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Bradley ER, Portanova J, Woolley JD, Buck B, Painter IS, Hankin M, Xu W, Cohen T. Quantifying abnormal emotion processing: A novel computational assessment method and application in schizophrenia. Psychiatry Res 2024; 336:115893. [PMID: 38657475 DOI: 10.1016/j.psychres.2024.115893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/31/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
Abnormal emotion processing is a core feature of schizophrenia spectrum disorders (SSDs) that encompasses multiple operations. While deficits in some areas have been well-characterized, we understand less about abnormalities in the emotion processing that happens through language, which is highly relevant for social life. Here, we introduce a novel method using deep learning to estimate emotion processing rapidly from spoken language, testing this approach in male-identified patients with SSDs (n = 37) and healthy controls (n = 51). Using free responses to evocative stimuli, we derived a measure of appropriateness, or "emotional alignment" (EA). We examined psychometric characteristics of EA and its sensitivity to a single-dose challenge of oxytocin, a neuropeptide shown to enhance the salience of socioemotional information in SSDs. Patients showed impaired EA relative to controls, and impairment correlated with poorer social cognitive skill and more severe motivation and pleasure deficits. Adding EA to a logistic regression model with language-based measures of formal thought disorder (FTD) improved classification of patients versus controls. Lastly, oxytocin administration improved EA but not FTD among patients. While additional validation work is needed, these initial results suggest that an automated assay using spoken language may be a promising approach to assess emotion processing in SSDs.
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Affiliation(s)
- Ellen R Bradley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, CA, USA.
| | - Jake Portanova
- Department of Biomedical Informatics and Medical Education, University of Washington, WA, USA
| | - Josh D Woolley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, CA, USA
| | - Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, USA
| | - Ian S Painter
- Department of Statistics, University of Washington, USA
| | | | - Weizhe Xu
- Department of Biomedical Informatics and Medical Education, University of Washington, WA, USA
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, WA, USA; Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, USA
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2
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Wynn JK, Green MF. An EEG-Based Neuroplastic Approach to Predictive Coding in People With Schizophrenia or Traumatic Brain Injury. Clin EEG Neurosci 2024:15500594241252897. [PMID: 38711326 DOI: 10.1177/15500594241252897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite different etiologies, people with schizophrenia (SCZ) or with traumatic brain injury (TBI) both show aberrant neuroplasticity. One neuroplastic mechanism that may be affected is prediction error coding. We used a roving mismatch negativity (rMMN) paradigm which uses different lengths of standard tone trains and is optimized to assess predictive coding. Twenty-five SCZ, 22 TBI (mild to moderate), and 25 healthy controls were assessed. We used a frequency-deviant rMMN in which the number of standards preceding the deviant was either 2, 6, or 36. We evaluated repetition positivity to the standard tone immediately preceding a deviant tone (repetition positivity [RP], to assess formation of the memory trace), deviant negativity to the deviant stimulus (deviant negativity [DN], which reflects signaling of a prediction error), and the difference wave between the 2 (the MMN). We found that SCZ showed reduced DN and MMN compared with healthy controls and with people with mild to moderate TBI. We did not detect impairments in any index (RP, DN, or MMN) in people with TBI compared to controls. Our findings suggest that prediction error coding assessed with rMMN is aberrant in SCZ but intact in TBI, though there is a suggestion that severity of head injury results in poorer prediction error coding.
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Affiliation(s)
- Jonathan K Wynn
- Center on Enhancement of Community Integration for Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michael F Green
- Center on Enhancement of Community Integration for Homeless Veterans, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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3
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Cernvall M, Bengtsson J, Bodén R. The Swedish version of the Motivation and Pleasure Scale self-report (MAP-SR): psychometric properties in patients with schizophrenia or depression. Nord J Psychiatry 2024; 78:339-346. [PMID: 38436927 DOI: 10.1080/08039488.2024.2324060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Negative symptoms are commonly regarded as a symptom dimension belonging to schizophrenia spectrum disorders but are also present in depression. The recently developed Clinical Assessment Interview for Negative Symptoms (CAINS) has shown to be reliable and valid. A corresponding self-report questionnaire has also been developed, named the Motivation and Pleasure Scale - Self Report (MAP-SR). The purpose was to evaluate the psychometric properties of the Swedish version of the MAP-SR in patients with either schizophrenia or depression. MATERIALS AND METHODS The MAP-SR was translated to Swedish. Participants were 33 patients with schizophrenia spectrum disorders and 52 patients with a depressive disorder and they completed the MAP-SR, the CAINS and other measures assessing adjacent psychopathology, functioning and cognition. RESULTS The internal consistency for the MAP-SR was adequate in both groups (schizophrenia spectrum α = .93, depressive disorder α = .82). Furthermore, the MAP-SR had a large correlation to the motivation and pleasure subscale of the CAINS in patients with schizophrenia disorders (r = -0.75, p < .001), however among patients with depression this correlation was medium-to-large (r = -0.48, p < 0.001). CONCLUSIONS Findings suggest that the Swedish version of the MAP-SR shows promise as a useful measure of motivation and pleasure, especially in patients with schizophrenia spectrum disorders. Furthermore, results also suggest that the MAP-SR does not assess negative symptoms specifically, but that there is an overlap between depressive and negative symptoms.
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Affiliation(s)
- Martin Cernvall
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Johan Bengtsson
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
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Moran EK, Shapiro M, Culbreth AJ, Nepal S, Ben-Zeev D, Campbell A, Barch DM. Loneliness in the Daily Lives of People With Mood and Psychotic Disorders. Schizophr Bull 2024; 50:557-566. [PMID: 38429937 PMCID: PMC11059807 DOI: 10.1093/schbul/sbae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND HYPOTHESIS Loneliness, the subjective experience of feeling alone, is associated with physical and psychological impairments. While there is an extensive literature linking loneliness to psychopathology, limited work has examined loneliness in daily life in those with serious mental illness. We hypothesized that trait and momentary loneliness would be transdiagnostic and relate to symptoms and measures of daily functioning. STUDY DESIGN The current study utilized ecological momentary assessment and passive sensing to examine loneliness in those with schizophrenia (N = 59), bipolar disorder (N = 61), unipolar depression (N = 60), remitted unipolar depression (N = 51), and nonclinical comparisons (N = 82) to examine relationships of both trait and momentary loneliness to symptoms and social functioning in daily life. STUDY RESULTS Findings suggest that both trait and momentary loneliness are higher in those with psychopathology (F(4,284) = 28.00, P < .001, ηp2 = 0.27), and that loneliness significantly relates to social functioning beyond negative symptoms and depression (β = -0.44, t = 6.40, P < .001). Furthermore, passive sensing measures showed that greater movement (β = -0.56, t = -3.29, P = .02) and phone calls (β = -0.22, t = 12.79, P = .04), but not text messaging, were specifically related to decreased loneliness in daily life. Individuals higher in trait loneliness show stronger relationships between momentary loneliness and social context and emotions in everyday life. CONCLUSIONS These findings provide further evidence pointing to the importance of loneliness transdiagnostically and its strong relation to social functioning. Furthermore, we show that passive sensing technology can be used to measure behaviors related to loneliness in daily life that may point to potential treatment implications or early detection markers of loneliness.
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Affiliation(s)
- Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Madelyn Shapiro
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Adam J Culbreth
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, Baltimore, MD, USA
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, NH, USA
| | - Dror Ben-Zeev
- Department of Psychiatry, BRiTE Center, University of Washington, Seattle, WA, USA
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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Zhou Z, Jones K, Ivleva EI, Colon-Perez L. Macro- and Micro-Structural Alterations in the Midbrain in Early Psychosis. bioRxiv 2024:2024.04.10.588901. [PMID: 38645197 PMCID: PMC11030414 DOI: 10.1101/2024.04.10.588901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Introduction Early psychosis (EP) is a critical period in the course of psychotic disorders during which the brain is thought to undergo rapid and significant functional and structural changes 1 . Growing evidence suggests that the advent of psychotic disorders is early alterations in the brain's functional connectivity and structure, leading to aberrant neural network organization. The Human Connectome Project (HCP) is a global effort to map the human brain's connectivity in healthy and disease populations; within HCP, there is a specific dataset that focuses on the EP subjects (i.e., those within five years of the initial psychotic episode) (HCP-EP), which is the focus of our study. Given the critically important role of the midbrain function and structure in psychotic disorders (cite), and EP in particular (cite), we specifically focused on the midbrain macro- and micro-structural alterations and their association with clinical outcomes in HCP-EP. Methods We examined macro- and micro-structural brain alterations in the HCP-EP sample (n=179: EP, n=123, Controls, n=56) as well as their associations with behavioral measures (i.e., symptoms severity) using a stepwise approach, incorporating a multimodal MRI analysis procedure. First, Deformation Based Morphometry (DBM) was carried out on the whole brain 3 Tesla T1w images to examine gross brain anatomy (i.e., seed-based and voxel-based volumes). Second, we extracted Fractional Anisotropy (FA), Axial Diffusivity (AD), and Mean Diffusivity (MD) indices from the Diffusion Tensor Imaging (DTI) data; a midbrain mask was created based on FreeSurfer v.6.0 atlas. Third, we employed Tract-Based Spatial Statistics (TBSS) to determine microstructural alterations in white matter tracts within the midbrain and broader regions. Finally, we conducted correlation analyses to examine associations between the DBM-, DTI- and TBSS-based outcomes and the Positive and Negative Syndrome Scale (PANSS) scores. Results DBM analysis showed alterations in the hippocampus, midbrain, and caudate/putamen. A DTI voxel-based analysis shows midbrain reductions in FA and AD and increases in MD; meanwhile, the hippocampus shows an increase in FA and a decrease in AD and MD. Several key brain regions also show alterations in DTI indices (e.g., insula, caudate, prefrontal cortex). A seed-based analysis centered around a midbrain region of interest obtained from freesurfer segmentation confirms the voxel-based analysis of DTI indices. TBSS successfully captured structural differences within the midbrain and complementary alterations in other main white matter tracts, such as the corticospinal tract and cingulum, suggesting early altered brain connectivity in EP. Correlations between these quantities in the EP group and behavioral scores (i.e., PANSS and CAINS tests) were explored. It was found that midbrain volume noticeably correlates with the Cognitive score of PA and all DTI metrics. FA correlates with the several dimensions of the PANSS, while AD and MD do not show many associations with PANSS or CAINS. Conclusions Our findings contribute to understanding the midbrain-focused circuitry involvement in EP and complimentary alteration in EP. Our work provides a path for future investigations to inform specific brain-based biomarkers of EP and their relationships to clinical manifestations of the psychosis course.
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Bismark AW, Mikhael T, Mitchell K, Holden J, Granholm E. Pupillary responses as a biomarker of cognitive effort and the impact of task difficulty on reward processing in schizophrenia. Schizophr Res 2024; 267:216-222. [PMID: 38569395 DOI: 10.1016/j.schres.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
Negative symptoms of schizophrenia robustly predict functional outcomes but remain relatively resistant to available treatments. Better measures of negative symptoms, especially motivational deficits, are needed to better understand these symptoms and improve treatment development. Recent research shows promise in linking behavioral effort tasks to motivational negative symptoms, reward processing deficits, and defeatist attitudes, but few studies account for individual or group (patient v. control) differences in cognitive ability to perform the tasks. Individuals with poorer abilities might be less motivated to perform tasks because they find them more difficult to perform. This study used a personalized digit span task to control task difficulty while measuring task effort via pupillary responses (greater dilation indicates greater cognitive effort) at varying monetary rewards ($1 & $2). Participants with schizophrenia (N = 34) and healthy controls (N = 41) performed a digit span task with personalized max span lengths and easy (max- 2 digits) and overload (max+ 2 digits) conditions. Consistent with many studies, pupillary responses (cognitive effort) increased with greater difficulty until exceeding capacity. A similar pattern of reward responsivity was seen in both groups, such that greater reward increased dilation (effort) comparably for both groups when difficulty was within capacity. Neither patients nor controls exerted increased effort for greater reward when difficulty exceeded capacity. In patients, positive relationships were found between pupil dilation and defeatist performance beliefs if task difficulty was within capacity; a relationship that reversed if the task was too difficult. The findings demonstrate the importance of accounting for cognitive capacity and task difficulty when evaluating motivation and reward sensitivity and illustrate the utility of pupillary responses as an objective measure of effort in schizophrenia.
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Affiliation(s)
- Andrew W Bismark
- Department of Psychiatry, University of California, San Diego, USA; VA San Diego Healthcare System, USA
| | - Tanya Mikhael
- VA San Diego Healthcare System, USA; Central Texas Veterans Healthcare System, USA
| | - Kyle Mitchell
- Department of Psychiatry, University of California, San Diego, USA; Johns Hopkins University School of Nursing, USA
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, USA; VA San Diego Healthcare System, USA.
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7
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Wynn JK, Clayson PE, Green MF, Jimenez A, Lee J, Reavis EA, Horan WP. Neurophysiological indices of face processing in people with psychosis and their siblings: An event-related potential study. Eur J Neurosci 2024; 59:1863-1876. [PMID: 37160716 PMCID: PMC10632544 DOI: 10.1111/ejn.16034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
People with schizophrenia experience difficulties with social interactions. One contributor to these social deficits is dysfunction in processing facial features and facial emotional expressions. However, it is not known whether face processing deficits are evident in those with other psychotic disorders or in those genetically at-risk for psychosis (i.e., first-degree relatives of those with psychosis). We assessed event-related potentials (ERPs) during a facial and emotion processing task in 100 people with a diagnosis of schizophrenia or another psychotic condition (PSY), 32 of their siblings (SIB) and 45 healthy comparison participants (CTL). In separate blocks, participants identified the sex (male or female) or emotion (happy, angry, neutral) of faces. In a comparison condition, participants indicated whether buildings had one or two floors. ERPs were examined in two stages. First, we compared ERPs across the emotion, sex and building identification conditions. Second, we compared ERPs among the three different facial emotions. PSY exhibited significantly lower amplitudes over parietal-occipital regions between 111 and 151 ms when viewing faces but not buildings than CTL, consistent with a face-selective N170 ERP component deficit. The SIB group was intermediate for faces, but not significantly different than PSY or CTL. During emotion identification, all three groups showed increased N170 amplitudes to angry and happy versus neutral expressions, with no group differences. In follow up analyses, we examined differences between PSY with or without affective psychosis, and differences between those with schizophrenia versus other psychotic disorders; there were no significant differences in these analyses. Face processing deficits assessed with ERPs were observed in a group of diverse psychotic disorders, though deficits were not seen to be modulated by facial emotion expression. Additionally, N170 deficits are not evident in siblings of those with PSY.
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Affiliation(s)
- Jonathan K. Wynn
- VA Greater Los Angeles Healthcare System, Los Angeles,
CA
- Semel Institute for Neuroscience and Human Behavior,
University of California, Los Angeles, Los Angeles, CA
| | - Peter E. Clayson
- VA Greater Los Angeles Healthcare System, Los Angeles,
CA
- Department of Psychology, University of South Florida,
Tampa, FL
| | - Michael F. Green
- VA Greater Los Angeles Healthcare System, Los Angeles,
CA
- Semel Institute for Neuroscience and Human Behavior,
University of California, Los Angeles, Los Angeles, CA
| | - Amy Jimenez
- VA Greater Los Angeles Healthcare System, Los Angeles,
CA
- Semel Institute for Neuroscience and Human Behavior,
University of California, Los Angeles, Los Angeles, CA
| | - Junghee Lee
- Semel Institute for Neuroscience and Human Behavior,
University of California, Los Angeles, Los Angeles, CA
- Department of Psychiatry, University of Alabama,
Birmingham
| | - Eric A. Reavis
- VA Greater Los Angeles Healthcare System, Los Angeles,
CA
- Semel Institute for Neuroscience and Human Behavior,
University of California, Los Angeles, Los Angeles, CA
| | - William P. Horan
- VA Greater Los Angeles Healthcare System, Los Angeles,
CA
- Semel Institute for Neuroscience and Human Behavior,
University of California, Los Angeles, Los Angeles, CA
- VeraSci, Durham, NC
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Fan L, Liang L, Wang Y, Ma X, Yuan L, Ouyang L, He Y, Li Z, Li C, Chen X, Palaniyappan L. Glutamatergic basis of antipsychotic response in first-episode psychosis: a dual voxel study of the anterior cingulate cortex. Neuropsychopharmacology 2024; 49:845-853. [PMID: 37752221 PMCID: PMC10948866 DOI: 10.1038/s41386-023-01741-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
A subgroup of patients with schizophrenia is believed to have aberrant excess of glutamate in the frontal cortex; this subgroup is thought to show poor response to first-line antipsychotic treatments that focus on dopamine blockade. If we can identify this subgroup early in the course of illness, we can reduce the repeated use of first-line antipsychotics and potentially stratify first-episode patients to intervene early with second-line treatments such as clozapine. The use of proton magnetic resonance spectroscopy (1H-MRS) to measure glutamate and Glx (glutamate plus glutamine) may provide a means for such a stratification. We must first establish if there is robust evidence linking elevations in anterior cingulate cortex (ACC) glutamate metabolites to poor response, and determine if the use of antipsychotics worsens the glutamatergic excess in eventual nonresponders. In this study, we estimated glutamate levels at baseline in 42 drug-naive patients with schizophrenia. We then treated them all with risperidone at a standard dose range of 2-6 mg/day and followed them up for 3 months to categorize their response status. We expected to see baseline "hyperglutamatergia" in nonresponders, and expected this to worsen over time at the follow-up. In line with our predictions, nonresponders had higher glutamate than responders, but patients as a group did not differ in glutamate and Glx from the healthy control (HC) group before treatment-onset (F1,79 = 3.20, p = 0.046, partial η2 = 0.075). Glutamatergic metabolites did not change significantly over time in both nonresponders and responders over the 3 months of antipsychotic exposure (F1,31 = 1.26, p = 0.270, partial η2 = 0.039). We conclude that the use of antipsychotics without prior knowledge of later response delays symptom relief in a subgroup of first-episode patients, but does not worsen the glutamatergic excess seen at the baseline. Given the current practice of nonstratified use of antipsychotics, longer-time follow-up MRS studies are required to see if improvement in symptoms accompanies a dynamic shift in glutamate profile.
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Affiliation(s)
- Lejia Fan
- 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, China
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Liangbing Liang
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yujue 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, China
| | - Xiaoqian 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, China
| | - Liu Yuan
- 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, China
| | - Lijun Ouyang
- 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, China
| | - Ying 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, China
| | - Zongchang 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, China
| | - Chunwang Li
- Department of Radiology, Hunan Children's Hospital, Changsha, China
| | - Xiaogang 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, China.
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Culbreth AJ, Moran EK, Mahaphanit W, Erickson MA, Boudewyn MA, Frank MJ, Barch DM, MacDonald AW, Ragland JD, Luck SJ, Silverstein SM, Carter CS, Gold JM. A Transdiagnostic Study of Effort-Cost Decision-Making in Psychotic and Mood Disorders. Schizophr Bull 2024; 50:339-348. [PMID: 37901911 PMCID: PMC10919776 DOI: 10.1093/schbul/sbad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Research suggests that effort-cost decision-making (ECDM), the estimation of work required to obtain reward, may be a relevant framework for understanding motivational impairment in psychotic and mood pathology. Specifically, research has suggested that people with psychotic and mood pathology experience effort as more costly than controls, and thus pursue effortful goals less frequently. This study examined ECDM across psychotic and mood pathology. HYPOTHESIS We hypothesized that patient groups would show reduced willingness to expend effort compared to controls. STUDY DESIGN People with schizophrenia (N = 33), schizoaffective disorder (N = 28), bipolar disorder (N = 39), major depressive disorder (N = 40), and controls (N = 70) completed a physical ECDM task. Participants decided between completing a low-effort or high-effort option for small or larger rewards, respectively. Reward magnitude, reward probability, and effort magnitude varied trial-by-trial. Data were analyzed using standard and hierarchical logistic regression analyses to assess the subject-specific contribution of various factors to choice. Negative symptoms were measured with a clinician-rated interview. STUDY RESULTS There was a significant effect of group, driven by reduced choice of high-effort options in schizophrenia. Hierarchical logistic regression revealed that reduced choice of high-effort options in schizophrenia was driven by weaker contributions of probability information. Use of reward information was inversely associated with motivational impairment in schizophrenia. Surprisingly, individuals with major depressive disorder and bipolar disorder did not differ from controls. CONCLUSIONS Our results provide support for ECDM deficits in schizophrenia. Additionally, differences between groups in ECDM suggest a seemingly similar behavioral phenotype, reduced motivation, could arise from disparate mechanisms.
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Affiliation(s)
- Adam J Culbreth
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, USA
| | - Erin K Moran
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, USA
| | - Wasita Mahaphanit
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, USA
| | - Molly A Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, USA
| | - Megan A Boudewyn
- Department of Psychology, University of California, Santa Cruz, USA
| | - Michael J Frank
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, Providence, USA
| | - Deanna M Barch
- Department of Psychological and Brain Sciences, Washington University in St. Louis, Saint Louis, USA
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, USA
| | | | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, School of Medicine, Davis, USA
| | - Steven J Luck
- Center for Mind and Brain, University of California, Davis, Davis, USA
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, School of Medicine, Davis, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland, School of Medicine, Baltimore, USA
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10
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Moussa-Tooks AB, Beermann A, Manzanarez Felix K, Coleman M, Bouix S, Holt D, Lewandowski KE, Öngür D, Breier A, Shenton ME, Heckers S, Walther S, Brady RO, Ward HB. Isolation of Distinct Networks Driving Action and Cognition in Psychomotor Processes. Biol Psychiatry 2024:S0006-3223(24)01133-8. [PMID: 38452884 DOI: 10.1016/j.biopsych.2024.02.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Psychomotor disturbances are observed across psychiatric disorders and often manifest as psychomotor slowing, agitation, disorganized behavior, or catatonia. Psychomotor function includes both cognitive and motor components, but the neural circuits driving these subprocesses and how they relate to symptoms have remained elusive for centuries. METHODS We analyzed data from the HCP-EP (Human Connectome Project for Early Psychosis), a multisite study of 125 participants with early psychosis and 58 healthy participants with resting-state functional magnetic resonance imaging and clinical characterization. Psychomotor function was assessed using the 9-hole pegboard task, a timed motor task that engages mechanical and psychomotor components of action, and tasks assessing processing speed and task switching. We used multivariate pattern analysis of whole-connectome data to identify brain correlates of psychomotor function. RESULTS We identified discrete brain circuits driving the cognitive and motor components of psychomotor function. In our combined sample of participants with psychosis (n = 89) and healthy control participants (n = 52), the strongest correlates of psychomotor function (pegboard performance) (p < .005) were between a midline cerebellar region and left frontal region and presupplementary motor area. Psychomotor function was correlated with both cerebellar-frontal connectivity (r = 0.33) and cerebellar-presupplementary motor area connectivity (r = 0.27). However, the cognitive component of psychomotor performance (task switching) was correlated only with cerebellar-frontal connectivity (r = 0.19), whereas the motor component (processing speed) was correlated only with cerebellar-presupplementary motor area connectivity (r = 0.15), suggesting distinct circuits driving unique subprocesses of psychomotor function. CONCLUSIONS We identified cerebellar-cortical circuits that drive distinct subprocesses of psychomotor function. Future studies should probe relationships between cerebellar connectivity and psychomotor performance using neuromodulation.
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Affiliation(s)
- Alexandra B Moussa-Tooks
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University Bloomington, Bloomington, Indiana
| | - Adam Beermann
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Michael Coleman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham & Women's Hospital, Boston, Massachusetts
| | - Sylvain Bouix
- Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, Québec, Canada
| | - Daphne Holt
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathryn E Lewandowski
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Belmont, Massachusetts
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Belmont, Massachusetts
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Martha E Shenton
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Brigham & Women's Hospital, Boston, Massachusetts; Department of Radiology, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Roscoe O Brady
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Belmont, Massachusetts
| | - Heather Burrell Ward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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11
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Wang LL, Gong JB, Huang YH, Shi SH, Yan C, Hu HX, Wang Y, Lui SS, Ju K, Chan RC. Range adaptation in schizophrenia: A one-year longitudinal study. Schizophr Res Cogn 2024; 35:100297. [PMID: 38115992 PMCID: PMC10728566 DOI: 10.1016/j.scog.2023.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023]
Abstract
Range adaptation refers to the representation of a stimulus value based on its relative position in the range of pre-experienced values. Altered range adaptation in value representation may be related to motivation and pleasure (MAP) deficit in schizophrenia (SCZ). This follow-up study examined the relationship between range adaptation performance and MAP symptoms in SCZ patients. We recruited 26 schizophrenia patients and followed them for 1 year. They completed an experimental task for estimating their range adaptation to outcome value (OV) and expected value (EV) at baseline and after 1 year. At baseline, we found a marginally significant and negative correlation between OV adaptation and avolition symptoms in SCZ patients. Moreover, the 1-year change of EV adaptation was significantly and negatively correlated with the change of self-report pleasure experience. Our results suggest that range adaptation may track the variations of MAP symptoms in SCZ.
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Affiliation(s)
- Ling-ling Wang
- School of Psychology, Shanghai Normal University, 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
| | - Jing-bo Gong
- Shanghai Changning Mental Health Center, Shanghai, China
| | - Yi-hang Huang
- 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
| | - Shu-hong Shi
- Shanghai Changning Mental Health Center, Shanghai, China
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Chao Yan
- Shanghai Changning Mental Health Center, Shanghai, China
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 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
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing, 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
| | - Simon S.Y. Lui
- Department of Psychiatry, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Kang Ju
- Shanghai Changning Mental Health Center, Shanghai, China
| | - Raymond C.K. Chan
- 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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12
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Kos C, Bais L, Klaasen N, Opmeer E, Liemburg E, Wardenaar KJ, van Tol MJ, Knegtering H, Aleman A. Effects of right prefrontal theta-burst transcranial magnetic stimulation or transcranial direct current stimulation on apathy in patients with schizophrenia: A multicenter RCT. Psychiatry Res 2024; 333:115743. [PMID: 38271887 DOI: 10.1016/j.psychres.2024.115743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
Apathy is a core negative symptom associated with an unfavorable functional outcome. Noninvasive brain stimulation has shown promise in the treatment of schizophrenia but has not been tested specifically for apathy. We conducted a randomized controlled trial of intermittent theta-burst (iTBS) transcranial magnetic stimulation and transcranial direct current stimulation (tDCS) targeted at the right dorsolateral prefrontal cortex (DLPFC) in patients diagnosed with a psychotic disorder suffering from apathy. The study was a multicenter, randomized, placebo-controlled, and rater-blinded trial. Patients (N = 88) were randomized into active iTBS, active tDCS, sham iTBS or sham tDCS treatment, daily for two weeks (excluding weekends). Effects were measured post-treatment and at four week and ten week follow-up. Primary outcome was apathy severity (Apathy Evaluation Scale, clinician-rated). Additional measures included assessment of negative symptoms, depression, anhedonia and quality of life. No significant difference in improvement of apathy or negative symptoms was observed for real versus sham treatment with either iTBS or tDCS, though all groups improved to a small extent. We conclude that two weeks of brain stimulation over the right DLPFC with either iTBS or tDCS is not effective for improving apathy or negative symptoms. Longer and more intensive protocols may yield different results.
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Affiliation(s)
- Claire Kos
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; ZorgfocuZ, Groningen, The Netherlands
| | - Leonie Bais
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; Lentis Research, Lentis Center for Mental Health Care, Hereweg 80, Groningen 9725 AG, The Netherlands
| | - Nicky Klaasen
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Esther Opmeer
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Edith Liemburg
- Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - Klaas J Wardenaar
- Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Henderikus Knegtering
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; Lentis Research, Lentis Center for Mental Health Care, Hereweg 80, Groningen 9725 AG, The Netherlands; Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands.
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13
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Karagoz AB, Moran EK, Barch DM, Kool W, Reagh ZM. Evidence for shallow cognitive maps in schizophrenia. bioRxiv 2024:2024.02.26.582214. [PMID: 38464042 PMCID: PMC10925159 DOI: 10.1101/2024.02.26.582214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Individuals with schizophrenia can have marked deficits in goal-directed decision making. Prominent theories differ in whether schizophrenia (SZ) affects the ability to exert cognitive control, or the motivation to exert control. An alternative explanation is that schizophrenia negatively impacts the formation of cognitive maps, the internal representations of the way the world is structured, necessary for the formation of effective action plans. That is, deficits in decision-making could also arise when goal-directed control and motivation are intact, but used to plan over ill-formed maps. Here, we test the hypothesis that individuals with SZ are impaired in the construction of cognitive maps. We combine a behavioral representational similarity analysis technique with a sequential decision-making task. This enables us to examine how relationships between choice options change when individuals with SZ and healthy age-matched controls build a cognitive map of the task structure. Our results indicate that SZ affects how people represent the structure of the task, focusing more on simpler visual features and less on abstract, higher-order, planning-relevant features. At the same time, we find that SZ were able to display similar performance on this task compared to controls, emphasizing the need for a distinction between cognitive map formation and changes in goal-directed control in understanding cognitive deficits in schizophrenia.
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Affiliation(s)
- Ata B Karagoz
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Erin K Moran
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine
| | - Wouter Kool
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | - Zachariah M Reagh
- Department of Psychological & Brain Sciences, Washington University in St. Louis
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14
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VAYISOĞLU S, KARAHAN S, GÜREL ŞC, YAĞCIOĞLU AEANIL. Validity and Reliability Study of Turkish Version of Clinical Assessment Interview for Negative Symptoms (CAINS). Noro Psikiyatr Ars 2024; 61:59-65. [PMID: 38496217 PMCID: PMC10943947 DOI: 10.29399/npa.28438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/27/2023] [Indexed: 03/19/2024] Open
Abstract
Introduction This study aims to translate and investigate the validity and reliability of the Turkish version of the Clinical Assessment Interview for Negative Symptoms (CAINS), which has additional features compared to other scales in assessing negative symptoms in patients with schizophrenia. Methods The Turkish version of CAINS was constructed upon an initial translation to Turkish, and an English back translation of the scale was later conducted. The patients diagnosed with schizophrenia (n=79) according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria were administered the Turkish version of CAINS, the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), the Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression Scale (CGI), the Global Assessment of Functioning Scale (GAF) and the Simpson-Angus Extrapyramidal Side Effects Assessment Scale (SAS). In addition, two interviewers assessed the video recordings of 11 patients for reliability analysis. Results Inter-rater reliability was found to be high (intraclass correlation coefficient (ICC): 0.831). Exploratory and confirmatory factor analyses indicated that Cronbach's alpha was 0.956 for the full scale, and the two-dimensional structure explained the scale better. In convergent validity analyses, CAINS overall scores correlated significantly with the SANS total score (r=0,932) and PANSS negative score (r=0,902). In discriminant validity analyses, CAINS overall scores markedly correlated with the SAPS total (r=0,615), PANSS positive (r=0,497) and PANSS general psychopathology (r=0,737) scores. Additionally, when CGI and GAF scores were considered covariant, the significant correlation of CAINS total scores with the SANS total and PANSS negative scores continued; however, the correlation with PANSS positive score was prominently reduced, and the correlation with PANSS general psychopathology disappeared. Conclusion The Turkish version of the CAINS appears to be a valid and reliable tool with strong psychometric properties in a sample consisting of patients with schizophrenia.
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Affiliation(s)
- Sefa VAYISOĞLU
- Bodrum State Hospital, Department of Mental Health and Diseases, Bodrum, Turkey
| | - Sevilay KARAHAN
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Şeref Can GÜREL
- Hacettepe University Faculty of Medicine, Department of Mental Health and Diseases, Ankara, Turkey
| | - Ayşe Elif ANIL YAĞCIOĞLU
- Hacettepe University Faculty of Medicine, Department of Mental Health and Diseases, Ankara, Turkey
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15
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Cowan T, Phalen P, Brown CH, Blanchard J, Bennett M. We need to make progress on blunted affect: A commentary. Schizophr Res 2024; 264:263-265. [PMID: 38198877 DOI: 10.1016/j.schres.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Affiliation(s)
- T Cowan
- Department of Psychiatry, University of Maryland School of Medicine, 717 W. Lombard St. 5th Floor, Baltimore, MD 21201, United States of America
| | - P Phalen
- Department of Psychiatry, University of Maryland School of Medicine, 717 W. Lombard St. 5th Floor, Baltimore, MD 21201, United States of America
| | - C H Brown
- Department of Epidemiology, University of Maryland School of Medicine, 660 W. Redwood St., Baltimore, MD 21201, United States of America; VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America
| | - J Blanchard
- Department of Psychology, University of Maryland College Park, Biology/Psychology Building, 4094 Campus Dr., College Park, MD 20742, United States of America
| | - M Bennett
- Department of Psychiatry, University of Maryland School of Medicine, 717 W. Lombard St. 5th Floor, Baltimore, MD 21201, United States of America; VA Capital Healthcare Network Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Maryland Health Care System (Baltimore Annex), 209 West Fayette Street, Baltimore, MD 20210, United States of America.
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16
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Catalano LT, Wynn JK, Eisenberger NI, Horan WP, Lee J, McCleery A, Miklowitz DJ, Reavis EA, Reddy LF, Green MF. An ERP Study of Face Processing in Schizophrenia, Bipolar Disorder, and Socially Isolated Individuals from the Community. Clin EEG Neurosci 2024:15500594231222979. [PMID: 38298008 DOI: 10.1177/15500594231222979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
People with schizophrenia (SCZ) and bipolar disorder (BD) have impairments in processing social information, including faces. The neural correlates of face processing are widely studied with the N170 ERP component. However, it is unclear whether N170 deficits reflect neural abnormalities associated with these clinical conditions or differences in social environments. The goal of this study was to determine whether N170 deficits would still be present in SCZ and BD when compared with socially isolated community members. Participants included 66 people with SCZ, 37 with BD, and 125 community members (76 "Community-Isolated"; 49 "Community-Connected"). Electroencephalography was recorded during a face processing task in which participants identified the gender of a face, the emotion of a face (angry, happy, neutral), or the number of stories in a building. We examined group differences in the N170 face effect (greater amplitudes for faces vs buildings) and the N170 emotion effect (greater amplitudes for emotional vs neutral expressions). Groups significantly differed in levels of social isolation (Community-Isolated > SCZ > BD = Community-Connected). SCZ participants had significantly reduced N170 amplitudes to faces compared with both community groups, which did not differ from each other. The BD group was intermediate and did not differ from any group. There were no significant group differences in the processing of specific emotional facial expressions. The N170 is abnormal in SCZ even when compared to socially isolated community members. Hence, the N170 seems to reflect a social processing impairment in SCZ that is separate from level of social isolation.
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Affiliation(s)
- Lauren T Catalano
- 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
| | - Jonathan K Wynn
- 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
| | - Naomi I Eisenberger
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - William P Horan
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
- VeraSci, Durham, NC, USA
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amanda McCleery
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Eric A Reavis
- 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
| | - L Felice Reddy
- 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
| | - Michael F Green
- 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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17
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Salabat D, Pourebrahimi A, Mayeli M, Cattarinussi G. The Therapeutic Role of Intermittent Theta Burst Stimulation in Schizophrenia: A Systematic Review and Meta-analysis. J ECT 2024:00124509-990000000-00140. [PMID: 38277616 DOI: 10.1097/yct.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
ABSTRACT Schizophrenia affects approximately 1% of the population worldwide. Multifactorial reasons, ranging from drug resistance to adverse effects of medications, have necessitated exploring further therapeutic options. Intermittent theta burst stimulation (iTBS) is a novel high-frequency form of transcranial magnetic stimulation, a safe procedure with minor adverse effects with faster and longer-lasting poststimulation effects with a potential role in treating symptoms; however, the exact target brain regions and symptoms are still controversial. Therefore, we aimed to systematically investigate the current literature regarding the therapeutic utilities of iTBS using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Twelve studies were included among which 9 found iTBS effective to some degree. These studies targeted the dorsolateral prefrontal cortex and the midline cerebellum. We performed a random-effects meta-analysis on studies that compared the effects of iTBS on schizophrenia symptoms measured by the Positive and Negative Syndrome Scale (PANSS) to sham treatment. Our results showed no significant difference between iTBS and sham in PANSS positive and negative scores, but a trend-level difference in PANSS general scores (k = 6, P = 0.07), and a significant difference in PANSS total scores (k = 6, P = 0.03). Analysis of the studies targeting the dorsolateral prefrontal cortex showed improvement in PANSS negative scores (k = 5, standardized mean difference = -0.83, P = 0.049), but not in PANSS positive scores. Moderators (intensity, pulse, quality, sessions) did not affect the results. However, considering the small number of studies included in this meta-analysis, future works are required to further explore the effects of these factors and also find optimum target regions for positive symptoms.
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18
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Dark F, Galloway G, Gray M, Cella M, De Monte V, Gore-Jones V, Ritchie G. Reward Learning as a Potential Mechanism for Improvement in Schizophrenia Spectrum Disorders Following Cognitive Remediation: Protocol for a Clinical, Nonrandomized, Pre-Post Pilot Study. JMIR Res Protoc 2024; 13:e52505. [PMID: 38252470 PMCID: PMC10845020 DOI: 10.2196/52505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Cognitive impairment is common with schizophrenia spectrum disorders. Cognitive remediation (CR) is effective in improving global cognition, but not all individuals benefit from this type of intervention. A better understanding of the potential mechanism of action of CR is needed. One proposed mechanism is reward learning (RL), the cognitive processes responsible for adapting behavior following positive or negative feedback. It is proposed that the structure of CR enhances RL and motivation to engage in increasingly challenging tasks, and this is a potential mechanism by which CR improves cognitive functioning in schizophrenia. OBJECTIVE Our primary objective is to examine reward processing in individuals with schizophrenia before and after completing CR and to compare this with a group of matched clinical controls. We will assess whether RL mediates the relationship between CR and improved cognitive function and reduced negative symptoms. Potential differences in social RL and nonsocial RL in individuals with schizophrenia will also be investigated and compared with a healthy matched control group. METHODS We propose a clinical, nonrandomized, pre-post pilot study comparing the impact of CR on RL and neurocognitive outcomes. The study will use a combination of objective and subjective measures to assess neurocognitive, psychiatric symptoms, and neurophysiological domains. A total of 40 individuals with schizophrenia spectrum disorders (aged 18-35 years) will receive 12 weeks of CR therapy (n=20) or treatment as usual (n=20). Reward processing will be evaluated using a reinforcement learning task with 2 conditions (social reward vs nonsocial reward) at baseline and the 12-week follow-up. Functional magnetic resonance imaging responses will be measured during this task. To validate the reinforcement learning task, RL will also be assessed in 20 healthy controls, matched for age, sex, and premorbid functioning. Mixed-factorial ANOVAs will be conducted to evaluate treatment group differences. For the functional magnetic resonance imaging analysis, computational modeling will allow the estimation of learning parameters at each point in time, during each task condition, for each participant. We will use a variational Bayesian framework to measure how learning occurred during the experimental task and the subprocesses that underlie this learning. Second-level group analyses will examine how learning in patients differs from that observed in control participants and how CR alters learning efficiency and the underlying neural activity. RESULTS As of September 2023, this study has enrolled 15 participants in the CR group, 1 participant in the treatment-as-usual group, and 11 participants in the healthy control group. Recruitment is expected to be completed by September 2024. Data analysis is expected to be completed and published in early 2025. CONCLUSIONS The results of this study will contribute to the knowledge of CR and RL processes in severe mental illness and the understanding of the systems that impact negative symptoms and cognitive impairments within this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52505.
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Affiliation(s)
- Frances Dark
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Graham Galloway
- Translational Research Institute, Woolloongabba, Australia
- Herston Imaging Research Facility, The University of Queensland, Brisbane, Australia
| | - Marcus Gray
- Translational Research Institute, Woolloongabba, Australia
| | | | - Veronica De Monte
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
| | | | - Gabrielle Ritchie
- Metro South Addiction and Mental Health Services, Woolloongabba, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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19
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Jonas KG, Cannon TD, Docherty AR, Dwyer D, Gur RC, Gur RE, Nelson B, Reininghaus U, Kotov R. Psychosis superspectrum I: Nosology, etiology, and lifespan development. Mol Psychiatry 2024:10.1038/s41380-023-02388-2. [PMID: 38200290 DOI: 10.1038/s41380-023-02388-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
This review describes the Hierarchical Taxonomy of Psychopathology (HiTOP) model of psychosis-related psychopathology, the psychosis superspectrum. The HiTOP psychosis superspectrum was developed to address shortcomings of traditional diagnoses for psychotic disorders and related conditions including low reliability, arbitrary boundaries between psychopathology and normality, high symptom co-occurrence, and heterogeneity within diagnostic categories. The psychosis superspectrum is a transdiagnostic dimensional model comprising two spectra-psychoticism and detachment-which are in turn broken down into fourteen narrow components, and two auxiliary domains-cognition and functional impairment. The structure of the spectra and their components are shown to parallel the genetic structure of psychosis and related traits. Psychoticism and detachment have distinct patterns of association with urbanicity, migrant and ethnic minority status, childhood adversity, and cannabis use. The superspectrum also provides a useful model for describing the emergence and course of psychosis, as components of the superspectrum are relatively stable over time. Changes in psychoticism predict the onset of psychosis-related psychopathology, whereas changes in detachment and cognition define later course. Implications of the superspectrum for genetic, socio-environmental, and longitudinal research are discussed. A companion review focuses on neurobiology, treatment response, and clinical utility of the superspectrum, and future research directions.
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Affiliation(s)
- Katherine G Jonas
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA.
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Anna R Docherty
- Huntsman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ruben C Gur
- Brain Behavior Laboratory, Department of Psychiatry and the Penn-CHOP Lifespan Brain Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Raquel E Gur
- Brain Behavior Laboratory, Department of Psychiatry and the Penn-CHOP Lifespan Brain Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Barnaby Nelson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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Parrish EM, Chalker S, Cano M, Harvey PD, Taylor CT, Pinkham A, Moore RC, Ackerman RA, Depp CA. Ecological Momentary Assessment of Social Approach and Avoidance Motivations in Serious Mental Illness: Connections to Suicidal Ideation and Symptoms. Arch Suicide Res 2024; 28:123-140. [PMID: 36377277 PMCID: PMC10183051 DOI: 10.1080/13811118.2022.2137445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM People with serious mental illness (SMI) are at an increased risk for suicide. Social approach and avoidance motivations are linked to social functioning, and social isolation is a risk factor for suicide. This study uses ecological momentary assessment (EMA) to understand social approach and avoidance motivations in relation to symptoms and suicidal ideation (SI). METHODS Participants (N = 128) diagnosed with schizophrenia, schizoaffective disorder, or a mood disorder with psychotic features completed assessments of SI and symptoms at baseline. They completed EMA surveys 3×/day for 10 days. EMA surveys included questions about approach and avoidance motivations and psychotic symptoms. Participants were split into four groups based on the median scores of approach and avoidance. RESULTS Participants with SI at baseline had higher mean social avoidance motivation, t(126) = 2.84, p = .003, and lower mean social approach motivation, t(126) = -2.44, p = .008, than participants without baseline SI. Greater baseline positive symptoms were related to greater mean avoidance, r = .231, p = .009, but not approach motivation. The low approach/high avoidance group had significantly higher current SI than those with high approach/low avoidance (p < .001). Overall, the low approach/high avoidance group reported more EMA-measured voices than the low approach/low avoidance group (p < .001) and the high approach/low avoidance group (p < .001). Similarly, the low approach/high avoidance group reported more EMA-measured suspiciousness than the low approach/low avoidance (p < .001) and the high approach/low avoidance groups (p < .001). CONCLUSION The results of this study point to the role of social approach and avoidance motivations in relation to SI and psychotic symptoms. Clinically, exposure therapies and cognitive behavioral therapies may help to address these social approach and avoidance processes linked to SI.
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Affiliation(s)
- Emma M. Parrish
- San Diego State University / University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Samantha Chalker
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Mayra Cano
- University of California San Diego Department of Psychiatry, San Diego, California
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, Florida, Research Service Miami VA Medical Center, Miami, FL
| | - Charles T. Taylor
- University of California San Diego Department of Psychiatry, San Diego, California
| | - Amy Pinkham
- The University of Texas at Dallas, Richardson, TX
| | - Raeanne C. Moore
- University of California San Diego Department of Psychiatry, San Diego, California
| | | | - Colin A. Depp
- University of California San Diego Department of Psychiatry, San Diego, California
- Veterans Affairs San Diego Healthcare System, San Diego, California
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21
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Luther L, Jarvis SA, Spilka MJ, Strauss GP. Global reward processing deficits predict negative symptoms transdiagnostically and transphasically in a severe mental illness-spectrum sample. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01714-7. [PMID: 38051397 DOI: 10.1007/s00406-023-01714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023]
Abstract
Reward processing impairments are a key factor associated with negative symptoms in those with severe mental illnesses. However, past findings are inconsistent regarding which reward processing components are impaired and most strongly linked to negative symptoms. The current study examined the hypothesis that these mixed findings may be the result of multiple reward processing pathways (i.e., equifinality) to negative symptoms that cut across diagnostic boundaries and phases of illness. Participants included healthy controls (n = 100) who served as a reference sample and a severe mental illness-spectrum sample (n = 92) that included psychotic-like experiences, clinical high-risk for psychosis, bipolar disorder, and schizophrenia participants. All participants completed tasks measuring four RDoC Positive Valence System constructs: value representation, reinforcement learning, effort-cost computation, and hedonic reactivity. A k-means cluster analysis of the severe mental illness-spectrum samples identified three clusters with differential reward processing profiles that were characterized by: (1) global reward processing deficits (22.8%), (2) selective impairments in hedonic reactivity alone (40.2%), and (3) preserved reward processing (37%). Elevated negative symptoms were only observed in the global reward processing cluster. All clusters contained participants from each clinical group, and the distribution of these groups did not significantly differ among the clusters. Findings identified one pathway contributing to negative symptoms that was transdiagnostic and transphasic. Future work further characterizing divergent pathways to negative symptoms may help to improve symptom trajectories and personalized treatments.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
| | - Sierra A Jarvis
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Michael J Spilka
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, 125 Baldwin St., Athens, GA, 30602, USA.
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22
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Bansal S, Bae GY, Robinson BM, Dutterer J, Hahn B, Luck SJ, Gold JM. Qualitatively Different Delay-Dependent Working Memory Distortions in People With Schizophrenia and Healthy Control Participants. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:1218-1227. [PMID: 37459911 PMCID: PMC10792108 DOI: 10.1016/j.bpsc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Impairments in working memory (WM) have been well documented in people with schizophrenia (PSZ). However, these quantitative WM impairments can often be explained by nonspecific factors, such as impaired goal maintenance. Here, we used a spatial orientation delayed response task to explore a qualitative difference in WM dynamics between PSZ and healthy control participants (HCs). More specifically, we took advantage of the discovery that WM representations may drift either toward or away from previous trial targets (serial dependence). We tested the hypothesis that WM representations would drift toward the previous trial target in HCs but away from the previous trial target in PSZ. METHODS We assessed serial dependence in PSZ (n = 31) and HCs (n = 25) using orientation as the to-be-remembered feature and memory delays lasting from 0 to 8 seconds. Participants were asked to remember the orientation of a teardrop-shaped object and reproduce the orientation after a delay period of varying length. RESULTS Consistent with prior studies, we found that current trial memory representations were less precise in PSZ than in HCs. We also found that WM for the current trial orientation drifted toward the previous trial orientation in HCs (representational attraction) but drifted away from the previous trial orientation in PSZ (representational repulsion). CONCLUSIONS These results demonstrate a qualitative difference in WM dynamics between PSZ and HCs that cannot be easily explained by nuisance factors such as reduced effort. Most computational neuroscience models also fail to explain these results because they maintain information solely by means of sustained neural firing, which does not extend across trials. The results suggest a fundamental difference between PSZ and HCs in longer-term memory mechanisms that persist across trials, such as short-term potentiation and neuronal adaptation.
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Affiliation(s)
- Sonia Bansal
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland.
| | - Gi-Yeul Bae
- Department of Psychology, Arizona State University, Tempe, Arizona
| | - Benjamin M Robinson
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Jenna Dutterer
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Britta Hahn
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Steven J Luck
- Center for Mind & Brain and Department of Psychology, University of California, Davis, Davis, California
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland
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23
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Le TP, Green MF, Wynn JK, Iglesias JE, Franco RL, Kopelowicz A, Kern RS. Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders. Schizophr Res 2023; 262:149-155. [PMID: 37979418 PMCID: PMC10923523 DOI: 10.1016/j.schres.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/29/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks - two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) - in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (total R2 = 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.
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Affiliation(s)
- Thanh P Le
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Jonathan K Wynn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Julio E Iglesias
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Richard L Franco
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Alex Kopelowicz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Robert S Kern
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
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24
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Moe AM, Kilicoglu MFV, Angers K, Huang K, Breitborde NJK. Coordinated specialty care for first-episode psychosis: Effects on social motivation and social pleasure. Schizophr Res 2023; 262:130-131. [PMID: 37950935 DOI: 10.1016/j.schres.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/28/2023] [Accepted: 10/28/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychology, The Ohio State University, Columbus, OH, USA.
| | - Melissa F V Kilicoglu
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Kaley Angers
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kexin Huang
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychology, The Ohio State University, Columbus, OH, USA
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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Gold JM, Corlett PR, Erickson M, Waltz JA, August S, Dutterer J, Bansal S. Phenomenological and Cognitive Features Associated With Auditory Hallucinations in Clinical and Nonclinical Voice Hearers. Schizophr Bull 2023; 49:1591-1601. [PMID: 37350507 PMCID: PMC10686332 DOI: 10.1093/schbul/sbad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND HYPOTHESES Auditory verbal hallucinations (AVH) are central features of schizophrenia (SZ). However, AVH also occur in a small percentage of the general population who do not have a need for care, termed nonclinical voice hearers (NCVH). We sought to determine the degree to which the experience of AVH was similar in NCVH and in people with schizophrenia (PSZ) and evaluate the degree to which NCVH shared other features of SZ such as delusional beliefs, cognitive impairment, and negative symptoms. STUDY DESIGN We recruited 76 people with a DSM-V diagnosis of SZ/schizoaffective disorder (PSZ; 49 with current AVH, 27 without), 48 NCVH, and 51 healthy controls. Participants received a broad battery of clinician-administered and self-report symptom assessments and a focused cognitive assessment. STUDY RESULTS The AVH of NCVH and PSZ shared very similar sensory features. NCVH experienced less distress, had greater control over their AVH, and, unlike PSZ, rarely heard 2 voices speaking to each other. NCVH demonstrated a wide range of deeply held unusual beliefs, but reported less paranoia, and fewer first-rank symptoms such as passivity and alterations in self-experience. NCVH showed no evidence of cognitive deficits or negative symptoms. CONCLUSIONS The AVH in NCVH and PSZ demonstrate important similarities as well as clear differences. Specific features, rather than the presence, of AVH appear to determine the need for care. NCVH do not share the cognitive and motivational deficits seen in PSZ. These results suggest that AVH and unusual beliefs can be separated from the broader phenotype of SZ.
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Affiliation(s)
- James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Philip R Corlett
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, CT and Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Molly Erickson
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sharon August
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jenna Dutterer
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sonia Bansal
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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27
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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28
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Wehr S, Weigel L, Davis J, Galderisi S, Mucci A, Leucht S. Clinical Assessment Interview for Negative Symptoms (CAINS): A Systematic Review of Measurement Properties. Schizophr Bull 2023:sbad137. [PMID: 37951838 DOI: 10.1093/schbul/sbad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND AND HYPOTHESIS Negative symptoms are very important for the overall loss of functioning observed in patients with schizophrenia. There is a need for valid tools to assess these symptoms. STUDY DESIGN We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review guideline to evaluate the quality of the clinical assessment interview for negative symptoms (CAINS) as a clinician-rated outcome measurement (ClinROM). STUDY RESULTS The search strategy resulted in the retrieval of 13 articles, 11 of which were included in this evaluation. In terms of risk of bias, most articles reported on measures of internal consistency and construct validity, which were overall of good quality. Structural validity, reliability, measurement error, and cross-cultural validity were reported with less than optimum quality. There was a risk of bias in ClinROM development. According to the updated criteria of good measurement properties, structural validity, internal consistency, and reliability showed good results. In contrast, hypothesis testing was somewhat poorer. Results for cross-cultural validity were indeterminate. According to the updated GRADE approach from the COSMIN group the scale received a moderate grade. CONCLUSIONS The COSMIN standard allows a judgment of the CAINS as an instrument with the potential to be recommended for use, but which requires further research to assess its quality, in particular in the domains of content validity, internal consistency, and cross-cultural validity.
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Affiliation(s)
- Sophia Wehr
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lucia Weigel
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL
- Maryland Psychiatric Research Center, Baltimore, MD
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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29
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Didier PR, Moore TM, Calkins ME, Prettyman G, Levinson T, Savage C, de Moraes Leme LFV, Kohler CG, Kable J, Satterthwaite T, Gur RC, Gur RE, Wolf DH. Evaluation of a new intrinsic and extrinsic motivation scale in youth with psychosis spectrum symptoms. Compr Psychiatry 2023; 127:152413. [PMID: 37696094 PMCID: PMC10644398 DOI: 10.1016/j.comppsych.2023.152413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Impairment in intrinsic motivation (IM), the drive to satisfy internal desires like mastery, may play a key role in disability in psychosis. However, we have limited knowledge regarding relative impairments in IM compared to extrinsic motivation (EM) or general motivation (GM), in part due to limitations in existing measures. METHODS Here we address this gap using a novel Trait Intrinsic and Extrinsic Motivation self-report scale in a sample of n = 243 participants including those with schizophrenia, psychosis-risk, and healthy controls. Each of the 7 IM and 6 EM items used a 7-point Likert scale assessing endorsement of dispositional statements. Bifactor analyses of these items yielded distinct IM, EM, and GM factor scores. Convergent and discriminant validity were examined in relation to General Causality Orientation Scale (GCOS-CP) and Quality of Life 3-item IM measure (QLS-IM). Utility was assessed in relation to psychosis-spectrum (PS) status and CAINS clinical amotivation. RESULTS IM and EM showed acceptable inter-item consistency (IM: α = 0.88; EM: α = 0.66); the bifactor model exhibited fit that varied from good to borderline to inadequate depending on the specific fit metric (SRMR = 0.038, CFI = 0.94, RMSEA = 0.106 ± 0.014). IM scores correlated with established IM measures: GCOS-CP Autonomy (rho = 0.38, p < 0.01) and QLS-IM (rho = 0.29, p < 0.01). Supporting discriminant validity, IM did not correlate with GCOS-CP Control (rho = -0.14, p > 0.05). Two-year stability in an available longitudinal subset (n = 35) was strong (IM: rho = 0.64, p < 0.01; EM: rho = 0.55, p < 0.01). Trait IM was lower in PS youth (t = 4.24, p < 0.01), and correlated with clinical amotivation (rho = -0.36, p < 0.01); EM did not show significant clinical associations. CONCLUSIONS These results demonstrate the clinical relevance of IM in psychosis risk. They also provide preliminary support for the reliability, validity and utility of this new Trait IM-EM scale, which addresses a measurement gap and can facilitate identification of neurobehavioral and clinical correlates of IM deficits.
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Affiliation(s)
- Paige R Didier
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychology, University of Maryland, College Park, MD 20742, USA.
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Greer Prettyman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tess Levinson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Lynch School of Education and Human Development, Boston College, Chestnut Hill, MA 02467, USA
| | - Chloe Savage
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Christian G Kohler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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Luther L, Westbrook A, Ayawvi G, Ruiz I, Raugh IM, Chu AOK, Chang WC, Strauss GP. The role of defeatist performance beliefs on cognitive effort-cost decision-making in schizophrenia. Schizophr Res 2023; 261:216-224. [PMID: 37801740 DOI: 10.1016/j.schres.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/01/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
Impairments in effort-cost decision-making have been consistently observed in people with schizophrenia (SZ) and may be an important mechanism of negative symptoms. However, the processes that give rise to impairments in effort-cost decision-making are unclear, leading to limited progress in identifying the most relevant treatment targets. Drawing from cognitive models of negative symptoms and goal-directed behavior, this study aimed to examine how and under what type of task conditions defeatist performance beliefs contribute to these decision-making processes. Outpatients with SZ (n = 30) and healthy controls (CN; n = 28) completed a cognitive effort allocation task, the Cognitive Effort-Discounting (COGED) task, which assesses participants' willingness to exert cognitive effort for monetary rewards based on parametrically varied working memory demands (completing N-back levels). Results showed that although participants with SZ demonstrated reduced willingness to work for rewards across N-back levels compared to CN participants, they showed less choice modulation across different N-back conditions. However, among SZ participants with greater defeatist performance beliefs, there was a reduced willingness to choose the high effort option at higher N-back levels (N-back levels 3, 4, and 5 versus 2-back). Results suggest that compared to CN, the SZ group's subjective willingness to expend effort largely did not dynamically adjust as cognitive load increased. However, defeatist beliefs may undermine willingness to expend cognitive effort, especially when cognitive task demands are high. These beliefs may be a viable treatment target to improve effort-cost decision-making impairments in people with SZ.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | | | - Gifty Ayawvi
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Ivan Ruiz
- Department of Psychology, University of Georgia, Athens, GA, USA; Department of Psychiatry, University of California, Los Angeles, USA
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Angel On Ki Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong; Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Saleh Y, Jarratt-Barnham I, Petitet P, Fernandez-Egea E, Manohar SG, Husain M. Negative symptoms and cognitive impairment are associated with distinct motivational deficits in treatment resistant schizophrenia. Mol Psychiatry 2023; 28:4831-4841. [PMID: 37626135 PMCID: PMC10914595 DOI: 10.1038/s41380-023-02232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Motivational deficits are a central feature of the negative syndrome in schizophrenia. They have consistently been associated with reduced willingness to expend physical effort in return for monetary rewards on effort based decision making (EBDM) paradigms. Nevertheless, the mechanisms underlying such altered performance are not well characterised, and it remains unclear if they are driven purely by negative symptoms, or also in part by cognitive impairment, antipsychotic treatment or even positive symptoms. Here we investigated the impact of all these factors using a paradigm that has not previously been used to measure EBDM in schizophrenia. METHODS Forty treatment resistant schizophrenia (TRS) patients on clozapine and matched controls (N = 80) completed a well validated EBDM task which offers monetary rewards in return for physical effort. Choice and reaction time data was analysed using logistic regressions, as well as Bayesian hierarchical drift diffusion modelling (HDDM). Behavioural parameters were compared between groups and their association with negative symptoms, cognitive function and serum clozapine levels were assessed. RESULTS Overall, TRS patients accepted significantly less offers than controls during effort-based decision making, suggesting they were less motivated. They demonstrated reduced sensitivity to increasing rewards, but surprisingly were also less averse to increasing effort. Despite a positive correlation between negative symptoms and cognitive function in TRS, reward sensitivity was associated only with cognitive performance. In contrast, reduced effort aversion correlated with negative symptom severity. Clozapine levels and positive symptoms were not associated with either behavioural parameter. CONCLUSION Motivational deficits in TRS are characterised by both diminished reward sensitivity and reduced effort aversion during EBDM. Cognitive dysfunction and negative symptom severity account for distinct aspects of these behavioural changes, despite positive associations between themselves. Overall, these findings demonstrate that negative symptoms and cognitive impairment have significant independent contributions to EBDM in TRS, thereby opening the possibility of individualised treatment targeting these mechanisms to improve motivation.
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Affiliation(s)
- Y Saleh
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - I Jarratt-Barnham
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - P Petitet
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- Centre de Recherche en Neurosciences de Lyon, Equipe Trajectories, Inserm UMR-S 1028, CNRS UMR 5292, Universite Lyon 1, Bron, France
| | - E Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- Cambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - S G Manohar
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - M Husain
- Nuffield Department Clinical Neurosciences, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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32
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Fuentes-Claramonte P, Garcia-Leon MA, Salgado-Pineda P, Ramiro N, Soler-Vidal J, Torres ML, Cano R, Argila-Plaza I, Panicali F, Sarri C, Jaurrieta N, Sánchez M, Boix-Quintana E, Albacete A, Maristany T, Sarró S, Raduà J, McKenna PJ, Salvador R, Pomarol-Clotet E. Do the negative symptoms of schizophrenia reflect reduced responsiveness to reward? Examination using a reward prediction error (RPE) task. Psychol Med 2023; 53:7106-7115. [PMID: 36987680 PMCID: PMC10719670 DOI: 10.1017/s0033291723000521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND A leading theory of the negative symptoms of schizophrenia is that they reflect reduced responsiveness to rewarding stimuli. This proposal has been linked to abnormal (reduced) dopamine function in the disorder, because phasic release of dopamine is known to code for reward prediction error (RPE). Nevertheless, few functional imaging studies have examined if patients with negative symptoms show reduced RPE-associated activations. METHODS Matched groups of DSM-5 schizophrenia patients with high negative symptom scores (HNS, N = 27) or absent negative symptoms (ANS, N = 27) and healthy controls (HC, N = 30) underwent fMRI scanning while they performed a probabilistic monetary reward task designed to generate a measure of RPE. RESULTS In the HC, whole-brain analysis revealed that RPE was positively associated with activation in the ventral striatum, the putamen, and areas of the lateral prefrontal cortex and orbitofrontal cortex, among other regions. Group comparison revealed no activation differences between the healthy controls and the ANS patients. However, compared to the ANS patients, the HNS patients showed regions of significantly reduced activation in the left ventrolateral and dorsolateral prefrontal cortex, and in the right lingual and fusiform gyrus. HNS and ANS patients showed no activation differences in ventral striatal or midbrain regions-of-interest (ROIs), but the HNS patients showed reduced activation in a left orbitofrontal cortex ROI. CONCLUSIONS The findings do not suggest that a generalized reduction of RPE signalling underlies negative symptoms. Instead, they point to a more circumscribed dysfunction in the lateral frontal and possibly the orbitofrontal cortex.
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Affiliation(s)
- Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
| | - Maria Angeles Garcia-Leon
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
- Benito Menni CASM, Sant Boi de Llobregat, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | | | - Ramon Cano
- Hospital Mare de Déu de la Mercè, Barcelona, Spain
| | | | | | - Carmen Sarri
- Benito Menni CASM, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Manel Sánchez
- Hospital Sagrat Cor, Martorell, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Auria Albacete
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Teresa Maristany
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
| | - Joaquim Raduà
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institute, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter J. McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Instituto de Salud Carlos III, Barcelona, Spain
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Bengtsson J, Rad P, Cernvall M, Bodén R. Psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression and its relationship to affective symptoms. Ann Gen Psychiatry 2023; 22:42. [PMID: 37885022 PMCID: PMC10604520 DOI: 10.1186/s12991-023-00474-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND There is a conceptual overlap between negative and depressive symptoms, requiring further exploration to advance the understanding of negative symptoms. The aim of this study was to examine psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression, and to explore the relationship between the negative and affective symptoms domains. METHODS Fifty-one patients with a depressive episode were included and interviewed with the CAINS and the Brief Psychiatric Rating Scale-Expanded (BPRS-E). Self-reported depressive symptoms were collected with the Montgomery-Asberg Depression Rating Scale (MADRS-S). Inter-rater agreement, internal consistency and validity measures were examined, as were correlations between negative and affective symptoms. RESULTS The intraclass correlation for the CAINS motivation and pleasure subscale (CAINS-MAP) was 0.98 (95% CI 0.96-0.99) and that for the expressional subscale (CAINS-EXP) was 0.81 (95% CI 0.67-0.89). Cronbach's alpha was 0.71 (95% CI 0.57-0.82) for the CAINS-MAP and 0.86 (95% CI 0.79-0.92) for the CAINS-EXP. The correlation with the negative symptoms subscale of the BPRS-E was 0.35 (p = 0.011, blinded/different raters) or 0.55 (p < 0.001, not blinded/same rater). The CAINS-MAP correlated with the affective symptoms subscale of the BPRS-E (r = 0.39, p = 0.005) and the MADRS-S total score (r = 0.50, p < 0.001), but not with anxiety symptoms. CONCLUSIONS Negative symptoms in depression can be assessed with the CAINS with good inter-rater agreement and acceptable internal consistency and validity. There are associations between negative and depressive symptoms that call for further exploration.
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Affiliation(s)
- Johan Bengtsson
- Department of Medical Sciences, Psychiatry, Uppsala University, Entrance 10, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - Parya Rad
- Uppsala University Hospital, Uppsala, Sweden
| | - Martin Cernvall
- Department of Medical Sciences, Psychiatry, Uppsala University, Entrance 10, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Robert Bodén
- Department of Medical Sciences, Psychiatry, Uppsala University, Entrance 10, Uppsala University Hospital, 751 85, Uppsala, Sweden
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Zhu T, Wang Z, Wu W, Ling Y, Wang Z, Zhou C, Fang X, Huang C, Xie C, Chen J, Zhang X. Altered brain functional networks in schizophrenia with persistent negative symptoms: an activation likelihood estimation meta-analysis. Front Hum Neurosci 2023; 17:1204632. [PMID: 37954938 PMCID: PMC10637389 DOI: 10.3389/fnhum.2023.1204632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To investigate brain structural and functional characteristics of three brain functional networks including default mode network (DMN), central executive network (CEN), and salience network (SN) in persistent negative symptoms (PNS) patients. Methods We performed an activation likelihood estimation (ALE) meta-analysis of functional connectivity (FC) studies and voxel-based morphometry (VBM) studies to detect specific structural and functional alterations of brain networks between PNS patients and healthy controls. Results Seventeen VBM studies and twenty FC studies were included. In the DMN, PNS patients showed decreased gray matter in the bilateral medial frontal gyrus and left anterior cingulate gyrus and a significant reduction of FC in the right precuneus. Also, PNS patients had a decrease of gray matter in the left inferior parietal lobules and medial frontal gyrus, and a significant reduction of FC in the bilateral superior frontal gyrus in the CEN. In comparison with healthy controls, PNS patients exhibited reduced gray matter in the bilateral insula, anterior cingulate gyrus, left precentral gyrus and right claustrum and lower FC in these brain areas in the SN, including the left insula, claustrum, inferior frontal gyrus and extra-nuclear. Conclusion This meta-analysis reveals brain structural and functional imaging alterations in the three networks and the interaction among these networks in PNS patients, which provides neuroscientific evidence for more personalized treatment.Systematic Review RegistrationThe PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, registration number: CRD42022335962).
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Affiliation(s)
- Tingting Zhu
- Department of Psychiatry, The Third People’s Hospital of Huai’an, Huaian, Jiangsu, China
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zengxiu Wang
- Department of Hepatology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Weifeng Wu
- Department of Hepatology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuru Ling
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zixu Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chengbing Huang
- Department of Psychiatry, The Third People’s Hospital of Huai’an, Huaian, Jiangsu, China
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chunming Xie
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine Southeast University, Nanjing, China
| | - Jiu Chen
- Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Abel DB, Minor KS. Social pleasure in daily life: A meta-analysis of experience sampling studies in schizophrenia. Schizophr Res 2023; 260:56-64. [PMID: 37625224 DOI: 10.1016/j.schres.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/19/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
Social anhedonia is considered a key feature of schizophrenia that leads to impaired social functioning. Although traditional laboratory measures assess non-current social pleasure, researchers have begun using experience sampling methods (ESM) to measure current, or consummatory, experiences of social pleasure in daily life. A recent meta-analysis examined deficits in consummatory social pleasure in schizophrenia and found vast heterogeneity in effect sizes across ESM studies. Thus, this meta-analysis aimed to extend those results by testing moderators of this effect. Meta-analysis of 14 ESM studies suggests those with psychotic disorders exhibit a moderate deficit in consummatory social pleasure compared to healthy controls. Yet, this effect was significantly moderated by the type of measure used to assess social pleasure. Measures that directly assessed positive emotional experience during socialization yielded small effects that failed to reach significance; indirect measures of other social factors related to pleasure yielded large, significant effects. This suggests daily social anhedonia observed in psychotic disorders is not due to reduced experience of positive emotion. Instead, social anhedonia may be driven by other elements of social functioning. Most clinical variables did not influence effects, but there was a trend such that patient groups with lower cognitive functioning exhibited greater pleasure deficits. Inconsistent reporting across studies limited our ability to examine other real-world variables that may contribute to deficits in social pleasure. Yet, results show different ESM items used to measure social pleasure do not assess the same construct. Future research is needed to validate ESM measures and standardize protocols across studies.
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Affiliation(s)
- Danielle B Abel
- Indiana University-Purdue University Indianapolis, 402 N Blackford St, Indianapolis, IN 46202, United States.
| | - Kyle S Minor
- Indiana University-Purdue University Indianapolis, 402 N Blackford St, Indianapolis, IN 46202, United States
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36
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Jimenez AM, Clayson PE, Hasratian AS, Lee J, Reavis EA, Wynn JK, Green MF, Horan WP. Neuroimaging of social motivation during winning and losing: Associations with social anhedonia across the psychosis spectrum. Neuropsychologia 2023; 188:108621. [PMID: 37321406 PMCID: PMC10527321 DOI: 10.1016/j.neuropsychologia.2023.108621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/10/2023] [Accepted: 06/10/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Individuals with psychosis spectrum disorders (PSD) have difficulty developing social relationships. This difficulty may reflect reduced response to social feedback involving functional alterations in brain regions that support the social motivation system: ventral striatum, orbital frontal cortex, insula, dorsal anterior cingulate cortex, and amygdala. Whether these alterations span PSD is unknown. METHODS 71 individuals with PSD, 27 unaffected siblings, and 37 control participants completed a team-based fMRI task. After each trial, participants received performance feedback paired with the expressive face of a teammate or opponent. A 2 × 2 (win versus loss outcome x teammate versus opponent) repeated measures ANOVA by group was performed on activation in the five key regions of interest during receipt of feedback. RESULTS Across groups, three social motivation regions, ventral striatum, orbital frontal cortex, and amygdala, showed sensitivity to feedback (significant main effect of outcome), with greater activation during win versus loss trials, regardless of whether the feedback was from a teammate or opponent. In PSD, ventral striatum and orbital frontal cortex activation to win feedback was negatively correlated with social anhedonia scores. CONCLUSIONS Patterns of neural activation during social feedback were similar in PSD, their unaffected siblings, and healthy controls. Across the psychosis spectrum, activity in key social motivation regions during social feedback was associated with individual differences in social anhedonia.
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Affiliation(s)
- Amy M Jimenez
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Peter E Clayson
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Arpi S Hasratian
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric A Reavis
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jonathan K Wynn
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Michael F Green
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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37
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Lyngstad SH, Lyne JP, Ihler HM, van der Meer L, Færden A, Melle I. Turning the Spotlight on Apathy: Identification and Treatment in Schizophrenia Spectrum Disorders. Schizophr Bull 2023; 49:1099-1104. [PMID: 37193675 PMCID: PMC10483442 DOI: 10.1093/schbul/sbad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Among negative symptoms, apathy is central to the impairments in real-life functioning in schizophrenia spectrum disorders (SSD). Thus, optimizing treatment for apathy appears key to improve outcomes. In treatment research, however, negative symptoms are typically studied as a unifactorial construct. We, therefore, aim to shed necessary light on the status of apathy identification and treatment in SSD.
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Affiliation(s)
- Siv Hege Lyngstad
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - John Paul Lyne
- Department of Psychiatry, Royal College of Surgeons in Ireland, Newcastle Hospital, Wicklow, Ireland
| | - Henrik Myhre Ihler
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Ann Færden
- Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Dalloul N, Moran EK, Gold JM, Carter CS, MacDonald AW, Ragland JD, Silverstein SM, Luck SJ, Barch DM. Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning. Schizophr Bull 2023; 49:1281-1293. [PMID: 37382553 PMCID: PMC10483466 DOI: 10.1093/schbul/sbad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND HYPOTHESIS Impairments in function (ie, the ability to independently accomplish daily tasks) have been established in psychotic disorders. Identifying factors that contribute to these deficits is essential to developing effective interventions. The current study had several goals: examine potential differential relationships across domains of neurocognition, assess whether reinforcement learning is related to function, identify if predictors of function are transdiagnostic, determine whether depression and positive symptoms contribute to function, and to explore whether the modality of assessment impacts observed relationships. STUDY DESIGN Data from 274 participants were examined with schizophrenia/schizoaffective disorder (SZ; n = 195) and bipolar disorder (BD; n = 79). To reduce dimensionality, a PCA was completed on neurocognitive tasks which resulted in 3 components. These components and clinical interview data were used to investigate predictors of functional domains across measures of function (self- and informant-report SLOF and UPSA). RESULTS Two components, working memory/processing speed/episodic memory (βs = 0.18-0.42), and negative/positive reinforcement learning (β = -0.04), predicted different functional domains. Predictors of function were largely transdiagnostic with two exceptions: reinforcement learning had a positive association with self-reported interpersonal relationships for SZ and a negative association for BD (β = 0.34), and the negative association between positive symptoms and self-reported social acceptability was stronger for BD than for SZ (β = 0.93). Depression robustly predicted self-reported but not informant-reported function, and anhedonia predicted all domains of informant-reported function. CONCLUSIONS These findings imply that reinforcement learning may differentially relate to function across disorders, traditional domains of neurocognition can be effective transdiagnostic targets for interventions, and positive symptoms and depression play a critical role in self-perceived functional impairments.
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Affiliation(s)
- Nada Dalloul
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Davis, CA, USA
| | - Angus W MacDonald
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - J Daniel Ragland
- Department of Psychiatry, University of California, Davis, CA, USA
| | | | - Steven J Luck
- Department of Psychology, University of California, Davis, CA, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Catalano LT, Green MF. Social Motivation in Schizophrenia: What's Effort Got to Do With It? Schizophr Bull 2023; 49:1127-1137. [PMID: 37354079 PMCID: PMC10483329 DOI: 10.1093/schbul/sbad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND HYPOTHESIS Social motivation, defined as the fundamental human desire to seek out, engage in, and maintain interpersonal bonds, has become a growing area of research in schizophrenia. The major focus has been on understanding the impact of social reward-related processes. An obvious but rarely acknowledged fact is that social interactions, much like other goal-directed acts, require the exertion of effort. In this Review Article, we argue that social motivation in schizophrenia can be conceptualized through the lens of an established framework: effort-based decision-making (EBDM). STUDY DESIGN We conducted a literature review on social reward processing in schizophrenia, then extended these findings by applying concepts and insights from the literature on EBDM to the study of social motivation. STUDY RESULTS Within the EBDM framework, decisions about whether or not to pursue social interactions are bound by cost/benefit calculations. That is, people do not pursue social behaviors when the estimated "cost" of the required effort outweighs the anticipated "benefit" or reward. We propose that people with schizophrenia are less likely to engage in social interaction compared with healthy samples because they: (1) underestimate the benefits of relationships (based on expectations of reward/punishment), (2) overestimate the effort costs associated with social interaction, and/or (3) fail to integrate cost-benefit information in an optimal manner. CONCLUSIONS EBDM is an especially promising framework of social motivation that goes beyond the current focus on social reward processing to include a focus on effort.
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Affiliation(s)
- Lauren T Catalano
- 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
| | - 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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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42
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Gangl N, Conring F, Federspiel A, Wiest R, Walther S, Stegmayer K. Resting-state perfusion in motor and fronto-limbic areas is linked to diminished expression of emotion and speech in schizophrenia. Schizophrenia (Heidelb) 2023; 9:51. [PMID: 37573445 PMCID: PMC10423240 DOI: 10.1038/s41537-023-00384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
Negative symptoms (NS) are a core component of schizophrenia affecting community functioning and quality of life. We tested neural correlates of NS considering NS factors and consensus subdomains. We assessed NS using the Clinical Assessment Interview for Negative Symptoms and the Scale for Assessment of Negative Symptoms. Arterial spin labeling was applied to measure resting-state cerebral blood flow (rCBF) in 47 schizophrenia patients and 44 healthy controls. Multiple regression analyses calculated the relationship between rCBF and NS severity. We found an association between diminished expression (DE) and brain perfusion within the cerebellar anterior lobe and vermis, and the pre-, and supplementary motor area. Blunted affect was linked to fusiform gyrus and alogia to fronto-striatal rCBF. In contrast, motivation and pleasure was not associated with rCBF. These results highlight the key role of motor areas for DE. Considering NS factors and consensus subdomains may help identifying specific pathophysiological pathways of NS.
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Affiliation(s)
- Nicole Gangl
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Frauke Conring
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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43
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Marder SR, Umbricht D. Negative symptoms in schizophrenia: Newly emerging measurements, pathways, and treatments. Schizophr Res 2023; 258:71-77. [PMID: 37517366 DOI: 10.1016/j.schres.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/20/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
The negative symptoms of schizophrenia, which often appear earlier than any other symptom, are prominent and clinically relevant in the majority of patients. As a result, interest in their treatment has increased. Patients who exhibit significant negative symptoms have worse functional outcomes than those without, resulting in impairments in occupational, household, and recreational functioning, as well as difficulties in relationships. Yet treatment with currently available medications does not lead to any significant improvements in this core component of schizophrenia. An increased understanding of the pathophysiology underlying negative symptoms and the discovery of novel treatments that do not directly target dopamine offer the potential to develop therapies that may reduce negative symptoms and increase quality of life for patients. The current article will discuss the impact of negative symptoms, outline current measurement tools for the assessment of negative symptoms, and examine how these measures may be improved. Insights into the neural circuitry underlying negative symptoms will be discussed, and promising targets for the development of effective treatments for these symptoms will be identified. As more prospective, large-scale, randomized studies focus on the effects of treatments on negative symptoms, progress in this area is foreseeable. However, improvements in clinical assessment instruments, a better understanding of the underlying neural mechanisms, development of novel treatments with varied targets, and a greater focus on personalized treatment are all important to produce significant benefits for patients with negative symptoms of schizophrenia.
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Affiliation(s)
- Stephen R Marder
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States of America.
| | - Daniel Umbricht
- Xperimed LLC, Basel, Switzerland; University of Zurich, Zurich, Switzerland
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44
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Weigel L, Wehr S, Galderisi S, Mucci A, Davis J, Giordano GM, Leucht S. The Brief negative Symptom Scale (BNSS): a systematic review of measurement properties. Schizophrenia (Heidelb) 2023; 9:45. [PMID: 37500628 PMCID: PMC10374652 DOI: 10.1038/s41537-023-00380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Negative symptoms of schizophrenia are linked with poor functioning and quality of life. Therefore, appropriate measurement tools to assess negative symptoms are needed. The NIMH-MATRICS Consensus defined five domains for negative symptoms, which The Brief Negative Symptom Scale (BNSS) covers. METHODS We used the COSMIN guidelines for systematic reviews to evaluate the quality of psychometric data of the BNSS scale as a Clinician-Rated Outcome Measure (ClinROM). RESULTS The search strategy resulted in the inclusion of 17 articles. When using the risk of bias checklist, there was a generally good quality in reporting of structural validity and hypothesis testing. Internal consistency, reliability and cross-cultural validity were of poorer quality. ClinROM development and content validity showed inadequate results. According to the updated criteria of good measurement properties, structural validity, internal consistency and interrater reliability showed good results, while hypothesis testing showed poorer results. Cross-cultural validity and test-retest reliability were indeterminate. The updated GRADE approach resulted in a moderate grade. CONCLUSIONS We can potentially recommend the use of the BNSS as a concise tool to rate negative symptoms. Due to weaknesses in certain domains further validations are warranted.
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Affiliation(s)
- Lucia Weigel
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Sophia Wehr
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - Armida Mucci
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - John Davis
- Psychiatric Institute, University of Illinois at Chicago (mc 912), 1601 W. Taylor St., Chicago, Il 60612, and Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Giulia Maria Giordano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School Of Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675, Munich, Germany.
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45
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Uka F, Konjufca J, Ramadani F, Arënliu A, Bërxulli D, Jovanović N, Russo M. The relations between socio-demographic information and negative symptoms, mental health, and quality of life: a latent profile analysis with psychotic patients in Kosovo. Front Psychiatry 2023; 14:1135385. [PMID: 37564239 PMCID: PMC10410071 DOI: 10.3389/fpsyt.2023.1135385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/27/2023] [Indexed: 08/12/2023] Open
Abstract
The current study aims to identify meaningful psychotic patients' profiles by examining certain combinations of patient's demographic and socio-economic variables (sex, age, marital status, number of children, cohabitant and level of education). Moreover, we aim to assess whether there is any significant effect of class membership (profile) on negative symptoms, health state, and quality of life among psychotic patients. A convenience sample of 103 patients (age: M = 22, SD = 1.75), was drawn from the clinical populations of Kosovo. Demographic and socio-economic data was obtained through individual interviews, meanwhile a battery of questionnaires was used to assess negative symptoms, mental health, and quality of life of patients. The 4-class solution was selected as the best fitting model and used in subsequent analyses. Results indicated a significant effect of class membership on health state, quality of life and negative symptoms. Practical implications are discussed.
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Affiliation(s)
- Fitim Uka
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Jon Konjufca
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Fjolla Ramadani
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Aliriza Arënliu
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Dashamir Bërxulli
- Department of Psychology, University of Pristina “Hasan Prishtina”, Prishtina, Kosovo
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Manuela Russo
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
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Culbreth AJ, Dershwitz SD, Barch DM, Moran EK. Associations Between Cognitive and Physical Effort-Based Decision Making in People With Schizophrenia and Healthy Control Subjects. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:695-702. [PMID: 36796513 PMCID: PMC10330111 DOI: 10.1016/j.bpsc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Effort can take a variety of forms including physical (e.g., button pressing) and cognitive (e.g., working memory tasks). Few studies have examined whether individual differences in willingness to expend effort are similar or different across modalities. METHODS We recruited 30 individuals with schizophrenia and 44 healthy control subjects to complete 2 effort-cost decision-making tasks: the Effort Expenditure for Rewards Task (physical effort) and the cognitive effort discounting task (cognitive effort). RESULTS Willingness to expend cognitive and physical effort was positively associated for both individuals with schizophrenia and control subjects. Further, we found that individual differences in motivation and pleasure dimension of negative symptoms modulated the association between physical and cognitive effort. Specifically, participants with lower motivation and pleasure scores, irrespective of group status, showed stronger associations between task measures of cognitive and physical effort-cost decision making. CONCLUSIONS These results suggest a generalized deficit across effort modalities in individuals with schizophrenia. Further, reductions in motivation and pleasure may impact effort-cost decision making in a domain-general manner.
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Affiliation(s)
- Adam J Culbreth
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, Maryland.
| | - Sally D Dershwitz
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Erin K Moran
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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47
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Levitt JJ, Zhang F, Vangel M, Nestor PG, Rathi Y, Cetin-Karayumak S, Kubicki M, Coleman MJ, Lewandowski KE, Holt DJ, Keshavan M, Bouix S, Öngür D, Breier A, Shenton ME, O'Donnell LJ. The organization of frontostriatal brain wiring in non-affective early psychosis compared with healthy subjects using a novel diffusion imaging fiber cluster analysis. Mol Psychiatry 2023; 28:2301-2311. [PMID: 37173451 DOI: 10.1038/s41380-023-02031-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/13/2023] [Accepted: 03/08/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Alterations in brain connectivity may underlie neuropsychiatric conditions such as schizophrenia. We here assessed the degree of convergence of frontostriatal fiber projections in 56 young adult healthy controls (HCs) and 108 matched Early Psychosis-Non-Affective patients (EP-NAs) using our novel fiber cluster analysis of whole brain diffusion magnetic resonance imaging tractography. METHODS Using whole brain tractography and our fiber clustering methodology on harmonized diffusion magnetic resonance imaging data from the Human Connectome Project for Early Psychosis we identified 17 white matter fiber clusters that connect frontal cortex (FCtx) and caudate (Cd) per hemisphere in each group. To quantify the degree of convergence and, hence, topographical relationship of these fiber clusters, we measured the inter-cluster mean distances between the endpoints of the fiber clusters at the level of the FCtx and of the Cd, respectively. RESULTS We found (1) in both groups, bilaterally, a non-linear relationship, yielding convex curves, between FCtx and Cd distances for FCtx-Cd connecting fiber clusters, driven by a cluster projecting from inferior frontal gyrus; however, in the right hemisphere, the convex curve was more flattened in EP-NAs; (2) that cluster pairs in the right (p = 0.03), but not left (p = 0.13), hemisphere were significantly more convergent in HCs vs EP-NAs; (3) in both groups, bilaterally, similar clusters projected significantly convergently to the Cd; and, (4) a significant group by fiber cluster pair interaction for 2 right hemisphere fiber clusters (numbers 5, 11; p = .00023; p = .00023) originating in selective PFC subregions. CONCLUSIONS In both groups, we found the FCtx-Cd wiring pattern deviated from a strictly topographic relationship and that similar clusters projected significantly more convergently to the Cd. Interestingly, we also found a significantly more convergent pattern of connectivity in HCs in the right hemisphere and that 2 clusters from PFC subregions in the right hemisphere significantly differed in their pattern of connectivity between groups.
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Affiliation(s)
- J J Levitt
- Department of Psychiatry, VA Boston Healthcare System, Brockton Division, Brockton, MA, 02301, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - F Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - M Vangel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - P G Nestor
- Department of Psychiatry, VA Boston Healthcare System, Brockton Division, Brockton, MA, 02301, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychology, University of Massachusetts, Boston, MA, 02125, USA
| | - Y Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - S Cetin-Karayumak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - M Kubicki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - M J Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - K E Lewandowski
- McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - D J Holt
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - M Keshavan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - S Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Software Engineering and Information Technology, École de technologie supérieure, Université du Québec, Montréal, QC, H3C 1K3, Canada
| | - D Öngür
- McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - A Breier
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - M E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - L J O'Donnell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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48
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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49
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Abel DB, Rand KL, Salyers MP, Myers EJ, Mickens JL, Minor KS. Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure. Schizophr Bull 2023; 49:809-822. [PMID: 36820515 PMCID: PMC10154728 DOI: 10.1093/schbul/sbac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND The "emotion paradox" of schizophrenia suggests people with schizophrenia demonstrate deficits when reporting anticipated and retrospective pleasure; yet, in-the-moment, consummatory pleasure is largely intact. It is uncertain how these findings extend to social situations. This meta-analysis aimed to (1) determine the mean difference in consummatory social pleasure between people with schizophrenia and healthy controls, and (2) examine moderators of this effect, including study design and clinical characteristics of participants. DESIGN A literature search using PsycINFO, Web of Science, Pubmed, and EMBASE databases was conducted. Studies measuring consummatory social pleasure using experience sampling methods and laboratory social simulations were included. Random effects meta-analyses were conducted using Hedge's g. RESULTS Meta-analysis of 26 studies suggests people with schizophrenia exhibited a small, significant deficit in consummatory social pleasure (g = -0.38, 90% CI [-0.53, -0.22]). There was significant heterogeneity in effect sizes; magnitude was moderated by study design and type of measure used to assess social pleasure. CONCLUSIONS Overall, people with schizophrenia seem to exhibit less consummatory social pleasure than controls. However, this deficit is smaller than in studies of anticipated and retrospective pleasure. Thus, consummatory social pleasure may not be quite as impaired in people with schizophrenia as traditional anhedonia research suggests. Moreover, pleasure deficits observed in people with schizophrenia may result from differences in the quality of their daily social experiences rather than differences in their capacity for social pleasure. Results have important implications for clinical interventions that address barriers to social engagement, low-pleasure beliefs, and cognitive remediation to treat schizophrenia.
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Affiliation(s)
- Danielle B Abel
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Evan J Myers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Jessica L Mickens
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
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50
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Luther L, Raugh IM, Collins DE, Knippenberg AR, Strauss GP. Negative symptoms in schizophrenia differ across environmental contexts in daily life. J Psychiatr Res 2023; 161:10-18. [PMID: 36893666 PMCID: PMC10149609 DOI: 10.1016/j.jpsychires.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
A recent environmental theory of negative symptoms posits that environmental contexts (e.g., location, social partner) play a significant-yet often unaccounted for-role in negative symptoms of schizophrenia (SZ). "Gold-standard" clinical rating scales offer limited precision for evaluating how contexts impact symptoms. To overcome some of these limitations, Ecological Momentary Assessment (EMA) was used to determine whether there were state fluctuations in experiential negative symptoms (anhedonia, avolition, and asociality) in SZ across contexts (locations, activities, social interaction partner, social interaction method). Outpatients with SZ (n = 52) and healthy controls (CN: n = 55) completed 8 daily EMA surveys for 6 days assessing negative symptom domains (anhedonia, avolition, and asociality) and contexts. Multilevel modeling demonstrated that negative symptoms varied across location, activity, social interaction partner, and social interaction method. For the majority of contexts, SZ and CN did not report significantly different levels of negative symptoms, with SZ only reporting higher negative symptoms than CN while eating, resting, interacting with a significant other, or being at home. Further, there were several contexts where negative symptoms were similarly reduced (e.g., recreation, most social interactions) or elevated (e.g., using the computer, working, running errands) in each group. Results demonstrate that experiential negative symptoms dynamically change across contexts in SZ. Some contexts may "normalize" experiential negative symptoms in SZ, while other contexts, notably some used to promote functional recovery, may increase experiential negative symptoms.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA.
| | - Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
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