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Giordano GM, Sanmarchi F, Mucci A, Rucci P, Brando F, Caporusso E, Giuliani L, Melillo A, Pezzella P, Bucci P, Rocca P, Rossi A, Bertolino A, Rossi R, Pergola G, Galderisi S, Maj M. External validation of the five domains of negative symptoms: Focus on cognition, functional capacity, and real-world functioning. Eur Psychiatry 2023; 67:e3. [PMID: 38097401 DOI: 10.1192/j.eurpsy.2023.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 01/06/2024] Open
Abstract
BACKGROUND The conceptualization of negative symptoms (NS) in schizophrenia is still controversial. Recent confirmatory factor-analytic studies suggested that the bi-dimensional model (motivational deficit [MAP] and expressive deficit [EXP]) may not capture the complexity of NS structure, which could be better defined by a five-factor (five NS domains) or a hierarchical model (five NS domains as first-order factors, and MAP and EXP, as second-order factors). A validation of these models is needed to define the structure of NS. To evaluate the validity and temporal stability of the five-factor or the hierarchical structure of the brief negative symptom scale (BNSS) in individuals with schizophrenia (SCZ), exploring associations between these models with cognition, social cognition, functional capacity, and functioning at baseline and at 4 years follow-up. METHODS Clinical variables were assessed using state-of-the-art tools in 612 SCZ at two-time points. The validity of the five-factor and the hierarchical models was analyzed through structural equation models. RESULTS The two models had both a good fit and showed a similar pattern of associations with external validators at the two-time points, with minor variations. The five-factor solution had a slightly better fit. The associations with external validators favored the five-factor structure. CONCLUSIONS Our findings suggest that both five-factor and hierarchical models provide a valid conceptualization of NS in relation to external variables and that five-factor solution provides the best balance between parsimony and granularity to summarize the BNSS structure. This finding has important implications for the study of pathophysiological mechanisms and the development of new treatments.
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Affiliation(s)
- Giulia M Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Brando
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Melillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Pezzella
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Dollfus S, Mucci A, Giordano GM, Bitter I, Austin SF, Delouche C, Erfurth A, Fleischhacker WW, Movina L, Glenthøj B, Gütter K, Hofer A, Hubenak J, Kaiser S, Libiger J, Melle I, Nielsen MØ, Papsuev O, Rybakowski JK, Sachs G, Üçok A, Brando F, Wojciak P, Galderisi S. European Validation of the Self-Evaluation of Negative Symptoms (SNS): A Large Multinational and Multicenter Study. Front Psychiatry 2022; 13:826465. [PMID: 35173641 PMCID: PMC8841841 DOI: 10.3389/fpsyt.2022.826465] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/04/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Negative symptoms are usually evaluated with scales based on observer ratings and up to now self-assessments have been overlooked. The aim of this paper was to validate the Self-evaluation of Negative Symptoms (SNS) in a large European sample coming from 12 countries. We wanted to demonstrate: (1) good convergent and divergent validities; (2) relationships between SNS scores and patients' functional outcome; (3) the capacity of the SNS compared to the Brief Negative Symptom Scale (BNSS) to detect negative symptoms; and (4) a five-domain construct in relation to the 5 consensus domains (social withdrawal, anhedonia, alogia, avolition, blunted affect) as the best latent structure of SNS. METHODS Two hundred forty-five subjects with a DSM-IV diagnosis of schizophrenia completed the SNS, the Positive and Negative Syndrome Scale (PANSS), the BNSS, the Calgary Depression Scale for Schizophrenia (CDSS), and the Personal and Social Performance (PSP) scale. Spearman's Rho correlations, confirmatory factor analysis investigating 4 models of the latent structure of SNS and stepwise multiple regression were performed. RESULTS Significant positive correlations were observed between the total score of the SNS and the total scores of the PANSS negative subscale (r = 0.37; P < 0.0001) and the BNSS (r = 0.43; p < 0.0001). SNS scores did not correlate with the level of insight, parkinsonism, or the total score of the PANSS positive subscale. A positive correlation was found between SNS and CDSS (r = 0.35; p < 0.0001). Among the 5 SNS subscores, only avolition subscores entered the regression equation explaining a lower functional outcome. The 1-factor and 2-factor models provided poor fit, while the 5-factor model and the hierarchical model provided the best fit, with a small advantage of the 5-factor model. The frequency of each negative dimension was systematically higher using the BNSS and the SNS vs. the PANSS and was higher for alogia and avolition using SNS vs. BNSS. CONCLUSION In a large European multicentric sample, this study demonstrated that the SNS has: (1) good psychometric properties with good convergent and divergent validities; (2) a five-factor latent structure; (3) an association with patients' functional outcome; and (4) the capacity to identify subjects with negative symptoms that is close to the BNSS and superior to the PANSS negative subscale.
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Affiliation(s)
- Sonia Dollfus
- Service de Psychiatrie, CHU de Caen, Caen, France.,UFR de Médecine, UNICAEN, Normandie Université, Caen, France.,ISTS, UNICAEN, Normandie Université, Caen, France
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giulia M Giordano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Stephen F Austin
- Psychiatric Research Unit, Region Zealand Psychiatry, Slagelse, Denmark
| | - Camille Delouche
- Service de Psychiatrie, CHU de Caen, Caen, France.,UFR de Médecine, UNICAEN, Normandie Université, Caen, France.,ISTS, UNICAEN, Normandie Université, Caen, France
| | - Andreas Erfurth
- 1st Department of Psychiatry and Psychotherapeutic Medicine, Klinik Hietzing, Vienna, Austria
| | - W Wolfgang Fleischhacker
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Larisa Movina
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Gütter
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Jan Hubenak
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Jan Libiger
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Ingrid Melle
- NORMENT Centre, Institute of Clinical Psychiatry, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Mette Ø Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oleg Papsuev
- Department of Psychotic Spectrum Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alp Üçok
- Psychotic Disorders Research Program, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Francesco Brando
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pawel Wojciak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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Russo M, Repisti S, Blazhevska Stoilkovska B, Jerotic S, Ristic I, Mesevic Smajic E, Uka F, Arenliu A, Bajraktarov S, Dzubur Kulenovic A, Injac Stevovic L, Priebe S, Jovanovic N. Corrigendum: Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue. Front Psychiatry 2022; 13:885883. [PMID: 35418890 PMCID: PMC8997331 DOI: 10.3389/fpsyt.2022.885883] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2021.785144.].
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Affiliation(s)
- Manuela Russo
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Selman Repisti
- Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro
| | | | - Stefan Jerotic
- Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Ristic
- Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Eldina Mesevic Smajic
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Fitim Uka
- Department of Psychology, University of Pristina, Pristina, Kosovo by United Nations resolution
| | - Aliriza Arenliu
- Department of Psychology, University of Pristina, Pristina, Kosovo by United Nations resolution
| | - Stojan Bajraktarov
- University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Alma Dzubur Kulenovic
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lidija Injac Stevovic
- Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Russo M, Repisti S, Blazhevska Stoilkovska B, Jerotic S, Ristic I, Mesevic Smajic E, Uka F, Arenliu A, Bajraktarov S, Dzubur Kulenovic A, Injac Stevovic L, Priebe S, Jovanovic N. Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue. Front Psychiatry 2021; 12:785144. [PMID: 34970168 PMCID: PMC8712471 DOI: 10.3389/fpsyt.2021.785144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Negative symptoms are core features of schizophrenia and very challenging to be treated. Identification of their structure is crucial to provide a better treatment. Increasing evidence supports the superiority of a five-factor model (alogia, blunted affect, anhedonia, avolition, and asociality as defined by the NMIH-MATRICS Consensus); however, previous data primarily used the Brief Negative Symptoms Scale (BNSS). This study, including a calibration and a cross-validation sample (n = 268 and 257, respectively) of participants with schizophrenia, used the Clinical Assessment Interview for Negative Symptoms (CAINS) to explore the latent structure of negative symptoms and to test theoretical and data-driven (from this study) models of negative symptoms. Methods: Exploratory factor analysis (EFA) was carried out to investigate the structure of negative symptoms based on the CAINS. Confirmatory factor analysis (CFA) tested in a cross-validation sample four competing theoretical (one-factor, two-factor, five-factor, and hierarchical factor) models and two EFA-derived models. Result: None of the theoretical models was confirmed with the CFA. A CAINS-rated model from EFA consisting of five factors (expression, motivation for recreational activities, social activities, vocational, and close/intimate relationships) was an excellent fit to the data (comparative fix index = 0.97, Tucker-Lewis index = 0.96, and root mean square error of approximation = 0.07). Conclusions: This study cannot support recent data on the superiority of the five-factor model defined by the NMIH-MATRICS consensus and suggests that an alternative model might be a better fit. More research to confirm the structure of negative symptoms in schizophrenia, and careful methodological consideration, should be warranted before a definitive model can put forward and shape diagnosis and treatment of schizophrenia.
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Affiliation(s)
- Manuela Russo
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Selman Repisti
- Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro
| | | | - Stefan Jerotic
- Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Ristic
- Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Eldina Mesevic Smajic
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Fitim Uka
- Department of Psychology, University of Pristina, Pristina, Albania
| | - Aliriza Arenliu
- Department of Psychology, University of Pristina, Pristina, Albania
| | - Stojan Bajraktarov
- University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Alma Dzubur Kulenovic
- Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lidija Injac Stevovic
- Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Kaliuzhna M, Kirschner M, Carruzzo F, Hartmann-Riemer MN, Bischof M, Seifritz E, Tobler PN, Kaiser S. Clinical, behavioural and neural validation of the PANSS amotivation factor. Schizophr Res 2020; 220:38-45. [PMID: 32349887 DOI: 10.1016/j.schres.2020.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/10/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 01/24/2023]
Abstract
Negative symptoms in schizophrenia have been suggested to map onto two distinct factors - amotivation and diminished expression. Only recently, two-factor solutions for measuring negative symptoms have been proposed for the Positive and Negative Symptom Scale (PANSS), the most commonly used scale to assess the psychopathology of patients with schizophrenia. We aimed to validate the PANSS two-factor structure on a clinical, behavioural and neural level. For this multi-level validation, we reanalysed several datasets with patients for whom both the Brief Negative Symptom Assessment Scale (BNSS) and PANSS data were collected. We used a clinical dataset (n = 120) as well as behavioural data from an effort-based decision making task (n = 31) and functional neuroimaging data from a monetary incentive delay task (n = 41). Both tasks have previously been shown to be associated with BNSS amotivation. On the clinical level, the PANSS amotivation and diminished expression were highly correlated with their BNSS counterparts. On the behavioural level, we found that the PANSS amotivation factor but not the diminished expression factor specifically associated with willingness to invest effort to obtain a reward. On the neural level, PANSS amotivation was specifically related to reduced ventral striatal activation during reward anticipation. Our data confirm that the PANSS clearly allows distinguishing amotivation from diminished expression, as it relates selectively to specific aspects of behaviour and brain function. Our results will allow a re-analysis and sharing of existing datasets that used the PANSS to further substantiate the distinction between the two factors in neuroscientific studies and clinical trials.
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Affiliation(s)
- Mariia Kaliuzhna
- Clinical and Experimental Psychopathology Group, Department of Psychiatry, University of Geneva, Switzerland.
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Fabien Carruzzo
- Clinical and Experimental Psychopathology Group, Department of Psychiatry, University of Geneva, Switzerland
| | - Matthias N Hartmann-Riemer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Martin Bischof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Philippe N Tobler
- Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Switzerland
| | - Stefan Kaiser
- Clinical and Experimental Psychopathology Group, Department of Psychiatry, University of Geneva, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
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Tatsumi K, Kirkpatrick B, Strauss GP, Opler M. The brief negative symptom scale in translation: A review of psychometric properties and beyond. Eur Neuropsychopharmacol 2020; 33:36-44. [PMID: 32081498 DOI: 10.1016/j.euroneuro.2020.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/20/2022]
Abstract
Negative symptoms are a core feature of schizophrenia and associated with social and occupational impairment. To encourage treatment development and address the limitations of existing rating instruments in this area across culture, the Brief Negative Symptoms Scale (BNSS) was developed. The authors reviewed studies published since the BNSS was published in 2010 that examined the psychometric properties of the instrument in translation and compared for consistency, psychometric performance and related features. Eleven published cross-cultural validation studies demonstrated the translated versions of the BNSS have strong psychometric properties, similar to the original English version. The internal consistency ranged from 0.88 to 0.98 and the inter-rater reliability ranged from 0.81 to 0.98 for the total score. The BNSS exhibited good convergent validity with existing measures of similar constructs and function, and good discriminant validity relative to other constructs. Recent research also reported that the BNSS is sensitive to drug effects, with effect sizes comparable to established scales. The results of confirmatory factor analyses revealed that the 5-factor structure of negative symptoms in schizophrenia (blunted affect, anhedonia, avolition, asociality, and alogia) crosses cultures. This psychometric evidence suggests that the BNSS is a valid and reliable instrument for assessing pathological mechanism underlying the negative symptoms of schizophrenia across cultures and can be a useful instrument in global clinical trials.
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Seelen-de Lang BL, Boumans CE, Nijman HLI. Validation of the Dutch Version of the Brief Negative Symptom Scale. Neuropsychiatr Dis Treat 2020; 16:2563-2567. [PMID: 33154643 PMCID: PMC7605941 DOI: 10.2147/ndt.s269037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/19/2020] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The Brief Negative Symptom Scale (BNSS) was developed to measure negative symptoms of schizophrenia. However, the Dutch translation of this instrument, called the "Korte Schaal voor Negatieve Symptomen" (KSNS), has not yet been validated. This study investigates the validity and reliability of this Dutch version of the instrument. PATIENTS AND METHODS The Psychotic Symptom Rating Scale (PSYRATS), Calgary Depression Scale for Schizophrenia (CDSS), the Health of the Nation Scale (HoNOS) and the KSNS were used for routine outcome monitoring to measure symptoms in 28 patients with a psychotic disorder who were being treated on a long-stay ward. RESULTS The internal consistency of the KSNS is fair to good. The inter-rater reliability is excellent. The concurrent validity is moderate but acceptable. The correlations between the KSNS and scales for depression and positive symptoms were not significant, which indicate good divergent validity. CONCLUSION Despite the small sample size of the current study, we conclude that the BNSS, called the KSNS in Dutch, appears to be a reliable and valid tool for investigating negative symptoms in detail in patients with psychotic disorders.
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Affiliation(s)
| | | | - Henk L I Nijman
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Mucci A, Vignapiano A, Bitter I, Austin SF, Delouche C, Dollfus S, Erfurth A, Fleischhacker WW, Giordano GM, Gladyshev I, Glenthøj B, Gütter K, Hofer A, Hubeňák J, Kaiser S, Libiger J, Melle I, Nielsen MØ, Papsuev O, Rybakowski JK, Sachs G, Üçok A, Wojciak P, Galderisi S. A large European, multicenter, multinational validation study of the Brief Negative Symptom Scale. Eur Neuropsychopharmacol 2019; 29:947-959. [PMID: 31255394 DOI: 10.1016/j.euroneuro.2019.05.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 02/13/2019] [Revised: 04/11/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022]
Abstract
Negative symptoms represent an unmet need of treatment in schizophrenia. Although a consensus exists on negative symptom construct, and second generation assessment instruments reflecting the consensus are available, studies still rely upon old assessment instruments, that do not reflect recent conceptualizations and might limit progress in the search for effective treatments. This is often the case in the European context, where one of the challenges encountered in designing large studies is the availability of validated instruments in the many languages of the continent. To address this challenge and promote sound research on negative symptoms in Europe, the ECNP Schizophrenia Network coordinated a large multicenter, multinational validation study of the Brief Negative Symptom Scale (BNSS). Clinically-stable subjects with schizophrenia (SCZ, N = 249) were recruited from 10 European Countries. Apart from BNSS, subjects were administered the Positive and Negative Syndrome Scale (PANSS) and standardized instruments for depression, extrapyramidal symptoms and psychosocial functioning. Results showed an excellent internal consistency, convergent and discriminant validity of BNSS and replicated a 5 factor-model. A larger number of subjects with predominant negative symptoms, i.e. the target population for clinical trials, was identified by using the BNSS compared to the PANSS. Regression analysis showed that BNSS-avolition, a key negative symptom poorly assessed by PANSS, explained 23.9% of psychosocial functioning, while no combination of the PANSS core negative symptoms showed the same impact on functioning. The study demonstrated that BNSS has substantial advantages with respect to PANSS for the identification of the avolition domain and subjects with predominant negative symptoms.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy.
| | - Annarita Vignapiano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Hillerød, Denmark
| | - Camille Delouche
- Service de Psychiatrie, CHU de Caen, Caen, France; UFR de Médecine, UNICAEN, Normandie Université, Caen, France; ISTS, UNICAEN, Normandie Université, Caen, France
| | - Sonia Dollfus
- Service de Psychiatrie, CHU de Caen, Caen, France; UFR de Médecine, UNICAEN, Normandie Université, Caen, France; ISTS, UNICAEN, Normandie Université, Caen, France
| | - Andreas Erfurth
- 6th Psychiatric Department, Otto-Wagner-Spital, Vienna, Austria
| | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Giulia M Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Igor Gladyshev
- Department of Socio-clinical and Biological Research of Psychotic spectrum disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Gütter
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Jan Hubeňák
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Jan Libiger
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Ingrid Melle
- NORMENT Centre, Institute of Clinical Psychiatry, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mette Ø Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oleg Papsuev
- Department of Socio-clinical and Biological Research of Psychotic spectrum disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alp Üçok
- Istanbul Faculty of Medicine, Psychotic Disorders Research Program, Istanbul University, Istanbul, Turkey
| | - Pawel Wojciak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
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Treen D, Savulich G, Mezquida G, García-Portilla MP, Toll A, García-Rizo C, García-Álvarez L, Bergé D, Bobes J, Bernardo M, Fernandez-Egea E, Mané A. Influence of secondary sources in the Brief Negative Symptom Scale. Schizophr Res 2019; 204:452-454. [PMID: 30318172 DOI: 10.1016/j.schres.2018.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 09/27/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Devi Treen
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - George Savulich
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom
| | - Gisela Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; University of Barcelona, Spain
| | - Maria Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Spain; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain
| | - Alba Toll
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Clemente García-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Leticia García-Álvarez
- Department of Psychiatry, University of Oviedo, Spain; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain
| | - Daniel Bergé
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Spain; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain
| | - Anna Mané
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
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10
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Garcia-Portilla MP, Garcia-Alvarez L, Mané A, Garcia-Rizo C, Sugranyes G, Bergé D, Bernardo M, Fernández-Egea E, Bobes J. The negative syndrome of schizophrenia: three -underlying components are better than two. Schizophr Res 2015; 166:115-8. [PMID: 26044112 DOI: 10.1016/j.schres.2015.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 10/17/2014] [Revised: 04/24/2015] [Accepted: 05/04/2015] [Indexed: 11/19/2022]
Abstract
AIMS To analyse the underlying structure of the negative syndrome of schizophrenia as it is represented in the Brief Negative Symptom Scale. METHODS Cross-sectional, multicentre study, employing data from 190 evaluations. STATISTICS Exploratory factor analysis using the principal component analysis method. RESULTS The three-component solution explained 77.4% of the total variance. Pearson correlation coefficients between components were: 1-2=-0.494, 1-3=-0.117, and 2-3=0.179. CONCLUSION Our solution favours a three-component structure of the negative syndrome, consisting of: external world (anhedonia and asociality), inner world (avolition and blunted affect), and alogia, with the latter only marginally related to the two former components.
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Affiliation(s)
- Maria Paz Garcia-Portilla
- Department of Psychiatry, University of Oviedo, Spain; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain.
| | | | - Anna Mané
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació IMIM, Barcelona, Spain
| | - Clemente Garcia-Rizo
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain
| | - Gisela Sugranyes
- Child and Adolescent Psychiatric Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Daniel Bergé
- Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació IMIM, Barcelona, Spain
| | - Miguel Bernardo
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Emilio Fernández-Egea
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Spain; Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Spain
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11
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Abstract
Depression and negative symptoms can be difficult to distinguish in schizophrenia. Assessments for negative symptoms usually account for the longitudinal nature of these symptoms, whereas instruments available to measure depression mainly assess current or recent symptoms. This construct difference may confound comparison of depressive and negative symptoms in schizophrenia because both domains may have trait-like aspects. We developed an instrument to measure both longitudinal "trait" as well as recent "state" symptoms of depression and tested this instrument (Maryland Trait and State Depression [MTSD] scale) in a sample of 98 individuals with schizophrenia or schizoaffective disorder and 115 community participants without psychotic illness. Exploratory factor analysis of the MTSD revealed 2 factors accounting for 73.4% of the variance; these 2 factors corresponded with "trait" and "state" depression inventory items. Neither MTSD-state nor MTSD-trait was correlated with negative symptoms as measured with the Brief Negative Symptom Scale (r = .07 and -.06, respectively) in schizophrenia patients. MTSD state and trait scores were significantly correlated with the Brief Psychiatric Rating Scale depression subscale (r = .58 and .53, respectively) as well as the Profile of Mood States depression subscale (r = .57 and .44). Persons with schizophrenia had significantly greater trait depressive symptoms than controls (P = .031). Individuals with schizoaffective disorder had significantly higher trait depression (P = .001), but not state depression (P = .146), compared with schizophrenia patients. Trait depressive symptoms are prominent in schizophrenia and are distinct from negative symptoms.
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Affiliation(s)
- Joshua Chiappelli
- *To whom correspondence should be addressed; Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228; tel: 410 402 6827, fax: 410 402 6023, e-mail:
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