarz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Urs Braun
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159, Mannheim, Germany.
- German Centre for Mental Health (DZPG), Partner Site Heidelberg/Mannheim/Ulm, Mannheim, Germany.
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Peng P, Wang Q, Zhou Y, Hao Y, Chen S, Wu Q, Li M, Wang Y, Yang Q, Wang X, Liu Y, Ma Y, He L, Liu T, Zhang X. Inter-relationships of insomnia and psychiatric symptoms with suicidal ideation among patients with chronic schizophrenia: A network perspective. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110899. [PMID: 38007211 DOI: 10.1016/j.pnpbp.2023.110899] [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: 05/21/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Insomnia is common in patients with schizophrenia, which contributes to worsening psychiatric symptoms and suicidality. We aimed to assess the inter-relationships of insomnia and psychopathology with suicidal ideation (SI) among 1407 Chinese patients with chronic schizophrenia via the network approach. METHOD We used Positive and Negative Syndrome Scale, Insomnia Severity Index, and Beck Scale for Suicidal Ideation to assess psychiatric symptoms, insomnia, and SI, respectively. Lifetime suicidal attempts (SA) were collected. RESULTS (1) The incidence of insomnia, lifetime SI, lifetime SA, and current SI was 13.5% (n = 190), 22.8% (n = 321), 13.5% (n = 190), and 9.7% (n = 136), respectively. (2) Patients with insomnia had worse clinical symptoms and higher suicidal risk. (3) Daytime dysfunction, sleep-related distress, conceptual disorganization, delusions, anxiety, and poor rapport were the core symptoms, while late sleep onset and sleep dissatisfaction emerged as bridge symptoms connecting insomnia and psychopathology. (4) Depressive mood, hallucinations, poor impulse control, guilty feelings, insomnia-related impaired quality of life, and sleep dissatisfaction were directly associated with SI. CONCLUSION Our findings called for formal assessment of insomnia in patients with schizophrenia, which should cover both nocturnal and daytime insomnia symptoms. Targeted interventions for key symptoms may help reduce insomnia, psychiatric symptoms, and SI in patients with schizophrenia.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Qianjin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People's Hospital), Changsha, China.
| | - Yuzhu Hao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Shubao Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Qiuxia Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Manyun Li
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Yunfei Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Qian Yang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Xin Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Yueheng Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Yuejiao Ma
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Li He
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Tieqiao Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Wolpe N, Vituri A, Jones PB, Shahar M, Fernandez-Egea E. The longitudinal structure of negative symptoms in treatment resistant schizophrenia. Compr Psychiatry 2024; 128:152440. [PMID: 38039918 DOI: 10.1016/j.comppsych.2023.152440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS The negative symptoms of schizophrenia are strong prognostic factors but remain poorly understood and treated. Five negative symptom domains are frequently clustered into the motivation and pleasure (MAP) and emotional expression (EE) 'dimensions', but whether this structure remains stable and behaves as a single entity or not remains unclear. STUDY DESIGN We examined a cohort of 153 patients taking clozapine for treatment-resistant schizophrenia in a regional mental health clinic. Patients were assessed longitudinally over a mean period of 45 months using validated scales for positive, negative and mood symptoms. Network analyses were performed to identify symptom 'communities' and their stability over time. The influence of common causes of secondary negative symptoms as well as centrality measures were also examined. STUDY RESULTS Across patients at baseline, two distinct communities matching the clinical domains of MAP and EE were found. These communities remained highly stable and independent over time. The communities remained stabled when considering psychosis, depression, and sedation severity, and these causes of secondary negative symptoms were clustered into the MAP community. Centrality measures also remained stable over time, with similar centrality measures across symptoms. CONCLUSIONS Our results suggest that MAP and EE are independent dimensions that remain highly stable over time in chronic schizophrenia patients treated with clozapine. Common causes of secondary negative symptoms mapped onto the MAP dimension. Our results emphasise the need for clinical trials to address either MAP or EE, and that treating causes of secondary negative symptoms may improve MAP.
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Affiliation(s)
- Noham Wolpe
- Department of Physical Therapy, The Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Aya Vituri
- Tel Aviv Center for Artificial Intelligence & Data Science (TAD), Tel Aviv University, 6997801, Israel
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridge CB21 5EF, UK
| | - Moni Shahar
- Tel Aviv Center for Artificial Intelligence & Data Science (TAD), Tel Aviv University, 6997801, Israel
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridge CB21 5EF, UK.
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Zhang W, Liu T, Leung DKY, Chan S, Wong G, Lum T. Sad Mood Bridges Depressive Symptoms and Cognitive Performance in Community-Dwelling Older Adults: A Network Approach. Innov Aging 2023; 8:igad139. [PMID: 38351984 PMCID: PMC10863485 DOI: 10.1093/geroni/igad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Indexed: 02/16/2024] Open
Abstract
Background and Objectives Depression and cognitive impairment are common and often coexist in older adults. The network theory of mental disorders provides a novel approach to understanding the pathways between depressive symptoms and cognitive domains and the potential "bridge" that links and perpetuates both conditions. This study aimed to identify pathways and bridge symptoms between depressive symptoms and cognitive domains in older adults. Research Design and Methods Data were derived from 2,792 older adults aged 60 years and older with mild and more severe depressive symptoms from the community in Hong Kong. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and cognition using the Montreal Cognitive Assessment 5-minute protocol (MoCA-5min). Summary descriptive statistics were calculated, followed by network estimation using graphical LASSO, community detection, centrality analysis using bridge expected influence (BEI), and network stability analyses to assess the structure of the PHQ-9 and MoCA-5min items network, the pathways, and the bridge symptoms. Results Participants (mean age = 77.3 years, SD = 8.5) scored 8.2 (SD = 3.4) on PHQ-9 and 20.3 (SD = 5.4) on MoCA-5min. Three independent communities were identified in PHQ-9 and MoCA-5min items, suggesting that depression is not a uniform entity (2 communities) and has differential connections with cognition. The network estimation results suggested that the 2 most prominent connections between depressive symptoms and cognitive domains were: (1) anhedonia with executive functions/language and (2) sad mood with memory. Among all depressive symptoms, sad mood had the highest BEI, bridging depressive symptoms and cognitive domains. Discussion and Implications Sad mood seems to be the pathway between depression and cognition in this sample of older Chinese. This finding highlights the importance of sad mood as a potential mechanism for the co-occurrence of depression and cognitive impairment, implying that intervention targeting sad mood might have rippling effects on cognitive health.
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Affiliation(s)
- Wen Zhang
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tianyin Liu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Dara Kiu Yi Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Stephen Chan
- Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Gloria Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Terry Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China
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Giordano GM, Sanmarchi F, Mucci A, Rucci P, Brando F, Caporusso E, Giuliani L, Melillo A, Pezzella P, Bucci P, Rocca P, Rossi A, Bertolino A, Rossi R, Pergola G, Galderisi S, Maj M. External validation of the five domains of negative symptoms: Focus on cognition, functional capacity, and real-world functioning. Eur Psychiatry 2023; 67:e3. [PMID: 38097401 DOI: 10.1192/j.eurpsy.2023.2478] [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] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The conceptualization of negative symptoms (NS) in schizophrenia is still controversial. Recent confirmatory factor-analytic studies suggested that the bi-dimensional model (motivational deficit [MAP] and expressive deficit [EXP]) may not capture the complexity of NS structure, which could be better defined by a five-factor (five NS domains) or a hierarchical model (five NS domains as first-order factors, and MAP and EXP, as second-order factors). A validation of these models is needed to define the structure of NS. To evaluate the validity and temporal stability of the five-factor or the hierarchical structure of the brief negative symptom scale (BNSS) in individuals with schizophrenia (SCZ), exploring associations between these models with cognition, social cognition, functional capacity, and functioning at baseline and at 4 years follow-up. METHODS Clinical variables were assessed using state-of-the-art tools in 612 SCZ at two-time points. The validity of the five-factor and the hierarchical models was analyzed through structural equation models. RESULTS The two models had both a good fit and showed a similar pattern of associations with external validators at the two-time points, with minor variations. The five-factor solution had a slightly better fit. The associations with external validators favored the five-factor structure. CONCLUSIONS Our findings suggest that both five-factor and hierarchical models provide a valid conceptualization of NS in relation to external variables and that five-factor solution provides the best balance between parsimony and granularity to summarize the BNSS structure. This finding has important implications for the study of pathophysiological mechanisms and the development of new treatments.
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Affiliation(s)
- Giulia M Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Brando
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Melillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Paul NB, Strauss GP, Gates-Woodyatt JJ, Barchard KA, Allen DN. Two and five-factor models of negative symptoms in schizophrenia are differentially associated with trait affect, defeatist performance beliefs, and psychosocial functioning. Eur Arch Psychiatry Clin Neurosci 2023; 273:1715-1724. [PMID: 36633673 DOI: 10.1007/s00406-022-01507-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/14/2022] [Indexed: 01/13/2023]
Abstract
Recent factor analytic evidence supports both two-factor (motivation and pleasure, MAP; diminished expression, EXP) and five-factor (anhedonia, asociality, avolition, blunted affect, alogia) conceptualizations of negative symptoms. However, it is unclear whether these two conceptualizations of the latent structure of negative symptoms have differential associations with external correlates. The current study evaluated external correlates of the two- and five-factor structures by examining associations with variables known to have critical relations with negative symptoms: trait affect, defeatist performance beliefs, neurocognition, and community-based psychosocial functioning. Participants included a total of 245 outpatients diagnosed with schizophrenia who were rated on the Brief Negative Symptom Scale and completed a battery of additional measures during periods of clinical stability. These additional measures included the Positive and Negative Affect Schedule, Defeatist Performance Beliefs scale, MATRICS Consensus Cognitive Battery, and Level of Function Scale. Pearson correlations indicated differential patterns of associations between the BNSS scores and the external correlates. Support for the two-factor model was indicated by a stronger association of MAP with positive affect and psychosocial functioning, compared to EXP with neurocognition. Significance tests examining a differential magnitude of associations showed that the two-dimension negative symptom structure masked unique correlational relationships among the five negative symptom domains with neurocognition and social/vocational community functioning and captured unique patterns of correlation with trait affect. Support for the five-factor model was shown by a stronger association between Blunted Affect with Attention/Vigilance, and stronger associations between Avolition, Anhedonia, and Asociality with psychosocial functioning. Results offer support for both the two-dimension and five-domain model of negative symptoms as well as a hierarchical two-dimensions-five-domains model of negative symptoms. Findings may have implications for diagnostic criteria and descriptions of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), as well as possible treatment targets of negative symptoms.
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Affiliation(s)
- Nina B Paul
- Department of Psychology, University of Nevada, 4505 S. Maryland Parkway, P. O. Box 455030, Las Vegas, NV, 89154-5030, USA
| | | | - Jessica J Gates-Woodyatt
- Department of Psychology, University of Nevada, 4505 S. Maryland Parkway, P. O. Box 455030, Las Vegas, NV, 89154-5030, USA
| | - Kimberly A Barchard
- Department of Psychology, University of Nevada, 4505 S. Maryland Parkway, P. O. Box 455030, Las Vegas, NV, 89154-5030, USA
| | - Daniel N Allen
- Department of Psychology, University of Nevada, 4505 S. Maryland Parkway, P. O. Box 455030, Las Vegas, NV, 89154-5030, USA.
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10
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Melillo A, Caporusso E, Giordano GM, Giuliani L, Pezzella P, Perrottelli A, Bucci P, Mucci A, Galderisi S. Correlations between Negative Symptoms and Cognitive Deficits in Individuals at First Psychotic Episode or at High Risk of Psychosis: A Systematic Review. J Clin Med 2023; 12:7095. [PMID: 38002707 PMCID: PMC10672428 DOI: 10.3390/jcm12227095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The present review aims to identify correlations between negative symptoms (NS) and deficits in neurocognition and social cognition in subjects with first-episode psychosis (FEP) and at-high-risk populations (HR). A systematic search of the literature published between 1 January 2005 and 31 December 2022 was conducted on PubMed, Scopus, and PsycInfo. Out of the 4599 records identified, a total of 32 studies met our inclusion/exclusion criteria. Data on a total of 3086 FEP and 1732 HR were collected. The available evidence shows that NS correlate with executive functioning and theory of mind deficits in FEP subjects, and with deficits in the processing speed, attention and vigilance, and working memory in HR subjects. Visual learning and memory do not correlate with NS in either FEP or HR subjects. More inconsistent findings were retrieved in relation to other cognitive domains in both samples. The available evidence is limited by sample and methodological heterogeneity across studies and was rated as poor or average quality for the majority of included studies in both FEP and CHR populations. Further research based on shared definitions of first-episode psychosis and at-risk states, as well as on more recent conceptualizations of negative symptoms and cognitive impairment, is highly needed.
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Affiliation(s)
| | | | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie, 80138 Naples, Italy
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11
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Wolpe N, Fernandez-Egea E. [The structural stability of negative symptoms over time]. BJPsych Open 2023; 9:e208. [PMID: 37920067 PMCID: PMC10753967 DOI: 10.1192/bjo.2023.600] [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: 09/06/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
Negative symptoms remain poorly understood and treated despite their huge impact on patients' lives and clinical outcomes. This is partly because of ongoing debates about the clinical constructs underlying negative symptoms. A longitudinal analysis of the structure of negative symptoms presented in BJPsych Open reports striking temporal stability of symptom structure, which behaves as a few independent domains. This further underscores the need to address specific symptom domains when considering interventions or pathophysiology studies.
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Affiliation(s)
- Noham Wolpe
- Department of Physical Therapy, The Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; and Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Cambridge, UK; and Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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12
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Rucci P, Caporusso E, Sanmarchi F, Giordano GM, Mucci A, Giuliani L, Pezzella P, Perrottelli A, Bucci P, Rocca P, Rossi A, Bertolino A, Galderisi S, Maj M. The structure stability of negative symptoms: longitudinal network analysis of the Brief Negative Symptom Scale in people with schizophrenia. BJPsych Open 2023; 9:e168. [PMID: 37674282 PMCID: PMC10594087 DOI: 10.1192/bjo.2023.541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/23/2023] [Accepted: 07/06/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The structure of negative symptoms of schizophrenia is still a matter of controversy. Although a two-dimensional model (comprising the expressive deficit dimension and the motivation and pleasure dimension) has gained a large consensus, it has been questioned by recent investigations. AIMS To investigate the latent structure of negative symptoms and its stability over time in people with schizophrenia using network analysis. METHOD Negative symptoms were assessed in 612 people with schizophrenia using the Brief Negative Symptom Scale (BNSS) at baseline and at 4-year follow-up. A network invariance analysis was conducted to investigate changes in the network structure and strength of connections between the two time points. RESULTS The network analysis carried out at baseline and follow-up, supported by community detection analysis, indicated that the BNSS's items aggregate to form four or five distinct domains (avolition/asociality, anhedonia, blunted affect and alogia). The network invariance test indicated that the network structure remained unchanged over time (network invariance test score 0.13; P = 0.169), although its overall strength decreased (6.28 at baseline, 5.79 at follow-up; global strength invariance test score 0.48; P = 0.016). CONCLUSIONS The results lend support to a four- or five-factor model of negative symptoms and indicate overall stability over time. These data have implications for the study of pathophysiological mechanisms and the development of targeted treatments for negative symptoms.
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Affiliation(s)
- Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulia M. Giordano
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Andrea Perrottelli
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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13
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Tiego J, Thompson K, Arnatkeviciute A, Hawi Z, Finlay A, Sabaroedin K, Johnson B, Bellgrove MA, Fornito A. Dissecting Schizotypy and Its Association With Cognition and Polygenic Risk for Schizophrenia in a Nonclinical Sample. Schizophr Bull 2023; 49:1217-1228. [PMID: 36869759 PMCID: PMC10483465 DOI: 10.1093/schbul/sbac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Schizotypy is a multidimensional construct that captures a continuum of risk for developing schizophrenia-spectrum psychopathology. Existing 3-factor models of schizotypy, consisting of positive, negative, and disorganized dimensions have yielded mixed evidence of genetic continuity with schizophrenia using polygenic risk scores. Here, we propose an approach that involves splitting positive and negative schizotypy into more specific subdimensions that are phenotypically continuous with distinct positive symptoms and negative symptoms recognized in clinical schizophrenia. We used item response theory to derive high-precision estimates of psychometric schizotypy using 251 self-report items obtained from a non-clinical sample of 727 (424 females) adults. These subdimensions were organized hierarchically using structural equation modeling into 3 empirically independent higher-order dimensions enabling associations with polygenic risk for schizophrenia to be examined at different levels of phenotypic generality and specificity. Results revealed that polygenic risk for schizophrenia was associated with variance specific to delusional experiences (γ = 0.093, P = .001) and reduced social interest and engagement (γ = 0.076, P = .020), and these effects were not mediated via the higher-order general, positive, or negative schizotypy factors. We further fractionated general intellectual functioning into fluid and crystallized intelligence in 446 (246 females) participants that underwent onsite cognitive assessment. Polygenic risk scores explained 3.6% of the variance in crystallized intelligence. Our precision phenotyping approach could be used to enhance the etiologic signal in future genetic association studies and improve the detection and prevention of schizophrenia-spectrum psychopathology.
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Affiliation(s)
- Jeggan Tiego
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Clayton, VIC 3800, Australia
| | - Kate Thompson
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Clayton, VIC 3800, Australia
| | - Aurina Arnatkeviciute
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Ziarih Hawi
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Amy Finlay
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Kristina Sabaroedin
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Clayton, VIC 3800, Australia
| | - Beth Johnson
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Mark A Bellgrove
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Clayton, VIC 3800, Australia
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14
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Strauss GP, Walker EF, Pelletier-Baldelli A, Carter NT, Ellman LM, Schiffman J, Luther L, James SH, Berglund AM, Gupta T, Ristanovic I, Mittal VA. Development and Validation of the Negative Symptom Inventory-Psychosis Risk. Schizophr Bull 2023; 49:1205-1216. [PMID: 37186040 PMCID: PMC10483448 DOI: 10.1093/schbul/sbad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND HYPOTHESES Early identification and prevention of psychosis is limited by the availability of tools designed to assess negative symptoms in those at clinical high-risk for psychosis (CHR). To address this critical need, a multi-site study was established to develop and validate a clinical rating scale designed specifically for individuals at CHR: The Negative Symptom Inventory-Psychosis Risk (NSI-PR). STUDY DESIGN The measure was developed according to guidelines recommended by the NIMH Consensus Conference on Negative Symptoms using a transparent, iterative, and data-driven process. A 16-item version of the NSI-PR was designed to have an overly inclusive set of items and lengthier interview to support the ultimate intention of creating a new briefer measure. Psychometric properties of the 16-item NSI-PR were evaluated in a sample of 218 CHR participants. STUDY RESULTS Item-level analyses indicated that men had higher scores than women. Reliability analyses supported internal consistency, inter-rater agreement, and temporal stability. Associations with measures of negative symptoms and functioning supported convergent validity. Small correlations with positive, disorganized, and general symptoms supported discriminant validity. Structural analyses indicated a 5-factor structure (anhedonia, avolition, asociality, alogia, and blunted affect). Item response theory identified items for removal and indicated that the anchor range could be reduced. Factor loadings, item-level correlations, item-total correlations, and skew further supported removal of certain items. CONCLUSIONS These findings support the psychometric properties of the NSI-PR and guided the creation of a new 11-item NSI-PR that will be validated in the next phase of this multi-site scale development project.
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Affiliation(s)
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | | | - Nathan T Carter
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Lauren M Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California- Irvine, Irvine, CA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Sydney H James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
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15
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Raugh IM, Luther L, Bartolomeo LA, Gupta T, Ristanovic I, Pelletier-Baldelli A, Mittal VA, Walker EF, Strauss GP. Negative Symptom Inventory-Self-Report (NSI-SR): Initial development and validation. Schizophr Res 2023; 256:79-87. [PMID: 37172500 PMCID: PMC10262695 DOI: 10.1016/j.schres.2023.04.015] [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: 10/03/2022] [Revised: 02/13/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Negative symptoms (i.e., anhedonia, avolition, asociality, blunted affect, alogia) are frequently observed in the schizophrenia-spectrum (SZ) and associated with functional disability. While semi-structured interviews of negative symptoms represent a gold-standard approach, they require specialized training and may be vulnerable to rater biases. Thus, brief self-report questionnaires measuring negative symptoms may be useful. Existing negative symptom questionnaires demonstrate that this approach may be promising in schizophrenia, but no measure has been devised for use across stages of psychotic illness. The present study reports initial psychometric validation of the Negative Symptom Inventory-Self-Report (NSI-SR), the self-report counterpart of the Negative Symptom Inventory-Psychosis Risk clinical interview. The NSI-SR is a novel transphasic negative symptoms measure assessing the domains of anhedonia, avolition, and asociality. The NSI-SR and related measures were administered to two samples: 1) undergraduates (n = 335), 2) community participants, including: SZ (n = 32), clinical-high risk for psychosis (CHR, n = 25), and healthy controls matched to SZ (n = 31) and CHR (n = 30). The psychometrically trimmed 11-item NSI-SR showed good internal consistency and a three-factor solution reflecting avolition, asociality, and anhedonia. The NSI-SR demonstrated convergent validity via moderate to large correlations with clinician-rated negative symptoms and related constructs in both samples. Discriminant validity was supported by lower correlations with positive symptoms in both samples; however, correlations with positive symptoms were still significant. These initial psychometric findings suggest that the NSI-SR is a reliable and valid brief questionnaire capable of measuring negative symptoms across phases of psychotic illness.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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16
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Wang LL, Tam MHW, Ho KKY, Hung KSY, Wong JOY, Lui SSY, Chan RCK. Bridge centrality network structure of negative symptoms in people with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2023; 273:589-600. [PMID: 35972557 DOI: 10.1007/s00406-022-01474-w] [Citation(s) in RCA: 4] [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] [Received: 02/04/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
Negative symptoms are complex psychopathology. Although evidence generally supported the NIMH five consensus domains, research seldom examined measurement invariance of this model, and domain-specific correspondence across multiple scales. This study aimed to examine the interrelationship between negative symptom domains captured by different rating scales, and to examine the domain-specific correspondence across multiple scales. We administered the Brief Negative Symptom Scale (BNSS), the Self-evaluation of Negative Symptoms (SNS), and the Scale for Assessment of Negative Symptoms (SANS) to 204 individuals with schizophrenia. We used network analysis to examine the interrelationship between negative symptom domains. Besides regularized partial correlation network, we estimated bridge centrality indices to investigate domain-specific correspondence, while taking each scale as an independent community. The regularized partial correlation network showed that the SNS nodes clustered together, whereas the SANS and the BNSS nodes intermingled together. The SANS attention domain lied at the periphery of the network according to the Fruchterman-Reingold algorithm. The SANS anhedonia-asociality (strength = 1.48; EI = 1.48) and the SANS affective flattening (strength = 1.06; EI = 1.06) had the highest node strength and EI. Moreover, the five nodes of the BNSS bridged the nodes of the SANS and the SNS. BNSS blunted affect (strength = 0.76; EI = 0.76) and SANS anhedonia-asociality (strength = 0.76; EI = 0.74) showed the highest bridge strength and bridge EI. The BNSS captures negative symptoms and bridges the symptom domains measured by the SANS and the SNS. The three scales showed domain-specific correspondence.
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Affiliation(s)
- Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Michelle H W Tam
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Karen K Y Ho
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Jessica O Y Wong
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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17
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Efficacy of Serotonin and Dopamine Activity Modulators in the Treatment of Negative Symptoms in Schizophrenia: A Rapid Review. Biomedicines 2023; 11:biomedicines11030921. [PMID: 36979900 PMCID: PMC10046337 DOI: 10.3390/biomedicines11030921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Schizophrenia is among the fifteen most disabling diseases worldwide. Negative symptoms (NS) are highly prevalent in schizophrenia, negatively affect the functional outcome of the disorder, and their treatment is difficult and rarely specifically investigated. Serotonin-dopamine activity modulators (SDAMs), of which aripiprazole, cariprazine, brexpiprazole, and lumateperone were approved for schizophrenia treatment, represent a possible therapy to reduce NS. The aim of this rapid review is to summarize the evidence on this topic to make it readily available for psychiatrists treating NS and for further research. We searched the PubMed database for original studies using SDAM, aripiprazole, cariprazine, brexpiprazole, lumateperone, schizophrenia, and NS as keywords. We included four mega-analyses, eight meta-analyses, two post hoc analyses, and 20 clinical trials. Aripiprazole, cariprazine, and brexpiprazole were more effective than placebo in reducing NS. Only six studies compared SDAMs with other classes of antipsychotics, demonstrating a superiority in the treatment of NS mainly for cariprazine. The lack of specific research and various methodological issues, related to the study population and the assessment of NS, may have led to these partial results. Here, we highlight the need to conduct new methodologically robust investigations with head-to-head treatment comparisons and long-term observational studies on homogeneous groups of patients evaluating persistent NS with first- and second-generation scales, namely the Brief Negative Symptom Scale and the Clinical Assessment Interview for Negative Symptoms. This rapid review can expand research on NS therapeutic strategies in schizophrenia, which is fundamental for the long-term improvement of patients’ quality of life.
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18
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Oh Y, Joung YS, Baek JH. The Core Symptoms of Adolescents Online and Offline Gambling in South Korea Using Network Analysis. Psychiatry Investig 2023; 20:228-235. [PMID: 36990666 PMCID: PMC10064209 DOI: 10.30773/pi.2022.0116] [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: 04/25/2022] [Accepted: 10/31/2022] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE Adolescent gambling is rapidly increasing recently. However, little is known about the core feature of adolescent gambling that should be the treatment target for adolescents. Thus, the objective of this study was to determine the core symptom of adolescent gambling using network analysis with large-scale data targeting community indwelling adolescents. METHODS We used dataset of the 2018 national survey on youth gambling problems collected by the Korea Center on Gambling Problems to explore symptom networks of gambling in adolescents. Of 17,520 respondents in the dataset of the 2018 national survey on youth gambling problems collected by the Korea Center on Gambling Problems, 5,619 adolescents with experience of gambling were included in the analysis. We computed an association network, a graphical least absolute shrinkage and selection operator, and a directed acyclic graph to model symptom interactions. RESULTS In each network of online, offline, and all gambling, stealing money or other valuable things in order to gamble or pay off gambling debts was the most centrally situated and skipping practice followed by dropping out of activities. Especially strong connections emerged between stealing money or other valuable things in order to gamble or pay off gambling debts and academic performance degradation due to gambling. Feeling bad due to gamble and skipping hanging out with friends who do not gamble emerged as a highly central node that might be distinctive to adolescents with online gambling. CONCLUSION These findings demonstrate central features of adolescent gambling. Different associations among specific network nodes suggest the existence of distinctive psychopathological constructs between online and offline gambling.
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Affiliation(s)
- Yunhye Oh
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Yoo-Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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19
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Galderisi S. Negative symptoms of schizophrenia: Trying to answer unanswered research questions. Psychiatry Res 2023; 320:115043. [PMID: 36623425 DOI: 10.1016/j.psychres.2022.115043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
My research has focused on unmet needs in caring for people with schizophrenia. In particular, I focused on negative symptoms, a complex psychopathological dimension of the disorder, with a significant impact on the disease outcome, and not effectively addressed by existing treatments. In the present commentary, I summarize the trajectory of my research activity. I start with the description of my initial attempts to define the role of the dorsolateral prefrontal cortex in the pathogenesis of broadly defined negative symptoms. Then, I report on the evidence that led me to realize that no progress in research on schizophrenia negative symptoms could occur without considering the heterogeneity and complexity of the construct. Finally, I illustrate my attempts to succeed in this direction and the most pressing unsolved issues in this research field.
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Affiliation(s)
- Silvana Galderisi
- Professor of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
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Gil-Berrozpe GJ, Peralta V, Sánchez-Torres AM, Moreno-Izco L, García de Jalón E, Peralta D, Janda L, Cuesta MJ. Psychopathological networks in psychosis: Changes over time and clinical relevance. A long-term cohort study of first-episode psychosis. Schizophr Res 2023; 252:23-32. [PMID: 36621323 DOI: 10.1016/j.schres.2022.12.046] [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: 01/24/2022] [Revised: 03/22/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND First-episode psychosis is a critical period for early interventions to reduce the risk of poor outcomes and relapse as much as possible. However, uncertainties about the long-term outcomes of symptomatology remain to be ascertained. METHODS The aim of the present study was to use network analysis to investigate first-episode and long-term stages of psychosis at three levels of analysis: micro, meso and macro. The sample was a cohort of 510 patients with first-episode psychoses from the SEGPEP study, who were reassessed at the long-term follow-up (n = 243). We used the Comprehensive Assessment of Symptoms and History for their assessments and lifetime outcome variables of clinical relevance. RESULTS Our results showed a similar pattern of clustering between first episodes and long-term follow-up in seven psychopathological dimensions at the micro level, 3 and 4 dimensions at the meso level, and one at the macro level. They also revealed significant differences between first-episode and long-term network structure and centrality measures at the three levels, showing that disorganization symptoms have more influence in long-term stabilized patients. CONCLUSIONS Our findings suggest a relative clustering invariance at all levels, with the presence of two domains of disorganization as the most notorious difference over time at micro level. The severity of disorganization at the follow-up was associated with a more severe course of the psychosis. Moreover, a relative stability in global strength of the interconnections was found, even though the network structure varied significantly in the long-term follow-up. The macro level was helpful in the integration of all dimensions into a common psychopathology factor, and in unveiling the strong relationships of psychopathological dimensions with lifetime outcomes, such as negative with poor functioning, disorganization with high antipsychotic dose-years, and delusions with poor adherence to treatment. These results add evidence to the hierarchical, dimensional and longitudinal structure of psychopathological symptoms and their clinical relevance in first-episode psychoses.
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Affiliation(s)
- Gustavo J Gil-Berrozpe
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Victor Peralta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elena García de Jalón
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - David Peralta
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud - Osasunbidea, Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
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21
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Sun Y, Zhang Y, Lu Z, Yan H, Guo L, Liao Y, Lu T, Wang L, Li J, Li W, Yang Y, Yu H, Lv L, Zhang D, Bi W, Yue W. Longitudinal Network Analysis Reveals Interactive Change of Schizophrenia Symptoms During Acute Antipsychotic Treatment. Schizophr Bull 2023; 49:208-217. [PMID: 36179110 PMCID: PMC9810008 DOI: 10.1093/schbul/sbac131] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Complex schizophrenia symptoms were recently conceptualized as interactive symptoms within a network system. However, it remains unknown how a schizophrenia network changed during acute antipsychotic treatment. The present study aimed to evaluate the interactive change of schizophrenia symptoms under seven antipsychotics from individual time series. STUDY DESIGN Data on 3030 schizophrenia patients were taken from a multicenter randomized clinical trial and used to estimate the partial correlation cross-sectional networks and longitudinal random slope networks based on multivariate multilevel model. Thirty symptoms assessed by The Positive and Negative Syndrome Scale clustered the networks. STUDY RESULTS Five stable communities were detected in cross-sectional networks and random slope networks that describe symptoms change over time. Delusions, emotional withdrawal, and lack of spontaneity and flow of conversation featured as central symptoms, and conceptual disorganization, hostility, uncooperativeness, and difficulty in abstract thinking featured as bridge symptoms, all showing high centrality in the random slope network. Acute antipsychotic treatment changed the network structure (M-test = 0.116, P < .001) compared to baseline, and responsive subjects showed lower global strength after treatment (11.68 vs 14.18, S-test = 2.503, P < .001) compared to resistant subjects. Central symptoms and bridge symptoms kept higher centrality across random slope networks of different antipsychotics. Quetiapine treatment network showed improvement in excitement symptoms, the one featured as both central and bridge symptom. CONCLUSION Our findings revealed the central symptoms, bridge symptoms, cochanging features, and individualized features under different antipsychotics of schizophrenia. This brings implications for future targeted drug development and search for pathophysiological mechanisms.
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Affiliation(s)
- Yaoyao Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Yuyanan Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Zhe Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Hao Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Liangkun Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Yundan Liao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Tianlan Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Lifang Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Jun Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
| | - Wenqiang Li
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
| | - Yongfeng Yang
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
| | - Hao Yu
- Department of Psychiatry, Jining Medical University, Jining, Shandong, P. R. China
| | - Luxian Lv
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
| | - Dai Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, P. R. China
| | - Wenjian Bi
- Department of Medical Genetics, School of Basic Medical Sciences, Peking University, Beijing, P. R. China
| | - Weihua Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, P. R. China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, P. R. China
- Henan Key Lab of Biological Psychiatry, Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, P. R. China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, P. R. China
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22
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The relative contributions of insight and neurocognition to intrinsic motivation in schizophrenia. SCHIZOPHRENIA 2022; 8:18. [PMID: 35260585 PMCID: PMC8904546 DOI: 10.1038/s41537-022-00217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
Intrinsic motivation was described as the mental process of pursuing a task or an action because it is enjoyable or interesting in itself and was found to play a central role in the determination of the functional outcome of schizophrenia. Neurocognition is one of the most studied determinants of intrinsic motivation in clinically stable schizophrenia while little is known about the role of insight. Following this need we decided to focus on the contribution of different aspects of insight and of neurocognition to intrinsic motivation in a large sample (n = 176) of patients with stable schizophrenia. We performed three hierarchical linear regressions from which resulted that, among different insight aspects, the ability to correctly attribute signs and symptoms to the mental disorder made the strongest contribution to intrinsic motivation. Neurocognition, also, was significantly related to intrinsic motivation when analyzed simultaneously with insight. Moreover, even after accounting for sociodemographic and clinical variables significantly correlated with intrinsic motivation, the relationship between insight and neurocognition and intrinsic motivation remained statistically significant. These findings put the emphasis on the complex interplay between insight, neurocognition, and intrinsic motivation suggesting that interventions targeting both insight and neurocognition might possibly improve this motivational deficit in stable schizophrenia should.
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23
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Li SB, Liu C, Zhang JB, Wang LL, Hu HX, Chu MY, Wang Y, Lv QY, Lui SSY, Cheung EFC, Yi ZH, Chan RCK. Revisiting the latent structure of negative symptoms in schizophrenia: Evidence from two second-generation clinical assessments. Schizophr Res 2022; 248:131-139. [PMID: 36037646 DOI: 10.1016/j.schres.2022.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Negative symptoms are core symptom of schizophrenia, and many previous research studied the latent structure of negative symptoms based on a single measurement scale. Applying two second-generation negative symptom scales to the same sample can address measurement-invariance of latent structure. METHODS Three-hundred-and-five schizophrenia patients were assessed using the CAINS and the BNSS. Confirmatory Factor Analysis (CFA) tested four competing factor-models: (1) a 1-factor model; (2) a 2-factor model comprising the motivation and pleasure (MAP) domain and the diminished expression (EXP) domain; (3) a 5-factor model comprising anhedonia, avolition, asociality, blunted affect and alogia; (4) a hierarchical model comprising the "first-order" 5-domain factors and the "second-order" MAP & EXP factors. RESULTS The CFA results for the data of the CAINS showed that the 2-factor model had the best data fit over the other competing models. The CFA using the BNSS data in the same sample also supported the superiority of the 2-factor model. Lastly, after combining the items of the BNSS and CAINS together in the same sample for CFA, the 2-factor model prevailed over the other competing models. CONCLUSIONS The 2-factor model appears to be measurement-invariant latent structure of negative symptoms. The novel method of combining the items of the CAINS and BNSS might have circumvented the possible imperfect construct of a single scale. Our findings support the MAP and EXP factors as the latent structure for negative symptoms.
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Affiliation(s)
- Shuai-Biao Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Liu
- Nantong Fourth People's Hospital, Jiangsu, China
| | | | - Ling-Ling Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hui-Xin Hu
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Min-Yi Chu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qin-Yu Lv
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, Shanghai, China
| | - Simon S Y Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Zheng-Hui Yi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Huashan Hospital, Fudan University, School of Medicine, Shanghai, China; Institute of Mental Health, Fudan University, Shanghai, China.
| | - Raymond C K Chan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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24
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Paul NB, Strauss GP, Woodyatt JJ, Paul MG, Keene JR, Allen DN. Cluster analysis of negative symptoms identifies distinct negative symptom subgroups. Schizophr Res 2022; 246:207-215. [PMID: 35809353 DOI: 10.1016/j.schres.2022.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
Abstract
The heterogeneity of schizophrenia has been acknowledged for decades because of the diverse presentation of symptoms, illness course, and treatment response noted between individuals diagnosed with the disorder. Cluster analysis has been used as a statistical method to determine whether schizophrenia subgroups might be identified based on symptom heterogeneity. However, there is very limited research examining whether heterogeneity in negative symptoms might be useful in establishing schizophrenia subtypes, particularly research examining newer models of negative symptoms based on five latent constructs including anhedonia, asociality, avolition, blunted affect, and alogia. The Brief Negative Symptom Scale was used to assess the five negative symptoms domains in a sample of 220 outpatients diagnosed with schizophrenia or schizoaffective disorder. Cluster analysis supported a four-cluster solution, comprising clusters of subjects with low negative symptoms (LNS), severe negative symptoms (SNS), and two clusters with moderate negative symptoms, one with predominantly elevated blunted affect (BA) and one with elevated avolition (AV). The LNS, SNS, BA, and AV clusters significantly differed on external validators including clinical characteristics, neurocognition, and functional outcome. Findings suggest that schizophrenia heterogeneity can be parsed according to negative symptom subtypes that have distinct clinical and neuropsychological profiles. Implications for diagnosis and treatment are discussed.
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Affiliation(s)
- Nina B Paul
- Department of Psychology, University of Nevada, Las Vegas, United States of America
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, United States of America
| | - Jessica J Woodyatt
- Department of Psychology, University of Nevada, Las Vegas, United States of America
| | - Michelle G Paul
- Department of Psychology, University of Nevada, Las Vegas, United States of America
| | - Jennifer R Keene
- Department of Psychology, University of Nevada, Las Vegas, United States of America
| | - Daniel N Allen
- Department of Psychology, University of Nevada, Las Vegas, United States of America.
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25
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Giordano GM, Caporusso E, Pezzella P, Galderisi S. Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia. Expert Rev Neurother 2022; 22:541-555. [PMID: 35758871 DOI: 10.1080/14737175.2022.2092402] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Negative symptoms in schizophrenia are associated with poor response to available treatments, poor quality of life, and functional outcome. Therefore, they represent a substantial burden for people with schizophrenia, their families, and health-care systems. AREAS COVERED In this manuscript, we will provide an update on the conceptualization, assessment, and treatment of this complex psychopathological dimension of schizophrenia. EXPERT OPINION Despite the progress in the conceptualization of negative symptoms and in the development of state-of-the-art assessment instruments made in the last decades, these symptoms are still poorly recognized, and not always assessed in line with current conceptualization. Every effort should be made to disseminate the current knowledge on negative symptoms, on their assessment instruments and available treatments whose efficacy is supported by research evidence. Longitudinal studies should be promoted to evaluate the natural course of negative symptoms, improve our ability to identify the different sources of secondary negative symptoms, provide effective interventions, and target primary and persistent negative symptoms with innovative treatment strategies. Further research is needed to identify pathophysiological mechanisms of primary negative symptoms and foster the development of new treatments.
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26
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Abplanalp SJ, Green MF. Symptom Structure in Schizophrenia: Implications of Latent Variable Modeling vs Network Analysis. Schizophr Bull 2022; 48:538-543. [PMID: 35243503 PMCID: PMC9077428 DOI: 10.1093/schbul/sbac020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The structure of schizophrenia symptoms has a substantial impact on the development of pharmacological and psychosocial interventions. Typically, reflective latent variable models (eg, confirmatory factor analysis) or formative latent variable models (eg, principal component analysis) have been used to examine the structure of schizophrenia symptoms. More recently, network analysis is appearing as a method to examine symptom structure. However, latent variable modeling and network analysis results can lead to different inferences about the nature of symptoms. Given the critical role of correctly identifying symptom structure in schizophrenia treatment and research, we present an introduction to latent variable modeling and network analysis, along with their distinctions and implications for examining the structure of schizophrenia symptoms. We also provide a simulation demonstration highlighting the statistical equivalence between these models and the subsequent importance of an a priori rationale that should help guide model selection.
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Affiliation(s)
- Samuel J Abplanalp
- To whom correspondence should be addressed; VA Greater Los Angeles Healthcare System, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; tel: 317-445-5810, e-mail:
| | - Michael F Green
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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27
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Lim K, Rapisarda A, Keefe RSE, Lee J. Social skills, negative symptoms and real-world functioning in individuals at ultra-high risk of psychosis. Asian J Psychiatr 2022; 69:102996. [PMID: 35026654 DOI: 10.1016/j.ajp.2021.102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/28/2021] [Accepted: 12/27/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Impairment in real-world social functioning is observed in individuals at Ultra-High Risk (UHR) of psychosis. Both social skills and negative symptoms appear to influence real-world functioning. This study aims to examine the psychometric properties of a social skills measure, the High-Risk Social Challenge task (HiSoC), and evaluate the relationship between social skills, negative symptoms, and real-world functioning in UHR individuals. METHODS HiSoC data was analysed in 87 UHR individuals and 358 healthy controls. Exploratory factor analysis (EFA) was used to evaluate the factor structure of the HiSoC task. Convergent and divergent validity were assessed. Negative symptoms were assessed on the Positive and Negative Syndrome Scale (PANSS) and real-world functioning was indexed by the Global Assessment of Functioning (GAF). Commonality analysis was used to partition unique and shared variance of HiSoC and negative symptoms with real-world functioning. RESULTS EFA yielded a three-factor structure of HiSoC consisting of Affect, Odd behaviour and language, and Social-interpersonal. The HiSoC task discriminated UHR and healthy controls (p < 0.001, Cohen's d = 0.437-0.598). Commonality analysis revealed that the unique variance of the social amotivation subdomain of negative symptoms was the strongest predictor of GAF (p < .001, R2 = .480). Shared variance of 3.7% between HiSoC Social-interpersonal and social amotivation was observed in relation to functioning. CONCLUSION The HiSoC is a psychometrically valid task that is sensitive to identify social skill deficits in UHR. While social skills are related to functioning, experiential negative symptoms appear to be an important target for improving real-world functional outcomes.
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Affiliation(s)
- Keane Lim
- Research Division, Institute of Mental Health, Singapore
| | - Attilio Rapisarda
- Research Division, Institute of Mental Health, Singapore; Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore
| | - Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; Department of Psychosis, Institute of Mental Health, Singapore; Neuroscience and Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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28
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Psychometric properties of the BIRT Motivation Questionnaire (BMQ), a self-measure of avolition in individuals with schizophrenia. J Psychiatr Res 2022; 147:274-282. [PMID: 35074744 DOI: 10.1016/j.jpsychires.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/20/2021] [Accepted: 01/13/2022] [Indexed: 11/21/2022]
Abstract
AIMS Avolition defined as a lack of interest or engagement in goal-directed behavior plays a key role in everyday functioning in schizophrenia and is considered as one of the main contributors to the burden of disease. The aim of this study was to 1) validate the self-report BIRT Motivation Questionnaire (BMQ-S) seldom used before in schizophrenia 2) examine the degree of agreement between the BMQ-S and its informant-report version 3) to assess its ability to predict real-world outcome at 12 month follow-up. METHODS One hundred and twenty-two (51.9% inpatients) adults with a diagnosis of schizophrenia were included. Exploratory Factor analysis was performed on the BMQ-S to identify the underlying structure. Real life functioning was measured with the Global Assessment of Functioning scale (GAF). Convergent validity was assessed with the Scale for Assessment of Negative Symptom (SANS) and the Lille Apathy Rating Scale (LARS). RESULTS The main psychometric properties of the BMQ-S (internal consistency, test-retest reliability) were satisfactory. Exploratory factorial analysis revealed a 4-factor model which explained 76% of the overall variance. The BMQ-S correlated significantly with the LARS and the SANS avolition subscore suggesting adequate convergent validity. The correlation between the BMQ-S and the clinician-report version was 0.48. The global score and in particular the Initiation/disorganisation dimension was a significant predictor of global functioning at 12-months even when adjusted for age, chlorpromazine intake and depression. CONCLUSION Our findings indicate that the BMQ-S has satisfactory psychometric properties and that schizophrenia patients can reliably assess their lack of motivation. Self-evaluation of avolition should be considered in the overall prediction of real-world functioning in schizophrenia.
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29
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Chan KN, Chang WC, Ng CM, Lee HC, Chan SI, Chiu SY, Wong CF, Wo SF, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Chan CWH, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Sex differences in symptom severity, cognition and psychosocial functioning among individuals with at-risk mental state for psychosis. Early Interv Psychiatry 2022; 16:61-68. [PMID: 33590717 DOI: 10.1111/eip.13131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 11/29/2022]
Abstract
AIM Sex differences are well documented in schizophrenia, but have been much less studied in at-risk mental state (ARMS) for psychosis. We aimed to examine sex differences in symptomatology, cognition, social and role functioning in individuals with ARMS, with specific focus on clarifying relationships between sex, negative symptoms and functioning. METHODS One hundred and seventy-seven Chinese participants aged 15-40 years with ARMS were recruited from a specialized early intervention service in Hong Kong. ARMS status was verified by Comprehensive Assessment of At-Risk Mental State. Assessments encompassing symptom profiles, a brief battery of cognitive tests and social and role functioning were conducted. Brief Negative Symptom Scale was adapted to measure negative symptoms at the level of five core domains. RESULTS Males with ARMS exhibited significantly poorer social functioning and more severe asociality of negative symptoms than female counterparts. Mediation analysis revealed that sex difference in social functioning became statistically insignificant when asocality was included in the model, indicating that asociality mediated the relationship between sex and social functioning. No sex differences were observed in other core domains of negative symptoms, other symptom dimensions, cognitive measures and role functioning. CONCLUSIONS This study suggests that sex differences in ARMS may be less pronounced that those observed in established psychotic disorders. Our findings of differential pattern of asociality between sexes and its mediating role on sex difference in social functioning underscore the importance in investigating negative symptoms at a separable domain-level. Further research is required to identify sex-specific predictors of longitudinal outcomes in at-risk populations.
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Affiliation(s)
- Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Chung Mun Ng
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Hoi Ching Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Suet In Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - San Yin Chiu
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Cheuk Fei Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sui Fung Wo
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Ming Cheuk Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Kwok Ling Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Wai Song Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Charles Wai Hong Chan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Lam Wai Choy
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Shiu Yin Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, China
| | - Man Wa Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, China
| | - Tak Lam Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong, China
| | - Wai Ching Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong, China
| | - Man Kin Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong, China
| | - Lap Tak Poon
- Department of Psychiatry, United Christian Hospital, Hong Kong, China
| | - Pui Fai Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong, China
| | - Wai Chung Lam
- Department of Psychiatry, United Christian Hospital, Hong Kong, China
| | - Yip Chau Wong
- Department of Psychiatry, Tai Po Hospital, Hong Kong, China
| | - Wai Sau Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong, China
| | - Yi Man Mo
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Sai Yu Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, China
| | - Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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30
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Turner JA, Calhoun VD, Thompson PM, Jahanshad N, Ching CRK, Thomopoulos SI, Verner E, Strauss GP, Ahmed AO, Turner MD, Basodi S, Ford JM, Mathalon DH, Preda A, Belger A, Mueller BA, Lim KO, van Erp TGM. ENIGMA + COINSTAC: Improving Findability, Accessibility, Interoperability, and Re-usability. Neuroinformatics 2022; 20:261-275. [PMID: 34846691 PMCID: PMC9149142 DOI: 10.1007/s12021-021-09559-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 01/07/2023]
Abstract
The FAIR principles, as applied to clinical and neuroimaging data, reflect the goal of making research products Findable, Accessible, Interoperable, and Reusable. The use of the Collaborative Informatics and Neuroimaging Suite Toolkit for Anonymized Computation (COINSTAC) platform in the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) consortium combines the technological approach of decentralized analyses with the sociological approach of sharing data. In addition, ENIGMA + COINSTAC provides a platform to facilitate the use of machine-actionable data objects. We first present how ENIGMA and COINSTAC support the FAIR principles, and then showcase their integration with a decentralized meta-analysis of sex differences in negative symptom severity in schizophrenia, and finally present ongoing activities and plans to advance FAIR principles in ENIGMA + COINSTAC. ENIGMA and COINSTAC currently represent efforts toward improved Access, Interoperability, and Reusability. We highlight additional improvements needed in these areas, as well as future connections to other resources for expanded Findability.
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Affiliation(s)
- Jessica A Turner
- Psychology Department, Georgia State University, Atlanta, GA, USA.
| | - Vince D Calhoun
- Psychology Department, Georgia State University, Atlanta, GA, USA
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, 30303, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Christopher R K Ching
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, CA, USA
| | - Eric Verner
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, 30303, USA
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, USA
| | - Anthony O Ahmed
- Weill Cornell Medicine, Department of Psychiatry, White Plains, NY, 10605, USA
| | - Matthew D Turner
- Psychology Department, Georgia State University, Atlanta, GA, USA
| | - Sunitha Basodi
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, 30303, USA
| | - Judith M Ford
- Veterans Affairs San Francisco Healthcare System, San Francisco, CA, 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, 94121, USA
| | - Daniel H Mathalon
- Veterans Affairs San Francisco Healthcare System, San Francisco, CA, 94121, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, 94121, USA
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, University of California Irvine Medical Center, 101 The City Drive S, Orange, CA, 92868, USA
| | - Aysenil Belger
- Department of Psychiatry and Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, 105 Smith Level Road, Chapel Hill, NC, 27599-8180, USA
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, 55414, USA
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, 55414, USA
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, 5251 California Ave, Irvine, CA, 92617, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, 309 Qureshey Research Lab, Irvine, CA, 92697, USA
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31
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Havers L, Cardno A, Freeman D, Ronald A. The Latent Structure of Negative Symptoms in the General Population in Adolescence and Emerging Adulthood. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac009. [PMID: 35156042 PMCID: PMC8827402 DOI: 10.1093/schizbullopen/sgac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Negative symptoms predict adverse outcomes within psychotic disorders, in individuals at high-risk for psychosis, and in young people in the community. There is considerable interest in the dimensional structure of negative symptoms in clinical samples, and accumulating evidence suggests a 5-factor structure. Little is known about the underlying structure of negative symptoms in young people despite the importance of this developmental stage for mental health. We used confirmatory factor analysis to test the structure of parent-reported negative symptoms at mean ages 16.32 (SD 0.68, N = 4974), 17.06 (SD 0.88, N = 1469) and 22.30 (SD 0.93, N = 5179) in a community sample. Given previously reported associations between total negative symptoms and genome-wide polygenic scores (GPS) for major depressive disorder (MDD) and schizophrenia in adolescence, we assessed associations between individual subdomains and these GPSs. A 5-factor model of flat affect, alogia, avolition, anhedonia, and asociality provided the best fit at each age and was invariant over time. The results of our linear regression analyses showed associations between MDD GPS with avolition, flat affect, anhedonia, and asociality, and between schizophrenia GPS with avolition and flat affect. We showed that a 5-factor structure of negative symptoms is present from ages 16 to 22 in the community. Avolition was most consistently associated with polygenic liability to MDD and schizophrenia, and alogia was least associated. These findings highlight the value of dissecting negative symptoms into psychometrically derived subdomains and may offer insights into early manifestation of genetic risk for MDD and schizophrenia.
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Affiliation(s)
- Laura Havers
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Alastair Cardno
- Division of Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Angelica Ronald
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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32
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Tortorella A. We Should Improve Personalization of Management in Patients with a Diagnosis of Schizophrenia. J Clin Med 2021; 11:jcm11010184. [PMID: 35011925 PMCID: PMC8745754 DOI: 10.3390/jcm11010184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 12/23/2022] Open
Abstract
The current management of patients with schizophrenia is marked by a lack of personalization. After the diagnosis is made, a second-generation antipsychotic is usually prescribed based on the current clinician’s preferences, sometimes accompanied by a psychosocial intervention which is typically not evidence-based and not targeted to the specific needs of the individual patient. In this opinion paper, some steps are outlined that could be taken in order to address this lack of personalization. A special emphasis is laid on the clinical characterization of the patient who has received a diagnosis of schizophrenia. Considerations are put forward concerning the assessment of the negative dimension in ordinary clinical practice, which is often neglected; the evaluation of cognitive functioning using a simple test battery which requires limited professional training and takes no more than 15 min to administer; the evaluation of social functioning using a validated instrument focusing on personal care skills, interpersonal relationships, social acceptability, activities, and work skills; and the assessment of the unmet needs of the person (including practical, social, and emotional needs, and existential or personal recovery). The implications of the assessment of these domains for the formulation of the management plan are discussed.
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Pelizza L, Azzali S, Paterlini F, Garlassi S, Scazza I, Chiri LR, Poletti M, Pupo S, Raballo A. Negative symptom dimensions in first episode psychosis: Is there a difference between schizophrenia and non-schizophrenia spectrum disorders? Early Interv Psychiatry 2021; 15:1513-1521. [PMID: 33238327 DOI: 10.1111/eip.13088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/27/2020] [Accepted: 11/14/2020] [Indexed: 01/24/2023]
Abstract
AIM Identifying discrete dimensions that underline negative symptoms in First Episode Psychosis (FEP) could improve the understanding and the treatment of such invalidating symptomatology. The aim of this study is to examine the negative symptom structure in FEP individuals and to compare the resulting factor configurations between FEP subjects with and without Schizophrenia Spectrum Disorders (SSD vs non-SSD). METHODS One hundred and seventy participants (88 SSD and 82 non-SSD), aged 13-35 years, completed the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Positive and Negative Syndrome Scale (PANSS). A principal component analysis was then performed to investigate PANSS negative symptom structure in both non-SSD and SSD groups. RESULTS Whereas in the SSD sample a 3-factor model solution (i.e., "Socio-Emotional Disengagement", "Motor/Thought Poverty", and "Avolition/Apathy" dimensions) was identified, a 2-factor model solution (with a mixed alogia/avolition domain in addition to a mixed socio-emotional disengagement/expressive deficits dimension) appeared more appropriate in the non-SSD group. CONCLUSIONS Our results show a relevant difference in the negative symptom factor structure between SSD and non-SSD individuals. In particular, a different specificity and significance of negative symptom models in FEP populations with diagnoses other than schizophrenia (compared to those with SSD) must be realistically considered. Notably, a "Motor/Thought Poverty" domain, which specifically includes alogia and motor retardation separately from the other PANSS negative items, appears to specifically characterize FEP young patients with the schizophrenia spectrum.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Paterlini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sara Garlassi
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Scazza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Rocco Chiri
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Primary Care, Azienda USL di Parma, Parma, Italy
| | - Michele Poletti
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Pupo
- Anesthesia and Resuscitation Service, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Raballo
- Department of Medicine, Division of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
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34
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Demyttenaere K, Leenaerts N, Acsai K, Sebe B, Laszlovszky I, Barabássy Á, Fonticoli L, Szatmári B, Earley W, Németh G, Correll CU. Disentangling the symptoms of schizophrenia: Network analysis in acute phase patients and in patients with predominant negative symptoms. Eur Psychiatry 2021; 65:e18. [PMID: 34641986 PMCID: PMC8926909 DOI: 10.1192/j.eurpsy.2021.2241] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Positive and Negative Syndrome Scale (PANSS) is widely used in schizophrenia and has been divided into distinct factors (5-factor models) and subfactors. Network analyses are newer in psychiatry and can help to better understand the relationships and interactions between the symptoms of a psychiatric disorder. The aim of this study was threefold: (a) to evaluate connections between schizophrenia symptoms in two populations of patients (patients in the acutely exacerbated phase of schizophrenia and patients with predominant negative symptoms [PNS]), (b) to test whether network analyses support the Mohr 5 factor model of the PANSS and the Kahn 2 factor model of negative symptoms, and finally (c) to identify the most central symptoms in the two populations. Methods Using pooled baseline data from four cariprazine clinical trials in patients with acute exacerbation of schizophrenia (n = 2193) and the cariprazine–risperidone study in patients with PNS (n = 460), separate network analyses were performed. Network structures were estimated for all 30 items of the PANSS. Results While negative symptoms in patients with an acute exacerbation of schizophrenia are correlated with other PANSS symptoms, these negative symptoms are not correlated with other PANSS symptoms in patients with PNS. The Mohr factors were partially reflected in the network analyses. The two most central symptoms (largest node strength) were delusions and uncooperativeness in acute phase patients and hostility and delusions in patients with PNS. Conclusions This network analysis suggests that symptoms of schizophrenia are differently structured in acute and PNS patients. While in the former, negative symptoms are mainly secondary, in patients with PNS, they are mainly primary. Further, primary negative symptoms are better conceptualized as distinct negative symptom dimensions of the PANSS.
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Affiliation(s)
- Koen Demyttenaere
- University of Leuven, Faculty of Medicine, Department of Neurosciences, Psychiatry Research Group and University Psychiatric Center KU Leuven, Belgium.,University Psychiatric Center KU Leuven, Belgium
| | | | - Károly Acsai
- Gedeon Richter Plc., Medical Division, Budapest, Hungary
| | - Barbara Sebe
- Gedeon Richter Plc., Medical Division, Budapest, Hungary
| | | | | | | | | | | | - György Németh
- Gedeon Richter Plc., Medical Division, Budapest, Hungary
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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35
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The Relationship between Negative Symptoms and Both Emotion Management and Non-social Cognition in Schizophrenia Spectrum Disorders. J Int Neuropsychol Soc 2021; 27:916-928. [PMID: 33342446 DOI: 10.1017/s1355617720001290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE There is ongoing debate regarding the relationship between clinical symptoms and cognition in schizophrenia spectrum disorders (SSD). The present study aimed to explore the potential relationships between symptoms, with an emphasis on negative symptoms, and social and non-social cognition. METHOD Hierarchical cluster analysis with k-means optimisation was conducted to characterise clinical subgroups using the Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms in n = 130 SSD participants. Emergent clusters were compared on the MATRICS Consensus Cognitive Battery, which measures non-social cognition and emotion management as well as demographic and clinical variables. Spearman's correlations were then used to investigate potential relationships between specific negative symptoms and emotion management and non-social cognition. RESULTS Four distinct clinical subgroups were identified: 1. high hallucinations, 2. mixed symptoms, 3. high negative symptoms, and 4. relatively asymptomatic. The high negative symptom subgroup was found to have significantly poorer emotion management than the high hallucination and relatively asymptomatic subgroups. No further differences between subgroups were observed. Correlation analyses revealed avolition-apathy and anhedonia-asociality were negatively correlated with emotion management, but not non-social cognition. Affective flattening and alogia were not associated with either emotion management or non-social cognition. CONCLUSIONS The present study identified associations between negative symptoms and emotion management within social cognition, but no domains of non-social cognition. This relationship may be specific to motivation, anhedonia and apathy, but not expressive deficits. This suggests that targeted interventions for social cognition may also result in parallel improvement in some specific negative symptoms.
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36
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Saleh Y, Jarratt-Barnham I, Fernandez-Egea E, Husain M. Mechanisms Underlying Motivational Dysfunction in Schizophrenia. Front Behav Neurosci 2021; 15:709753. [PMID: 34566594 PMCID: PMC8460905 DOI: 10.3389/fnbeh.2021.709753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022] Open
Abstract
Negative symptoms are a debilitating feature of schizophrenia which are often resistant to pharmacological intervention. The mechanisms underlying them remain poorly understood, and diagnostic methods rely on phenotyping through validated questionnaires. Deeper endo-phenotyping is likely to be necessary in order to improve current understanding. In the last decade, valuable behavioural insights have been gained through the use of effort-based decision making (EBDM) tasks. These have highlighted impairments in reward-related processing in schizophrenia, particularly associated with negative symptom severity. Neuroimaging investigations have related these changes to dysfunction within specific brain networks including the ventral striatum (VS) and frontal brain regions. Here, we review the behavioural and neural evidence associated with negative symptoms, shedding light on potential underlying mechanisms and future therapeutic possibilities. Findings in the literature suggest that schizophrenia is characterised by impaired reward based learning and action selection, despite preserved hedonic responses. Associations between amotivation and reward-processing deficits have not always been clear, and may be mediated by factors including cognitive dysfunction or dysfunctional or self-defeatist beliefs. Successful endo-phenotyping of negative symptoms as a function of objective behavioural and neural measurements is crucial in advancing our understanding of this complex syndrome. Additionally, transdiagnostic research–leveraging findings from other brain disorders, including neurological ones–can shed valuable light on the possible common origins of motivation disorders across diseases and has important implications for future treatment development.
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Affiliation(s)
- Youssuf Saleh
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Isaac Jarratt-Barnham
- Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, University of Cambridge, Cambridge, United Kingdom.,Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Herchel Smith Building for Brain & Mind Sciences, University of Cambridge, Cambridge, United Kingdom.,Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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37
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Căpățână O, Fadgyas Stănculete M, Micluția I. "Predictors of Negative Symptom Domains in Outpatients with Schizophrenia:
A Cross-Sectional Study". JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2021. [DOI: 10.24193/jebp.2021.2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"Background: Current research suggests that negative symptoms may not be
a unitary construct. Factor analytic studies typically found evidence for a
two-factor solution of the negative symptom domain: the expressive and the
volitional deficit. This study aimed to investigate whether the two-factor
solution of negative symptoms is supported across different instruments of
evaluation: PANSS and NSA-16 in outpatients with schizophrenia and to
explore the relationship between these domains and sociodemographic,
clinical, and metabolic outcomes, routinely assessed in daily
practice.Another aim was to determine clinical predictors of negative
symptoms domains among these variables.
Materials and methods: 107 patients with schizophrenia were included in
this cross-sectional study. The Principal Component Analysis was used to
identify negative symptom domains and Spearman's rank correlation
coefficient and multiple regression analyses were used to assess the
relationship between the negative symptom domains and clinical variables.
Results: PCA indicated a two-component solution explaining 85.2% of the
variance for the NSA-16 subscales, reflecting an expressive deficit and an
experiential deficit component. Age of onset of the disease and the cognitive
deficit were significant predictors of the expressive deficit , body mass index
and the number of admissions in the hospital for the experiential deficit.
Conclusions: The current findings indicate that the expressive deficit and the
experiential deficit should be considered as distinct domains of the
psychopathology and should be rated separately"
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Affiliation(s)
- Octavia Căpățână
- "Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Romania"
| | - Mihaela Fadgyas Stănculete
- "Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Romania"
| | - Ioana Micluția
- "Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Romania"
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38
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Gupta T, Strauss GP, Cowan HR, Pelletier-Baldelli A, Ellman LM, Schiffman J, Mittal VA. Secondary Sources of Negative Symptoms in Those Meeting Criteria for a Clinical High-Risk Syndrome. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:210-218. [PMID: 35415704 PMCID: PMC8996819 DOI: 10.1016/j.bpsgos.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Negative symptoms are diagnostic characteristics of schizophrenia. They can result from primary (i.e., idiopathic) or secondary (i.e., due to other factors such as depression, anxiety, psychosis, disorganization, medication effects) features of the illness. Although secondary sources of negative symptoms are prevalent among individuals meeting criteria for clinical high-risk syndromes that are due to high rates of comorbidity, the extent to which secondary sources account for variance in negative symptom domains is unknown. Addressing this gap is an important step in informing vulnerability models and treatments for negative symptoms. This study aimed to investigate secondary sources of negative symptoms in those meeting criteria for a clinical high-risk syndrome (N = 192). METHODS Simultaneous regression and hierarchical partitioning methods were used to determine the proportion of variance explained by selective serotonin reuptake inhibitor use, anxiety, depression, unusual thought content, and disorganized communication in predicting severity of five negative symptom domains (avolition, anhedonia, asociality, blunted affect, and alogia). RESULTS Findings revealed that depression explained the largest proportion of variance in avolition, asociality, and anhedonia. Anxiety was the most predictive of blunted affect, and selective serotonin reuptake inhibitor use explained the most variance in alogia. Analyses within male and female samples revealed that in males, depression explained a large proportion of variance in several negative symptom domains, while in females, selective serotonin reuptake inhibitor use explained variance in alogia. CONCLUSIONS Results highlight heterogeneity in variance explained by secondary sources of negative symptoms. These findings guide treatment development for secondary sources of negative symptoms. Furthermore, results inform etiologic models of psychosis and negative symptom conceptualizations.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Illinois
| | | | - Henry R. Cowan
- Department of Psychology, Northwestern University, Evanston, Illinois
| | | | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
- Department of Psychological Science, University of California, Irvine, Irvine, California
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois
- Department of Psychiatry, Northwestern University, Evanston, Illinois
- Department of Medical Social Science, Northwestern University, Evanston, Illinois
- Institute for Policy Research, Northwestern University, Evanston, Illinois
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39
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Moura BM, van Rooijen G, Schirmbeck F, Wigman JTW, Madeira L, van Harten P, van Os J, Bakker PR, Marcelis M. A Network of Psychopathological, Cognitive, and Motor Symptoms in Schizophrenia Spectrum Disorders. Schizophr Bull 2021; 47:915-926. [PMID: 33533401 PMCID: PMC8266645 DOI: 10.1093/schbul/sbab002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Schizophrenia spectrum disorders (SSDs) are complex syndromes involving psychopathological, cognitive, and also motor symptoms as core features. A better understanding of how these symptoms mutually impact each other could translate into diagnostic, prognostic, and, eventually, treatment advancements. The present study aimed to: (1) estimate a network model of psychopathological, cognitive, and motor symptoms in SSD; (2) detect communities and explore the connectivity and relative importance of variables within the network; and (3) explore differences in subsample networks according to remission status. A sample of 1007 patients from a multisite cohort study was included in the analysis. We estimated a network of 43 nodes, including all the items from the Positive and Negative Syndrome Scale, a cognitive assessment battery and clinical ratings of extrapyramidal symptoms. Methodologies specific to network analysis were employed to address the study's aims. The estimated network for the total sample was densely interconnected and organized into 7 communities. Nodes related to insight, abstraction capacity, attention, and suspiciousness were the main bridges between network communities. The estimated network for the subgroup of patients in remission showed a sparser density and a different structure compared to the network of nonremitted patients. In conclusion, the present study conveys a detailed characterization of the interrelations between a set of core clinical elements of SSD. These results provide potential novel clues for clinical assessment and intervention.
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Affiliation(s)
- Bernardo Melo Moura
- Department of Psychiatry, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Department of Psychiatry and Mental Health, North Lisbon University Hospital Centre, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Arkin Institute for Mental Health, 1033 NN Amsterdam, The Netherlands
| | - Johanna T W Wigman
- Rob Giel Onderzoekscentrum, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Luís Madeira
- Department of Psychiatry, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
- Department of Psychiatry and Mental Health, North Lisbon University Hospital Centre, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Peter van Harten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht University, 6200 MD Maastricht, The Netherlands
- GGz Centraal, Innova Medical Centre, 3800 DB Amersfoort, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht University, 6200 MD Maastricht, The Netherlands
- Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht University, 3508 AB Utrecht, The Netherlands
| | - P Roberto Bakker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht University, 6200 MD Maastricht, The Netherlands
- Arkin Institute for Mental Health, 1033 NN Amsterdam, The Netherlands
- Brain Center Rudolf Magnus University Medical Center Utrecht, Utrecht University, 3508 AB Utrecht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht University, 6200 MD Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), 5600 AX Eindhoven, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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Xi YB, Guo F, Liu WM, Fu YF, Li JM, Wang HN, Chen FL, Cui LB, Zhu YQ, Li C, Kang XW, Li BJ, Yin H. Triple network hypothesis-related disrupted connections in schizophrenia: A spectral dynamic causal modeling analysis with functional magnetic resonance imaging. Schizophr Res 2021; 233:89-96. [PMID: 34246865 DOI: 10.1016/j.schres.2021.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/15/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The symptom-related neurobiology characteristic of schizophrenia in the brain from a network perspective is still poorly understood, leading to a lack of potential biologically-based markers and difficulty identifying therapeutic targets. We aim to test the dysregulated cross-network interactions among the Salience Network (SN), Central Executive Network (CEN) and Default Mode Network (DMN) and how they contributed to different symptoms in schizophrenia patients. METHODS We examined network interactions among the SN, CEN and DMN in 76 patients with schizophrenia vs. 80 well-matched controls using dynamic causal modeling (DCM). We further analyzed the relation between network dynamics and Positive and Negative Syndrome Scale (PANSS). RESULTS We observed that the DMN, CEN and SN across healthy controls and schizophrenia patients showed several similarities within or between-network pattern in the resting state. Comparing schizophrenia to controls, SN-centered cross-network interactions were most significantly reduced. Crucially, the strength of connections from CEN subnetwork 1 to DMN subnetwork 1 was positively correlated with the Positive Score of PANSS. The connection from the DMN subnetwork 2 to CEN subnetwork 2 was negatively correlated with the Negative Score of PANSS. CONCLUSIONS Our study provides strong evidence for the dysregulation among SN, CEN and DMN in a triple-network perspective in schizophrenia. The connection between DMN and CEN could be clinically-relevant neurobiological signature of schizophrenia symptoms. Our study indicated that the description of brain triple network hypothesis could be a novel and possible bio-marker for schizophrenia.
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Affiliation(s)
- Yi-Bin Xi
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wen-Ming Liu
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yu-Fei Fu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jia-Ming Li
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fu-Lin Chen
- College of Life Sciences, Northwest University, Taibai North Rd 229, Xi'an, Shaanxi, China
| | - Long-Biao Cui
- Department of Clinical Psychology, School of Medical Psychology, Fourth Military Medical University, Xi'an, Shaanxi, China; The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuan-Qiang Zhu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chen Li
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiao-Wei Kang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bao-Juan Li
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
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Latent structure of self-report negative symptoms in patients with schizophrenia: A preliminary study. Asian J Psychiatr 2021; 61:102680. [PMID: 34000499 DOI: 10.1016/j.ajp.2021.102680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Negative symptoms are associated with poor outcomes and functioning. Latent structure of negative symptoms is important for identifying potential intervention targets for novel treatments. Self-report instruments have been developed to measure negative symptoms. Previous findings on latent structure of negative symptoms are inconsistently and mainly rely on clinician-rated instruments. METHOD We aimed to explore the latent structure of the Self-Evaluation of Negative Symptoms Scale (SNS) in 204 clinically-stable outpatients with schizophrenia. Confirmatory factor analysis (CFA) was used to compare the competing models (i.e., one-factor, two-factor and five-factor models), and estimated goodness-of-fit indexes. Other clinician-rated scales for psychopathology and medication side-effects were also collected. RESULTS The CFA found the five-factor model performing best, with a comparative fit index (CFI) of > 0.95, a Tucker Lewis Index (TLI) of > 0.95, and a root mean square error of approximation (RMSEA) of < 0.06. The robust chi-square difference test for the weighted least squares with mean and variance adjusted estimation (WLSMV) also indicated a significant better fit for the five-factor model. DISCUSSION Our preliminary findings support a five-factor latent structure of self-report negative symptoms in schizophrenia patients. Further research in this area should utilize multiple clinician-rated and self-report measures, and recruit large and homogeneous samples with schizophrenia.
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Neurocognitive functions in persistent negative symptoms following a first episode of psychosis. Eur Neuropsychopharmacol 2021; 47:86-97. [PMID: 33663901 DOI: 10.1016/j.euroneuro.2021.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 02/08/2023]
Abstract
Negative symptoms are present at the onset of psychosis and their persistence is significantly associated with poor psychosocial functioning and lower quality of life. Persistent negative symptoms (PNS) may be idiopathic or secondary to other factors such as depression, positive symptoms, and medication side-effects. Several studies have examined neurocognitive functions in early psychosis patients with PNS relative to non-PNS, but have not systematically controlled for secondary PNS (sPNS). The latter may have a distinct neurocognitive profile that could obscure differences between PNS and non-PNS. Using a large (n = 425) sample, we examined neurocognitive functions in PNS, sPNS, and non-PNS and hypothesized that PNS would be associated with greater impairments relative to non-PNS. Following admission to an early intervention program, a neurocognitive battery was administered after at least 3 months of treatment, and symptom data collected during a subsequent 6-month period were used to classify patients as PNS, sPNS and non-PNS. At month 12, both PNS and sPNS groups had significantly lower level of functioning relative to the non-PNS group but the sPNS group experienced higher levels of depressive and positive symptoms and were on a higher dose of antipsychotics. Relative to non-PNS, PNS patients exhibited significant impairments in verbal memory and working memory, whereas sPNS patients exhibited a trend towards greater impairments in verbal memory. This study confirms that the presence of PNS or sPNS negatively influences functioning with more selective cognitive impairments found in PNS, providing evidence that these groups of patients could benefit from different personalised interventions.
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High frequency repetitive transcranial magnetic stimulation of dorsomedial prefrontal cortex for negative symptoms in patients with schizophrenia: A double-blind, randomized controlled trial. Psychiatry Res 2021; 299:113876. [PMID: 33770710 DOI: 10.1016/j.psychres.2021.113876] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
Negative symptoms are the major challenge in clinical management of schizophrenia. Dorsomedial prefrontal cortex (DMPFC) has been suggested to be highly involved in the mechanisms of negative symptoms of schizophrenia. However, the effect of repetitive Transcranial Magnetic Stimulation (rTMS) over DMPFC has not yet been well studied. In this double-blind, randomized controlled rTMS clinical trial, thirty-three participants (17 in active group and 16 in sham group) were enrolled. This study includes the rTMS treatment phase (lasts for 4 weeks) and a subsequently naturalistic follow-up phase (lasts for another 4 weeks). Schizophrenia patients with prominently negative symptoms were randomly assigned to receive 10 Hz or sham rTMS intervention. The score change in Scale of Negative Symptoms (SANS) was defined as the primary outcome measure. There was a significant decrease in negative symptoms, especially affective flattening and anhedonia in schizophrenia patients after DMPFC-rTMS intervention. Moreover, the negative symptoms improvement could maintain at least another 4 weeks. In addition, no memory impairment or serious adverse reaction of rTMS emerged. Our results suggest that high frequency rTMS over DMPF may represent a safe and effective treatment for negative symptoms in patients with schizophrenia.
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Ye H, Zalesky A, Lv J, Loi SM, Cetin-Karayumak S, Rathi Y, Tian Y, Pantelis C, Di Biase MA. Network Analysis of Symptom Comorbidity in Schizophrenia: Relationship to Illness Course and Brain White Matter Microstructure. Schizophr Bull 2021; 47:1156-1167. [PMID: 33693887 PMCID: PMC8266579 DOI: 10.1093/schbul/sbab015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Recent network-based analyses suggest that schizophrenia symptoms are intricately connected and interdependent, such that central symptoms can activate adjacent symptoms and increase global symptom burden. Here, we sought to identify key clinical and neurobiological factors that relate to symptom organization in established schizophrenia. METHODS A symptom comorbidity network was mapped for a broad constellation of symptoms measured in 642 individuals with a schizophrenia-spectrum disorder. Centrality analyses were used to identify hub symptoms. The extent to which each patient's symptoms formed clusters in the comorbidity network was quantified with cluster analysis and used to predict (1) clinical features, including illness duration and psychosis (positive symptom) severity and (2) brain white matter microstructure, indexed by the fractional anisotropy (FA), in a subset (n = 296) of individuals with diffusion-weighted imaging (DWI) data. RESULTS Global functioning, substance use, and blunted affect were the most central symptoms within the symptom comorbidity network. Symptom profiles for some patients formed highly interconnected clusters, whereas other patients displayed unrelated and disconnected symptoms. Stronger clustering among an individual's symptoms was significantly associated with shorter illness duration (t = 2.7; P = .0074), greater psychosis severity (ie, positive symptoms expression) (t = -5.5; P < 0.0001) and lower fractional anisotropy in fibers traversing the cortico-cerebellar-thalamic-cortical circuit (r = .59, P < 0.05). CONCLUSION Symptom network structure varies over the course of schizophrenia: symptom interactions weaken with increasing illness duration and strengthen during periods of high positive symptom expression. Reduced white matter coherence relates to stronger symptom clustering, and thus, may underlie symptom cascades and global symptomatic burden in individuals with schizophrenia.
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Affiliation(s)
- Hua Ye
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia,Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Jinglei Lv
- School of Biomedical Engineering & Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Samantha M Loi
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | | | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Ye Tian
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Maria A Di Biase
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,To whom correspondence should be addressed; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Bld. 161 Barry St, Carlton South, Victoria, Australia; tel: +61-3-9035-3404, fax: +61-3-9035-8842, e-mail:
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Strauss GP, Bartolomeo LA, Harvey PD. Avolition as the core negative symptom in schizophrenia: relevance to pharmacological treatment development. NPJ SCHIZOPHRENIA 2021; 7:16. [PMID: 33637748 PMCID: PMC7910596 DOI: 10.1038/s41537-021-00145-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
Negative symptoms have long been considered a core component of schizophrenia. Modern conceptualizations of the structure of negative symptoms posit that there are at least two broad dimensions (motivation and pleasure and diminished expression) or perhaps five separable domains (avolition, anhedonia, asociality, blunted affect, alogia). The current review synthesizes a body of emerging research indicating that avolition may have a special place among these dimensions, as it is generally associated with poorer outcomes and may have distinct neurobiological mechanisms. Network analytic findings also indicate that avolition is highly central and interconnected with the other negative symptom domains in schizophrenia, and successfully remediating avolition results in global improvement in the entire constellation of negative symptoms. Avolition may therefore reflect the most critical treatment target within the negative symptom construct. Implications for targeted treatment development and clinical trial design are discussed.
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Affiliation(s)
| | | | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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46
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Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, Giordano GM, Vandevelde A, Nielsen MØ, Glenthøj LB, Sabé M, Pezzella P, Bitter I, Gaebel W. EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e23. [PMID: 33597064 PMCID: PMC8080207 DOI: 10.1192/j.eurpsy.2021.11] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
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Affiliation(s)
- S Galderisi
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - S Dollfus
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - P Pezzella
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, Guloksuz S, Harvey PD, Jones PB, Malaspina D, McGorry P, Miettunen J, Murray RM, Nuechterlein KH, Peralta V, Thornicroft G, van Winkel R, Ventura J. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry 2021; 20:4-33. [PMID: 33432763 PMCID: PMC7801854 DOI: 10.1002/wps.20809] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
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Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, LVR-Klinikum Düsseldorf, and WHO Collaborating Center on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Dolores Malaspina
- Department of Psychiatry and Neuroscience, Ichan Medical School at Mount Sinai, New York, NY, USA
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jouko Miettunen
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Keith H Nuechterlein
- Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine, and Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ruud van Winkel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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48
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Motivation in schizophrenia: preliminary findings of a theory-driven approach using time-series network analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-020-01321-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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49
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Adamczyk P, Płonka O, Kruk D, Jáni M, Błądziński P, Kalisz A, Castelein S, Cechnicki A, Wyczesany M. On the relation of white matter brain abnormalities and the asociality symptoms in schizophrenia outpatients - a DTI study. Acta Neurobiol Exp (Wars) 2021; 81:80-95. [PMID: 33949167 DOI: 10.21307/ane-2021-009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/29/2021] [Indexed: 11/11/2022]
Abstract
Recent MRI studies have shown that abnormal functional connections in schizophrenia coexist with subtle changes in the structure of axons in the brain. However, there is a discrepancy in the literature concerning the relationship between white matter abnormalities and the occurrence of negative psychopathological symptoms. In the present study, we investigate the relationship between the altered white matter structure and specific psychopathology symptoms, i.e., subscales of Positive and Negative Syndrome Scale (PANSS) and Brief Negative Symptoms Scale (BNSS) in a sample of schizophrenia outpatients. For investigation on white matter abnormalities in schizophrenia, the diffusion tensor imaging analysis of between-group differences in main diffusion parameters by tract-based spatial statistics was conducted on schizophrenia outpatients and healthy controls. Hence, the correlation of PANSS and BNSS psychopathology subscales in the clinical group with fractional anisotropy was analyzed in the 17 selected cortical regions of interest. Presented between-group results revealed widespread loss of white matter integrity located across the brain in schizophrenia outpatients. Results on the white matter relationship with psychopathology revealed the negative correlation between fractional anisotropy in the left orbital prefrontal cortex, right Heschl's gyrus, bilateral precuneus and posterior cingulate cortex and the severity of asociality, as assessed with the BNSS. In conclusion, the presented study confirms the previous evidence on the widespread white matter abnormalities in schizophrenia outpatients and indicates the existence of the subtle but specific association between fractional anisotropy in the fronto-temporo-parietal regions with the asociality. Recent MRI studies have shown that abnormal functional connections in schizophrenia coexist with subtle changes in the structure of axons in the brain. However, there is a discrepancy in the literature concerning the relationship between white matter abnormalities and the occurrence of negative psychopathological symptoms. In the present study, we investigate the relationship between the altered white matter structure and specific psychopathology symptoms, i.e., subscales of Positive and Negative Syndrome Scale (PANSS) and Brief Negative Symptoms Scale (BNSS) in a sample of schizophrenia outpatients. For investigation on white matter abnormalities in schizophrenia, the diffusion tensor imaging analysis of between-group differences in main diffusion parameters by tract-based spatial statistics was conducted on schizophrenia outpatients and healthy controls. Hence, the correlation of PANSS and BNSS psychopathology subscales in the clinical group with fractional anisotropy was analyzed in the 17 selected cortical regions of interest. Presented between-group results revealed widespread loss of white matter integrity located across the brain in schizophrenia outpatients. Results on the white matter relationship with psychopathology revealed the negative correlation between fractional anisotropy in the left orbital prefrontal cortex, right Heschl’s gyrus, bilateral precuneus and posterior cingulate cortex and the severity of asociality, as assessed with the BNSS. In conclusion, the presented study confirms the previous evidence on the widespread white matter abnormalities in schizophrenia outpatients and indicates the existence of the subtle but specific association between fractional anisotropy in the fronto-temporo-parietal regions with the asociality.
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Affiliation(s)
| | - Olga Płonka
- Institute of Psychology , Jagiellonian University , Krakow , Poland
| | - Dawid Kruk
- Psychosis Research and Psychotherapy Unit , Association for the Development of Community Psychiatry and Care , Krakow , Poland ; Community Psychiatry and Psychosis Research Center , Chair of Psychiatry , Medical College , Jagiellonian University , Krakow , Poland
| | - Martin Jáni
- Institute of Psychology , Jagiellonian University , Krakow , Poland ; Department of Psychiatry , Faculty of Medicine , Masaryk University and University Hospital Brno , Brno , Czech Republic
| | - Piotr Błądziński
- Community Psychiatry and Psychosis Research Center , Chair of Psychiatry , Medical College , Jagiellonian University , Krakow , Poland
| | - Aneta Kalisz
- Community Psychiatry and Psychosis Research Center , Chair of Psychiatry , Medical College , Jagiellonian University , Krakow , Poland
| | - Stynke Castelein
- Lentis Research , Lentis Psychiatric Institute , Groningen , The Netherlands ; Faculty of Behavioural and Social Sciences , University of Groningen , Groningen , The Netherlands
| | - Andrzej Cechnicki
- Psychosis Research and Psychotherapy Unit , Association for the Development of Community Psychiatry and Care , Krakow , Poland ; Community Psychiatry and Psychosis Research Center , Chair of Psychiatry , Medical College , Jagiellonian University , Krakow , Poland
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Shmukler A, Latanov AV, Karyakina M, Anisimov VN, Churikova MA, Sukhachevsky IS, Spektor VA. Eye Movements and Cognitive Functioning in Patients With Schizophrenia Spectrum Disorders: Network Analysis. Front Psychiatry 2021; 12:736228. [PMID: 34858224 PMCID: PMC8631397 DOI: 10.3389/fpsyt.2021.736228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Eye movement parameters are often used during cognitive functioning assessments of patients with psychotic spectrum disorders. It is interesting to compare these oculomotor parameters with cognitive functions, as assessed using psychometric cognitive tests. A network analysis is preferable for understanding complex systems; therefore, the aim of this study was to determine the multidimensional relationships that exist between oculomotor reactions and neurocognition in patients with schizophrenia spectrum disorders. Materials and Methods: A total of 134 subjects (93 inpatients with schizophrenia spectrum disorders (ICD-10) and 41 healthy volunteers) participated in this study. Psychiatric symptom severity was assessed using the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, and the Young Mania Rating Scale. Extrapyramidal symptoms were assessed using the Simpson-Angus Scale, and akathisia was assessed using the Barnes Akathisia Rating Scale. Eye movements were recorded using an eye-tracker SMI RED 500, and cognitive function was assessed using the Brief Assessment of Cognition in Schizophrenia. The statistical analyses were conducted using Minitab 17 Statistical Software, version 17.2.1. Data visualization and additional analyses were performed in the R 4.0.3 environment, using RStudio V 1.3.1093 software. Results: A network model of neurocognitive and oculomotor functions was constructed for the patients. In the full network (which includes all correlations) the median antisaccade latency value is the central element of the oculomotor domain, and the Symbol Coding test, the Digit Sequencing test, and the Verbal Fluency test are central elements in the neurocognitive domain. Additionally, there were connections between other cognitive and oculomotor functions, except for the antisaccade error latency in the oculomotor domain and the Token Motor Task in the neurocognitive domain. Conclusion: Network analysis provides measurable criteria for the assessment of neurophysiological and neurocognitive abnormalities in patients with schizophrenic spectrum disorders and allows to select key targets for their management and cognitive remediation.
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Affiliation(s)
- Alexander Shmukler
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, The Branch of V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | | | - Maria Karyakina
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, The Branch of V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - Victor N Anisimov
- Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia
| | | | - Ivan S Sukhachevsky
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, The Branch of V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - Valery A Spektor
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, The Branch of V. Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia
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