Schizophrenia Experience Research Articles

Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies.

People with severe mental illness such as schizophrenia experience high physical comorbidity, leading to a 15-20-year mortality gap compared with the general population. Lifestyle behaviours such as physical activity (PA) play important roles in the quest to bridge this gap. Interventions to increase PA engagement in this population have potential to be efficacious; however, their effectiveness can be hindered by low participant engagement, including low adherence and high drop-out, and by implementation of interventions that are not designed to compensate for the cognitive and motivational impairments characteristic for this group. Moreover, and importantly, the negative symptoms of schizophrenia are associated with neurobiological changes in the brain, which-based on principles of biopsychology-can contribute to poor motivation and impaired decision-making processes and behavioural maintenance. To increase PA levels in people with schizophrenia, better understanding of these neurological changes that impact PA engagement is needed. This has the potential to inform the design of interventions that, through enhancement of motivation, could effectively increase PA levels in this specific population. Incorporating strategies that address the dopamine dysregulation associated with schizophrenia, such as boosting the role of reward and self-determined motivation, may improve long-term PA maintenance, leading to habitual PA. Consideration of motivation and behavioural maintenance is also needed to impart health benefits such as prevention of chronic disease, which is associated with currently low PA levels in this high metabolic risk population. Taking a biopsychological perspective, we outline the neural pathways involved in motivation that are impacted by schizophrenia and propose strategies for promoting motivation for and PA engagement from adoption to habit formation.

The impact of neurotypical cognition on communication deficits attributed to pathologized people: schizophrenia as a case study

AbstractSocial communication deficits have been robustly documented in schizophrenia spectrum disorders. Historically, attempts to lessen this dysfunction have focused almost exclusively on modifying the person with schizophrenia’s own behaviors and cognition. However, social communication is inherently dyadic, and this approach leaves unaddressed the role of the neurotypical interlocutor in communication breakdown. In this position piece, we review psycholinguistic theories and research in order to propose a more comprehensive and equitable understanding of the social dysfunction that people with schizophrenia experience. We do so by drawing attention to the manner in which neurotypical individuals may drive communication failure in schizophrenia. Stigma is proposed to be a major component of this phenomenon. In addition to an overview of our theoretical framework, we provide a research agenda to test the hypotheses this framework has produced. We hope this piece can inform future research directions within psycholinguistics.

Cognition, Symptomatology, and Community Living Skills in Schizophrenia

Background: Independence in community living is an important aspect of rehabilitation in schizophrenia. Previous studies investigating relationships of coginitive, symptomatic, and demographic factors in community living ability of schizophrenia showed inconsistent findings. These findings may be due to variations in functional measures used or a heterogenous sample of participants recruited. Aim: To investigate the relationships of cognitive, symptomatic and demographic factors with community living skills for people with schizophrenia living in supported living facilities. Method: This is a cross-sectional study. Thirty-seven adults with schizophrenia and 32 matched healthy controls were recruited. Both groups completed the Verbal Fluency Test, subtests of Cognistat, and the Color Trail Test. Additional assessments (i.e., Chinese version of St. Louis Inventory of Community Living Skills – SLICLS-C and Positive and Negative Syndrome Scale – PANSS) were used to evaluate participants with schizophrenia. Cognitive profile was compared between the two groups. Correlation analysis was used to explore the relationships of cognitive abilities, symptomatology, and demographic factors with community living skills in schizophrenia. Results: Results showed that participants with schizophrenia performed worse than the control group in verbal fluency, visual memory, immediate memory, delayed memory, and executive function tests. Significant moderate correlations between SLICLS-C score and participants’ years of education, positive symptoms, general psychopathology, and PANSS total score were identified. Discussions and conclusion: Results indicated cognitive impairments are persistent in schizophrenia who are in remission and have been partially integrated back into the community. Cognitive deficits that people with schizophrenia experience might be stable over most of the course of the illness. Participants’ years of education, positive symptoms, general psychopathology, and PANSS total score might be important moderating variables to include in future investigations related to predicting community living performance in schizophrenia.

From scary places to therapeutic landscapes: Voices from the community of people living with schizophrenia.

This article discusses how people living with schizophrenia experience, understand, and respond to their urban environment. Our study relies on experiential photo-voice data gathered with a sample of six people diagnosed with schizophrenia and living in non-institutional settings in Montréal, Canada, to identify how individuals in this community perceive the urban landscape. We adopt a therapeutic landscapes' framework that explores the urban fabric at three levels: physical, social, and symbolic. Research participants identified both health-denying and health-enhancing places within ordinary urban landscapes. Landscapes identified as health-denying are characterized by environmental stressors and loss of control, with construction sites an example highlighted by participants. Healing and restorative landscapes, as identified by participants, were physically attractive or quiet, socially safe and welcoming, and symbolically affirmative of one's identity, all factors worthy of further study. The findings are also policy-relevant: they suggest that people living with schizophrenia and their clinicians can develop strategies to make health-enhancing uses of urban landscapes; and that urban policies and practices can foster urban environments conducive to enhanced health and well-being, both for the community of people living with schizophrenia and the wider population of urban dwellers.

STUDY OF LIFE EVENTS AND PREMORBID FUNCTION IN RECENT ONSET SCHIZOPHRENIA

Background and Objectives: Stressful life events preceded onset of psychosis like schizophrenia. Factors which help to identify disease at an earlier stage enable to seek early medical care. This study aims to compare occurrence of life events in subjects presenting 1st time with schizophrenia in the preceding year and to assess premorbid function of individuals. Methods: This was a case–control study with subjects attending psychiatry outpatient department for the 1st time with schizophrenia and controls from general population. After obtaining informed consent, sociodemographic data were collected along with premorbid functioning using premorbid adjustment scale (PAS), presumptive stressful life events scale (PSLES), positive and negative syndrome scale, premorbid schizoid and schizotypal assessment scale, and global assessment functioning scale (GAF). Data analysis was done using SPSS 22 software. p<0.05 was considered significant. Results: Sixty cases and 60 controls were compared. Mean age was 30.45±9.21 years, 55% were male, 56.66% were married, 68.33% were from rural background, and 81.66% were from low socioeconomic status. Mean number of stressful life events in the preceding year, PSLES score, PAS scale, Premorbid schizoid and schizotypal traits scale, and GAF scale were all significantly higher in cases. Married men showed higher stress and life events score. Conclusion: Subjects with schizophrenia experience severe stress before onset of illness and showed more premorbid social dysfunction. Married subjects experience severe stress than others. Duration of untreated illness was less in urban subjects and those with positive family history but had no correlation with severity.

Związki diadyczne osób chorujących na schizofrenię

Creating successful partnerships is important for the overall quality of life. People suffering from schizophrenia experience significant difficulties in entering and maintaining dyadic relationships due to psychotic symptoms, consequences of the disease and its treatment or social stigmatization. Difficulties in creating intimate relationships are noticed already during adolescence, constituting one of the elements of prepsychotic changes. Among people diagnosed with schizophrenia, women more often than men create dyadic relationships, which may be due to the later onset of the disease, better indicators of social functioning, and favorable socio-cultural patterns. Among coupled individuals, the quality of their relationships is important for the course of the disease and treatment. People with schizophrenia often prefer to bond with other patients because of the possibility of creating a balanced relationship providing acceptance and support. Healthy partners of people with schizophrenia, due to the burden arising from the specificity of the disease and commitment to care for a sick partner, also need professional support. Issues regarding dyadic relationships should be included in a holistic therapeutic approach to people diagnosed with schizophrenia.

Patients' and healthcare professionals' perspectives on a community-based intervention for schizophrenia in Pakistan: A focus group study.

ObjectiveTo explore the perceptions and experiences of schizophrenia from patients, their care givers, health care providers, spiritual and traditional healers to develop a community-based intervention for improving treatment adherence for people with schizophrenia in Pakistan.MethodsThis qualitative study involved four focus group discussions (FGD) with a total of 26 participants: patients and carers (n = 5), primary care staff (n = 7), medical technicians (n = 8) and traditional and spiritual healers (n = 6). The participants were selected using purposive sampling method. FGDs were audio-recorded and transcribed. A thematic analysis was applied to the data set.ResultsThe themes identified were (i) Schizophrenia is not merely a biomedical problem: participants believed that poverty and an inferiority complex resulting from social disparity caused schizophrenia and contributed to non-adherence to medications; (ii) Spiritual healing goes hand in hand with the medical treatment: participants regarded spiritual and traditional treatment methods as an inherent part of schizophrenia patients’ well-being and rehabilitation; (iii) Services for mental illness: mental health is not covered under primary health in a basic health unit: participants believed that the lack of services, training and necessary medication in primary care are major issues for treating schizophrenia in community; (iv) Barriers to community-based interventions: primary care staff believed that multiple pressures on staff, lack of incentives, non-availability of medication and lack of formal referral pathways resulted in disintegration of dealing with schizophrenia patients in primary care facilities.ConclusionThe study has identified a number of barriers and facilitators to developing and delivering a psychosocial intervention to support people living with schizophrenia in Pakistan. In particular, the importance of involving spiritual and traditional healers was highlighted by our diverse group of stakeholders.

Quantitative electroencephalography parameters as neurophysiological biomarkers of schizophrenia-related deficits: A Phase II substudy of patients treated with iclepertin (BI 425809)

Patients with schizophrenia experience cognitive impairment related to neural network dysfunction and deficits in sensory processing. These deficits are thought to be caused by N-methyl-D-aspartate receptor hypofunction and can be assessed in patient populations using electroencephalography (EEG). This substudy from a Phase II, randomized, double-blind, placebo-controlled, parallel-group study investigating the safety and efficacy of the novel glycine transporter-1 inhibitor, iclepertin (BI 425809), assessed the potential of EEG parameters as clinically relevant biomarkers of schizophrenia and response to iclepertin treatment. Eligible patients were randomized to once-daily add-on iclepertin (2, 5, 10, or 25 mg), or placebo (1:1:1:1:2 ratio) for 12 weeks. EEG data were recorded from a subgroup of patients (n = 79) at baseline and end of treatment (EoT). EEG parameters of interest were mismatch negativity (MMN), auditory steady-state response (ASSR), and resting state gamma power, and their correlations with clinical assessments. At baseline, MMN and ASSR exhibited consistent correlations with clinical assessments, indicating their potential value as neurophysiological biomarkers of schizophrenia-related deficits. ASSR measures were positively correlated to the MATRICS Consensus Cognitive Battery overall and neurocognitive composite scores; MMN amplitude was positively correlated with Positive and Negative Syndrome Scale scores. However, correlations between change from baseline (CfB) at EoT in clinical assessments, and baseline or CfB at EoT for EEG parameters were modest and inconsistent between dose groups, which might indicate low potential of these EEG parameters as predictive and treatment response biomarkers. Further methodological refinement is needed to establish EEG parameters as useful drug development tools for schizophrenia.

Clinical and psychosocial outcomes of Black Americans in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study.

In the US, Black people diagnosed with schizophrenia experience worse psychosocial and clinical outcomes than their White counterparts. While racism-related factors contribute to these disparities, an additional understudied explanation may be that psychosocial treatments for psychotic disorders are less effective for Black than White individuals. The purpose of this study is to examine the extent to which best treatment practices for first-episode psychosis (FEP) are effective for Black and White participants. We conducted a secondary data analysis of the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP), a two-year multisite trial that compared a coordinated specialty care intervention for FEP (NAVIGATE) to community care as usual (CC) in 34 sites across the US. Specifically, we compared interviewer-rated quality of life and symptoms, as well as self-reported mental health and stigma, between 139 Non-Latinx Black and 172 Non-Latinx White participants with FEP in NAVIGATE and CC. We found few differences between Black and White participants over two-year outcomes, either overall or in terms of benefit from NAVIGATE. Across both treatment conditions, Black participants improved less than White participants on positive symptoms, an effect driven primarily by suspiciousness/persecution. In NAVIGATE, self-reported mental health stigma decreased for both Black and White participants, while in CC stigma decreased for White participants but increased for Black participants. This effect was driven primarily by experienced stigma rather than self-stigma. NAVIGATE benefits both Black and White individuals diagnosed with FEP. Mental health stigma and positive symptoms may be particularly important aspects of treatment for Black individuals diagnosed with FEP.

Uncertainty in illness among individuals with schizophrenia: a phenomenology study in Indonesia

PurposeIndividuals with schizophrenia experience uncertainty due to the unpredictable symptoms, the course of the illness and poor knowledge about the disease, treatment and prognosis. Uncertainty in illness is linked with poor treatment outcomes, coping strategies, check-up decisions and psychological distress. This study aims to explore the uncertainty in illness among individuals with schizophrenia.Design/methodology/approachEight individuals with schizophrenia living in the community were interviewed regarding their illness. The phenomenology approach was used to collect and analyze the data.FindingsThree themes emerged from the findings of the study; the unpredictable course of the illness, compliance amid uncertainty and uncertainty of information about their illness. This study provides an essential overview of how patients with schizophrenia live in uncertain conditions.Originality/valueIt should be considered by various parties, particularly the community mental health nurses working with individuals with schizophrenia. Considering the uncertainty of illness while looking after or interacting with patients and their family is significant in improving adequate mental health-care delivery.

The concept of psychotic arousal and its relevance to abnormal subjective experiences in schizophrenia. A hypothesis for the formation of primary delusions

The presence of abnormal subjective experiences in the prodromal stages of schizophrenia as well as their contribution to delusional formation have been highlighted in psychiatric literature, but their nature and their involvement in the transition and establishment of full-blown psychosis remains elusive. In this paper, we venture to form a coherent hypothesis for the formation of primary delusions by attributing importance to the emotional and affective symptoms experienced by patients during the acute state of psychosis. We underline the presence of abnormal subjective experiences described as ‘feelings’ in patients’ narratives, their co-occurrence with discernible emotional manifestations and symptoms, and their rather simultaneous retreat from the clinical picture shortly after the effective administration of antipsychotic treatment. We further distinguish them from their enveloping thought content, on the base of their different course pattern and natural characteristics. We argue that this composite emotional picture – which we call “psychotic arousal” – though resembling the acknowledged “delusional mood”, traverses the acute state of psychosis to a greater extent and intensity, as long as we observe delusions flourishing and expanding. We specifically suggest that altered subjective experiences can be seen as emotional in nature and best described as “experiential feelings”. Consequently, we reflect upon neuroscientific theories and models supporting a layered concept for the formation of consciousness that attribute a paramount role on emotions as a representation of neural maps of the material body’s state. We explore patients’ “experiential feelings” as the morbid outcome of an otherwise normal process and we provide a theoretical solution for the psychotic transition and the formation of primary delusions. Our hypothesis, eventually, responds to long-standing questions regarding the content of the delusions, their abrupt appearance, their self-referential character, their selectivity and specificity, as well as their impact on awareness and the erroneous deployment of extended consciousness. We suggest that further enquiry of the proposed hypothesis could elucidate more deeply the phenomenology of schizophrenia and benefit both psychopathology and neuroscience of self.

Psychopharmacological treatment patterns prior to a schizophrenia diagnosis: A Danish nationwide study

BackgroundMany patients with schizophrenia experience psychiatric symptoms long before being diagnosed. We investigated patterns of pre-diagnostic psychopharmacological treatment in individuals diagnosed with first-episode schizophrenia during the last two decades. DesignUsing Danish nationwide healthcare registers, we identified all individuals aged ≥10 years registered with their first ICD-10 schizophrenia diagnosis between January 1999 and March 2019. For each calendar year from 1999 to 2019, we calculated the proportion of patients – among those having received their first schizophrenia diagnosis in the respective calendar year – who redeemed prescriptions for various psychotropics in the two years preceding the schizophrenia diagnosis. We calculated proportions of all pre-diagnostic prescriptions since 1995 for a sub-population diagnosed 2011–2019 and for an age- and sex-matched reference group without schizophrenia. ResultsAmong 33,361 individuals with schizophrenia (58 % males), the schizophrenia incidence rate was stable during the study period but the mean age at diagnosis decreased by >10 years. In the two pre-diagnostic years, 69 % received psychopharmacological treatment (52 % antipsychotics, 40 % antidepressants). This was stable between 1999 and 2019. Among 14,425 individuals diagnosed 2011–2019, psychotropic drug use was observed among 14–20 % between 24 and 10 years before the diagnosis, being four times higher than the reference group. Particularly antipsychotic and antidepressant drug use increased steadily during the ten pre-diagnostic years. ConclusionsPre-diagnostic psychotropic drug use in schizophrenia was frequent but stable between 1999 and 2019 despite an earlier identification of schizophrenia patients. Our findings emphasize the continued importance of thorough diagnostic interviews, particularly among patients in need of antipsychotic treatment.

Electroconvulsive therapy in treatment resistant schizophrenia: Old beacon of hope when nothing else works

IntroductionElectroconvulsive therapy (ECT) is one of the oldest psychiatric treatments used to this day. It is particularly useful in cases of schizophrenia resistant to treatment with antipsychotics. 49% of patients with schizophrenia experience little or no response with one trial of antipsychotics, 71% do not achieve remission and up to 20% of patients are also resistant to clozapine.ObjectivesDescription of a clinical case where ECT is used in the treatment of resistant schizophrenia and review of the literature.MethodsDescription of a clinical case. Non systematic review of the literature, searching the terms “treatment resistant”; “schizophrenia”; “ect” in the databases Pubmed, Medline, Cochrane and Uptodate.ResultsMale, 38-year-old patient, diagnosed with schizophrenia for 20 years, with history of multiple hospitalizations, institutionalized for 9 years. Treated with risperidone 50 mg intramuscular fortnightly, clozapine 750 mg daily, aripiprazol 30 mg daily and diazepam 10 mg daily. He presented with increased delusional intensity for a year. Hospitalized for treatment with ECT, submitted to 12 sessions with bitemporal stimuli, with effective convulsions. MoCA, PANSS and BPRS were applied before and after treatment, with an increase of 25% in MoCA and a decrease of 47.3% and 57.9% respectively, in the psychotic symptoms scales.ConclusionsWe present a case of schizophrenia resistant to treatment with multiple antipsychotics, including clozapine. ECT was used, with clinically demonstrated efficacy. In the future, it might be interesting to study in detail the mechanism of action of this treatment with the goal of deepening the knowledge of the neurobiology of schizophrenia.DisclosureNo significant relationships.

Lived Experiences of Persons with Chronic Schizophrenia Living in the Community.

Each individual with schizophrenia experiences life uniquely, despite the sameness in their diagnosis. Understanding their experiences is vital for their better community integration and social work practice. We used the interpretative phenomenological approach. Persons with schizophrenia seeking outpatient services at a tertiary care institute in Bengaluru, India, were recruited through purposive sampling. In-depth interviews were conducted with six participants. Some of the meta-themes and subthemes identified were as follows: (a) perception about self (struggling with the sense of self, desire for normalcy, wanting to be in control of self and desire to live independently), (b) relationship with others (feeling supported by others and feeling rejected by others), (c) coping with consequences of illness (coping with disruptions in personal life and coping with disruptions in family life), and (d) experience of seeking treatment (reasons for seeking treatment, being on medication, and behavior of mental health professionals). The participants tried to find meaning in their lives by making sense of their illness. Family and community can have a significant impact on how persons with schizophrenia perceive their lives. Mental health professionals need to encourage persons' and their families' greater participation in treatment planning and clinical interventions, which will enhance persons integration within the community and will help decrease the feeling of isolation commonly experienced when one lives with chronic mental illnesses.

‘Gypsum on water. That schizophrenia.’ schizophrenia – a meeting of stories: a qualitative study

The purpose of the study was to enrich our understanding of how personal and master narratives ‘met’ in stories of individuals who experienced schizophrenia. Qualitative, in-depth and semi-structured interviews conducted in Poland with people diagnosed with paranoid schizophrenia were processed using the thematic analysis method. Interview analysis yielded three ways in which the master and the personal narratives of schizophrenia met: reception of master narrative content, its negotiation within personal narratives, and application, i.e. using phrases from the master narrative to fill in or supplement descriptions of own experience. We emphasize the importance of self-awareness in using master narrative in encounters with individuals diagnosed with mental illness and its associated consequences. We point out the need to support the construction of personal narratives and, as postulated by phenomenological psychiatry, we stress the need to recognize subjective stories of the experience of schizophrenia as a special mode of human existence. Points of Interest This article looks in detail into stories created by people with a diagnosis of schizophrenia about their experiences and into the way they construct their narratives. Participants of this study recall in their stories statements of medical specialists and people from social environment talking about schizophrenia. Terms and phrases about schizophrenia cause versatile reactions among people with this diagnosis. Sometimes participants accept them, often they disagree with them, other times, however, they ascribe new meanings to them. It is important to be attentive in our use of language when speaking about schizophrenia and when talking to people with this diagnosis. The accounts of the participants in our study are another voice in the debate on the idea of abandoning the label of ‘schizophrenia’.

How do social factors relate to blunted facial affect in schizophrenia? A digital phenotyping study using ambulatory video recordings

Clinical interviews and laboratory-based emotional induction paradigms provide consistent evidence that facial affect is blunted in many individuals with schizophrenia. Although it is clear that blunted facial affect is not a by-product of diminished emotional experience in schizophrenia, factors contributing to blunted affect remain unclear. The current study used a combination of ambulatory video recordings that were evaluated via computerized facial affect analysis and concurrently completed ecological momentary assessment surveys to assess whether blunted affect reflects insufficient reactivity to affective or contextual factors. Specifically, whether individuals with schizophrenia require more intense affective experiences to produce expression, or whether they are less reactive to social factors (i.e. being in the presence of others, social motivation). Participants included outpatients with schizophrenia (n = 33) and healthy controls (n = 31) who completed six days of study procedures. Multilevel linear models were evaluated using both Null-Hypothesis Statistical Testing and Bayesian analyses. Individuals with schizophrenia displayed comparable expression of positive and negative emotion to controls during daily life, and no evidence was found for a different intensity of experience required for expression in either group. However, social factors differentially influenced facial expression in schizophrenia compared to controls, such that individuals with schizophrenia did not modulate their expressions based on social motivation to the same extent as controls. These findings suggest that social motivation may play an important role in determining when blunting occurs.

Patient-reported impact of symptoms in schizophrenia scale (PRISS): Development and validation.

We report the psychometric properties of the Patient-Reported Impact of Symptoms in Schizophrenia Scale (PRISS), which assesses the impact of subjective experiences or qualia in outpatients with this condition. A cross-sectional study was carried out in 162 patients diagnosed with schizophrenia in Spain. The PRISS measures the presence, frequency, concern and interference with daily life of self-reported experiences related to the main symptoms observed in these patients. The psychometric analysis included test-retest reliability, internal consistency and structural and convergent validity. The 28-item PRISS showed good test-retest reliability as 64.3% of the intraclass correlation coefficient values were between 0.40 and 0.79, which were statistically significant (p<0.01). Analysis of the structural validity revealed a three-factor structure, (1) productive subjective experiences, (2) affective-negative subjective experiences and (3) excitation, which accounted for 56.11% of the variance. Of the Pearson's correlation coefficients analysed between the PRISS and the Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Negative Symptoms (SANS) and World Health Organization Disability Assessment Schedule (WHO-DAS), 72.2% were statistically significant (p<0.05) and ranged from 0.38-0.42, 0.32-0.42 and 0.40-0.42, respectively. Our results indicate that the PRISS appears to be a brief, reliable and valid scale to measure subjective experiences in schizophrenia and provides valuable information complementary to clinical evaluation.

Isolated by Oneself: Ontologically Impossible Experiences in Schizophrenia

Isolated by Oneself: Ontologically Impossible Experiences in Schizophrenia

Episodic memory impairment in children and adolescents at risk for schizophrenia: A role for context processing

People with schizophrenia experience episodic memory impairments that have been theorized to reflect deficits in processing context (e.g., spatio-temporal features tied to a specific event). Although past research has reported episodic memory impairments in young people at-risk for schizophrenia, the extent to which these impairments reflect context processing deficits remains unknown. We addressed this gap in the literature by examining whether children and adolescents at risk for schizophrenia exhibit context processing deficits during free recall, a memory task with high contextual demands. Our sample included three groups (N = 58, 9–16 years old) varying in risk for schizophrenia:16 high-risk, unaffected first-degree relatives of patients with schizophrenia, bipolar disorder, and/or schizoaffective disorder, 22 clinical control participants with a comorbid disorder (ADHD and/or an anxiety disorder), and 20 healthy control participants. Participants first completed a free recall task and then completed a recognition memory task. Based on established theories of episodic memory, we assumed that context processing played a more pivotal role in free recall than recognition memory. Consequently, if schizophrenia risk is associated with context processing deficits, then memory impairment should be present in free recall measures that are most sensitive to context processing (i.e., recall accuracy and temporal contiguity). Consistent with this prediction, free recall accuracy and temporal contiguity were lower for the high-risk group than the healthy controls, whereas recognition memory was comparable across groups. These findings suggest that episodic memory impairments associated with schizophrenia in unaffected, first-degree relatives may reflect context processing deficits.

Negative and depressive symptoms differentially relate to real-world anticipatory and consummatory pleasure in schizophrenia

It has been suggested that schizophrenia is associated with deficits in anticipatory but not consummatory pleasure, though there is mixed support for this hypothesis. As individuals with schizophrenia can experience both negative and depressive symptoms, symptom heterogeneity in this population could contribute to these mixed hedonic findings. Specifically, while some research suggests that negative symptoms of schizophrenia are related to reduced anticipatory but not consummatory pleasure, research on major depressive disorder suggests that depressive symptoms are associated with both decreased anticipatory and consummatory pleasure. Still, it is unclear whether depressive symptoms are associated with experiences of pleasure in schizophrenia as they are in major depressive disorder. Thus, the present study used Ecological Momentary Assessment (four prompts per day over one week) to investigate the unique relationships of negative and depressive symptoms with daily reports of real-world anticipatory and consummatory pleasure in 63 individuals with schizophrenia. Higher negative symptoms related to reduced anticipatory but not consummatory pleasure. On the other hand, higher depressive symptoms related to reductions in both anticipatory and consummatory pleasure. Overall, these results indicate that negative and depressive symptoms are differentially associated with hedonic experience in schizophrenia, and suggest the need to account for the severity of both these symptom types when examining pleasure in this population. Elucidating the nature of these symptom contributions to hedonic impairments could increase causal understanding of these deficits and contribute to the development of more targeted treatments to enhance motivation and pleasure in schizophrenia.