Higher Levels Of Negative Symptoms Research Articles

Negative Symptoms and Avoidance of Social Interaction: A Study of Non-Verbal Behaviour

Background: Non-verbal behaviour is fundamental to social interaction. Patients with schizophrenia display an expressivity deficit of non-verbal behaviour, exhibiting behaviour that differs from both healthy subjects and patients with different psychiatric diagnoses. The present study aimed to explore the association between non-verbal behaviour and symptom domains, overcoming methodological shortcomings of previous studies. Sampling and Methods: Standardised interviews with 63 outpatients diagnosed with schizophrenia were videotaped. Symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS), the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale. Independent raters later analysed the videos for non-verbal behaviour, using a modified version of the Ethological Coding System for Interviews (ECSI). Results: Patients with a higher level of negative symptoms displayed significantly fewer prosocial (e.g., nodding and smiling), gesture, and displacement behaviours (e.g., fumbling), but significantly more flight behaviours (e.g., looking away, freezing). No gender differences were found, and these associations held true when adjusted for antipsychotic medication dosage. Conclusions: Negative symptoms are associated with both a lower level of actively engaging non-verbal behaviour and an increased active avoidance of social contact. Future research should aim to identify the mechanisms behind flight behaviour, with implications for the development of treatments to improve social functioning.

Coping strategies in individuals at ultra-high risk of psychosis: A systematic review.

The impact of dysfunctional coping strategies during the prodromal phase of psychosis has recently been explored by several studies. What has yet to be clarified is whether maladaptive coping is evident in the prodromal phase and the impact that this might have on symptomatic and functional outcomes. The aim of this study was to review the findings on coping in individuals at ultra-high risk of psychosis (UHR) in relation to symptoms and level of functioning. Original articles were identified by searching 7 databases using the terms "prodrom*," "ultra high risk," "clinical high risk," "at-risk mental state," "coping style*," "coping strategies," "cope," "coping" and "psychosis". We included original articles that: (1) reported a measure of coping and (2) evaluated UHR individuals. A total of 9 original articles of 335 that examined coping in individuals at high risk of psychosis were included. UHR subjects were more likely to use maladaptive coping strategies than healthy controls and were more likely to use emotion-focussed than task-oriented coping. Maladaptive coping was associated with higher levels of negative symptoms, whereas positive coping was associated with fewer negative symptoms. The coping style employed by UHR individuals was found to negatively influence their psychosocial functioning. It is still unclear whether coping heightens or reduces the likelihood of transition to psychosis in relation to other factors, including environment. Longitudinal studies could clarify whether coping styles remain stable after the onset of psychosis or whether the emerging psychotic symptoms influence the coping strategies.

Allocating effort and anticipating pleasure in schizophrenia: Relationship with real world functioning

BackgroundPoor motivation to engage in goal-oriented behavior has been recognized as a hallmark feature of schizophrenia spectrum disorders (SZ). Low drive in SZ may be related to anticipating rewards as well as to poor working memory. However, few studies to date have examined beliefs about self-efficacy and satisfaction for future rewards (anticipatory pleasure). Additionally, few studies to date have examined how these deficits may impact SZ patients’ real world functioning. MethodThe present study examined SZ patients’ (n=57) anticipatory pleasure, working memory, self-efficacy and real world functioning in relation to their negative symptom severity. ResultsResults revealed that SZ patients’ negative symptom severity was related to decisions in effort allocation and reward probability, working memory deficits, self-efficacy and anticipatory pleasure for future reward. Effort allocation deficits also predicted patients’ daily functioning skills. ConclusionsSZ patients with high levels of negative symptoms are not merely effort averse, but have more difficulty effectively allocating effort and anticipating pleasure engaging in effortful activities. It may be the case that continuously failing to achieve reinforcement from engagement and participation may lead SZ patients to form certain negative beliefs about their abilities which contributes to amotivation and cognitive deficits. Lastly, our findings provide further support for a link between SZ patients functional daily living skills their effort allocation.

Negative psychotic symptoms in 22q11.2 deletion and their association with neuropsychological profile

22q11.2 deletion syndrome (22q11.2 DS) is associated with a markedly elevated risk for schizophrenia spectrum disorders. The role of negative symptoms in the pathogenesis of schizophrenia in this population and their link to role, social and cognitive functioning is still unclear. Aims of this study were investigate the association between negative symptoms, social and role functioning and neurocognitive performance in the sample of individuals with 22q11.2DS and compare them to healthy controls. The study was conducted on a sample of 60 individuals with 22q11.2DS (mean age = 14.8; SD = 4.8) and 56 healthy control (HC) participants (mean age = 13.8; SD = 5.4). Individuals with 22q11DS and high level of negative symptoms showed significantly higher level of impairment in several neurocognitive domain (i.e. visuospatial abilities, verbal response inhibition) compared with individuals with 22q11DS and low level of negative symptoms and healthy controls. They showed also lower global functioning, specifically role functioning and not social functioning. Negative symptoms are frequent in 22q11.2DS and are associated with specific cognitive deficit and low role functioning. These results suggest that negative symptoms should be considered an important target in the assessment of risk of conversion to full-blown psychosis and in planning of psychological interventions for this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The effect of positive symptoms on social cognition in first-episode schizophrenia is modified by the presence of negative symptoms.

There is considerable evidence that patients with schizophrenia have neurocognitive and social-cognitive deficits. It is unclear how such deficits in first-episode schizophrenia relate to current clinical symptoms. Fifty-nine patients with first-episode schizophrenia (FES) were tested using the Danish version of NART (premorbid IQ), subtests from WAIS-III (current IQ), and global cognition using Brief Assessment of Cognition in Schizophrena (BACS), a neurocognitive test battery. Social perception was tested using film clips of everyday interactions (TASIT). Theory of mind (ToM) was tested using silent animations (Animated Triangles Task). The FES subjects had been experiencing psychotic symptoms for several years (mean duration 9.5 years 95% confidence interval (CI [7.6;11.3]). The FES patients were divided into clinical subgroups based on their level of positive and negative symptoms (using SANS and SAPS). Healthy controls were matched to the patients. High levels of negative symptoms were associated with low estimated functional IQ and poor neurocognition and social cognition. All SANS subscales, but Avolition-Apathy, had significant negative impact on social cognition. The effects of positive symptoms were complex. High levels of delusions were associated with higher premorbid IQ. In the presence of high levels of negative symptoms, high levels of positive symptoms were associated with the most comprehensive deficits in social perception, while, in the absence of negative symptoms, high levels of positive symptoms were not associated with such deficits. The results suggest that social-cognitive training will need to take account of the above mentioned effects of symptoms. (PsycINFO Database Record

The course of negative symptom in first episode psychosis and the relationship with social recovery

AimsTo investigate trajectories of negative symptoms during the first 12months of treatment for first episode psychosis (FEP), their predictors and relationship to social recovery. Method1006 participants were followed up for 12months following acceptance into Early Intervention in Psychosis services. Negative symptom trajectories were modelled using latent class growth analysis (LCGA) and predictors of trajectories examined using multinomial regression. Social recovery trajectories – also modelled using LCGA – of members of each negative symptom trajectory were ascertained and the relationship between negative symptom and social recovery trajectories examined. ResultsFour negative symptom trajectories were identified: Minimal Decreasing (63.9%), Mild Stable (13.5%), High Decreasing (17.1%) and High Stable (5.4%). Male gender and family history of non-affective psychosis predicted stably high negative symptoms. Poor premorbid adolescent adjustment, family history of non-affective psychosis and baseline depression predicted initially high but decreasing negative symptoms. Members of the Mild Stable, High Stable and High Decreasing classes were more likely to experience stably low functioning than the Minimal Decreasing class. ConclusionsDistinct negative symptom trajectories are evident in FEP. Only a small subgroup present with persistently high levels of negative symptoms. A substantial proportion of FEP patients with elevated negative symptoms at baseline will achieve remission of these symptoms within 12months. However, elevated negative symptoms at baseline, whether or not they remit, are associated with poor social recovery, suggesting targeted interventions for service users with elevated baseline negative symptoms may help improve functional outcomes.

Metacognition in first-episode psychosis and its association with positive and negative symptom profiles

There is growing evidence that metacognitive abilities which include the ability to synthesize knowledge regarding mental states in self and others and use this ability to solve problems are impaired in non-affective psychosis and associated with positive and negative symptom severity. We sought to (a) investigate the severity of metacognitive impairments in first-episode psychosis (FEP) compared to non-clinical controls and (b) explore associations with positive and negative symptom profiles. Ninety-seven people with FEP were compared to 101 control persons. Metacognition was assessed with interviews and the Metacognitive assessment scale-abbreviated. Four groups based on positive and negative symptoms were identified by cluster analysis and compared on metacognition, childhood adversities, duration of untreated psychosis and premorbid social and academic adjustment. Those with high levels of negative symptoms had poorer metacognitive abilities. Those with high positive and low negative symptoms did not have poorer metacognitive abilities than those with low positive and negative symptoms. None of the other predictors differed between the groups. The FEP group had poorer metacognitive abilities than the control group. Inclusion of metacognition in psychosis models may improve our understanding of negative symptoms, while previous findings of a relation with positive symptoms may have been confounded. Implications for current interventions are discussed.

Recovery among patients with severe mental illness: Factor analysis of recovery assessment scale in Indian setting

Aim: This study aimed to evaluate recovery among patients with severe mental disorders by using Recovery Assessment Scale (RAS). Additionally this study evaluated the, factor structure of RAS in the Indian setting, and assessed the correlates of recovery in severe mental illness. Methodology: Two hundred and eighty-five patients with severe mental illness (bipolar disorder-185 [BD], schizophrenia-100) currently in remission were recruited for the study. Clinical rating scales - Young Mania Rating Scale, Hamilton Depression Rating Scale, and Positive and Negative Syndrome Scale for Schizophrenia were used for assessing remission and residual symptoms. RAS was administered for recovery assessment. Results: Majority of the patients were married males belonging to urban background with no significant difference in sociodemographic profile of schizophrenia and BD groups. On factor analysis of RAS, all 41 items had loaded on one of the factors (compared to 24 items on the old factor structure). Five-factor were obtained with two factors - personal confidence and hope, goal and success orientation being similar to the old factor structure and three new factors being identified as awareness and control over the illness, seeking and relying on social support and, defeated/overcome the illness. Overall recovery measures were higher in BD group, and higher levels of residual depressive symptoms were associated with significantly lower level of recovery in BD. In the schizophrenia group, level of positive symptoms correlated negatively with goal and success orientation (as per the current analysis) and higher level of negative symptoms correlated positively with the domain of “reliance on others” as per the old factor structure. Conclusion: RAS follows a five-factor structure in Indian context, which is different than that reported in the previous study. There are few sociodemographic and clinical correlates of recovery.

Subclinical negative symptoms and the anticipation, experience and recall of emotions related to social interactions: An experimental study

Healthy individuals use anticipated and recalled emotions to guide their decisions to seek out social interactions. It is unknown whether individuals with negative symptoms of schizophrenia, who are commonly observed to socially withdraw, show a bias in anticipation and recall of emotions related to a social interaction. To close this knowledge gap, this study examines whether higher levels of subclinical negative symptoms are associated with less positive and more negative anticipated and recalled emotions related to a social interaction. In a mixed model design participants were instructed to either predict or to experience and then recall emotions related to a simulated social inclusion- or exclusion-interaction. Disregarding the type of situation, participants with higher levels of subclinical negative symptoms anticipated more intense fear than participants with lower levels of subclinical negative symptoms. Divided by type of situation, however, participants with higher levels of negative symptoms experienced and recalled more sadness related to being socially included and even recalled more positive emotions after being excluded. These specific associations are likely to reflect negative expectations about potentially rewarding social situations in people with negative symptoms. A replication in populations with clinically relevant negative symptoms and inclusion of measures to assess memory is warranted.

Long-term trajectories of positive and negative symptoms in first episode psychosis: A 10 year follow-up study in the OPUS cohort

ObjectiveKnowledge about course of illness can help clinicians to develop effective interventions and improve treatment outcomes. The goal of this study was to construct positive and negative symptom trajectories based on structured clinical assessments collected over 10years within a cohort of people with first episode psychosis. MethodA cohort of 496 people with first episode psychosis (ICD-10, F20-28) originally recruited for the OPUS study (1998–2000) and treated in community psychiatric services were rated on clinical symptoms at 5 different occasions across ten years. Psychopathology was assessed using the Scales for Assessment of Positive and Negative Symptoms. Symptom trajectories were constructed using Latent Class Analysis. ResultsFive distinct trajectories were identified for positive symptoms (response — 47%, delayed response — 12%, relapse — 15%, non-response — 13% and episodic response — 13%). Four distinct trajectories were identified for negative symptoms (response — 28%, delayed response — 19%, relapse — 26% and non-response — 27%). Multivariable regression analysis of baseline characteristics identified that longer duration of untreated psychosis (OR 1.27–1.47, p<0.05) and substance abuse (OR 3.47–5.90, p<0.01) were associated with poorer positive symptom trajectories (higher levels of psychotic symptoms) while poor social functioning (OR 1.34–5.55, p<0.05), disorganized symptoms (OR 2.01–2.38, p<0.05) and schizophrenia diagnosis (OR 5.70–8.86, p<0.05) were associated with poorer negative symptom trajectories (higher levels of negative symptoms). A proportion of people displayed significant changes in symptoms several years after diagnosis. ConclusionsTrajectories of illness for positive and negative symptoms were heterogeneous among people with first episode psychosis. Positive symptoms showed a general pattern of reduction and stabilization over time while negative symptoms typically showed less variation over the ten years. Results have implications for the focus, timing and length of interventions in first episode psychosis.

Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and self-expectation of goal attainment

The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale—Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed.

Cariprazine in Negative Symptoms of Schizophrenia: Post-hoc Analyses of a Fixed-dose Phase Iii, Randomized, Double-blind, Placebo- and Active-controlled Trial

Introduction Cariprazine, a dopamine D 3 /D 2 receptor partial agonist with preferential binding to D 3 receptors, is being developed for the treatment of schizophreni a Objective To explore the effect of cariprazine on negative symptoms of schizophrenia. Methods Subjects aged 18-60 years with acute schizophrenia, current acute episode >2 weeks, and a PANSS total score ≥80 and ≤120 were randomly allocated in a 6-Week study NCT01104766 to cariprazine 3 mg/d, cariprazine 6 mg/d, aripiprazole 10 mg/d (active control), or placebo [1]. Post–hoc analyses were performed on subjects with severe negative symptoms and low-to-moderate positive symptoms, defined according to Marder. Results of the Post-Hoc Analyses Data of 26 subjects were included in the cariprazine 3 mg/d (17.2% of the total sample), 34 in the cariprazine 6 mg/d (22.1%), 35 in the aripiprazole (23.3%) and 35 in the placebo (23.5%) groups, respectively. Change from baseline to Week 6 in the PANSS Factor Score for Negative Symptoms (PFSNS) was statistically significant for cariprazine 6 mg/d versus placebo (least squares mean difference: cariprazine 3 mg/d=-2.15, p = 0.20; cariprazine 6 mg/d = −3.68, p =.019). Cariprazine 6 mg/d was superior to placebo at each weekly assessment from Week 3. The changes in PFSNS for aripiprazole were not statistically significant at any weekly assessment. Conclusion Post–hoc analyses performed on subjects with acute schizophrenia, high level of negative symptoms and low-to-moderate positive symptoms, showed that the patients in the cariprazine 6 mg/d group had a significantly greater improvement relative to placebo on the PFSNS.

Psychosocial functioning in first-episode psychosis and associations with neurocognition, social cognition, psychotic and affective symptoms.

Most studies on the determinants of psychosocial functioning in first-episode psychosis used few predictors. This study examines the effects of multiple cognitive domains and multiple symptoms on psychosocial functioning. A total of 162 patients with a first-episode psychosis were assessed within 3 months after referral to an early psychosis treatment department. Four psychopathological subdomains (positive and negative symptoms, depression and anxiety) and five subdomains of psychosocial functioning (work/study, relationships, self-care, disturbing behaviour and general psychosocial functioning) were measured. Neurocognitive and social cognitive factors were identified through principal component analyses (PCA) of a 15-measure cognitive battery. Stepwise backward regression models were computed to identify the determinants of psychosocial functioning. The three neurocognitive and four social cognitive factors identified through PCA were largely independent of psychopathology. The strongest associations were between cognitive factors and anxiety. Higher levels of negative symptoms, poor general neurocognition and poor general social cognition showed strongest associations with impaired psychosocial functioning, followed by low verbal processing speed and low emotion processing speed. Together, these factors accounted for 39.4% of the variance in psychosocial functioning. The results suggest that negative symptoms, impaired neurocognition and poor social cognition are related to psychosocial problems in patients with first-episode psychosis. None of the affective or positive symptoms had a marked impact on psychosocial functioning.

Indicated prevention with long-chain polyunsaturated omega-3 fatty acids in patients with 22q11DS genetically at high risk for psychosis. Protocol of a randomized, double-blind, placebo-controlled treatment trial.

It has been found that long-chain omega-3 polyunsaturated fatty acids (PUFAs) reduce the risk of progression to first episode of psychosis (FEP) and may offer a safe and efficacious strategy for selective and indicated prevention in young people with ultra-high-risk (UHR) states. An opportunity for exploring the trajectory of FEP and for investigating the efficacy of preventive treatments exists in 22q11.2 deletion syndrome (22q11DS), which has a 30% psychotic transition rate. The fact that 22q11DS patients are more homogeneous than other UHR groups and are characterized by high level of negative symptoms provides a strong rationale for the use of PUFAs. The principal aim of the present trial is to investigate the effects of PUFAs in individuals with 22q11DS who are at UHR for developing FEP. A prospective, randomized, double-blind, placebo-controlled, single-centre study design will be used. Eighty individuals aged 12-26 will be randomly assigned to two treatment conditions. The experimental group will receive PUFAs. The placebo group will receive paraffin oil. Standard clinical assessments and neuropsychological tests will be performed at baseline and at 8-, 12-, 26- and 52-week follow-up. Blood samples will be collected at baseline and after 12 weeks. This study is registered as an International Standard RCT, number 02070211. The corresponding author is supported by a NARSAD Young Investigator Award. This is the protocol of a planned study that aims to test the efficacy of PUFAs in the prodromal phase of FEP, in a specific syndrome where there is strong evidence that a high genetic load is involved in the disorder.

C-78 * Predicting Insufficient Effort in Schizophrenia using the Repeated Battery for the Assessment of Neuropsychological Status Effort Index

Objective: There is some evidence that insufficient effort may be common in schizophrenia, posing significant threats to the validity of neuropsychological test results. Low effort may account for a significant proportion of variance in neuropsychological test scores and the generalized cognitive deficit that characterizes the disorder. The current study evaluated the role of effort in neuropsychological test results in schizophrenia using an embedded effort measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI). Method: Participants were 347 patients meeting DSM-IV-TR criteria for schizophrenia or schizoaffective disorder. Patients received a battery of neuropsychological tests, including: (1) Wechsler Test of Adult Reading (WTAR), (2) Wechsler Abbreviated Scale of Intelligence (WASI), and (3) RBANS, as well as instruments designed to measure functional outcome, symptoms, and premorbid adjustment. Results: Sixty-four schizophrenia patients (18.4%) failed the EI. Patients who failed had lower full-scale, verbal, and performance IQ, as well as poorer performance on RBANS domains not included in the EI (immediate memory, language), with the exception of visuospatial/construction. Patients who failed also had poorer community-based functional outcome, greater severity of negative symptoms, and poorer premorbid adjustment in childhood and adolescence. Conclusion(s): Poor effort in schizophrenia occurs in a significant minority of patients who appear to have a more severe form of the illness with poor premorbid development, higher levels of negative symptoms, and poorer functional outcomes. Poor effort, which is likely the result of apathy and motivational processes characteristic of the disease, may therefore be an important consideration in the neuropsychological evaluation of schizophrenia.

Cognitive effort avoidance and detection in people with schizophrenia.

Many people with schizophrenia exhibit avolition, a difficulty initiating and maintaining goal-directed behavior, considered to be a key negative symptom of the disorder. Recent evidence indicates that patients with higher levels of negative symptoms differ from healthy controls in showing an exaggerated cost of the physical effort needed to obtain a potential reward. We examined whether patients show an exaggerated avoidance of cognitive effort, using the demand selection task developed by Kool, McGuire, Rosen, and Botvinick (Journal of Experimental Psychology. General, 139, 665-682, 2010). A total of 83 people with schizophrenia or schizoaffective disorder and 71 healthy volunteers participated in three experiments where instructions varied. In the standard task (Experiment 1), neither controls nor patients showed expected cognitive demand avoidance. With enhanced instructions (Experiment 2), controls demonstrated greater demand avoidance than patients. In Experiment 3, patients showed nonsignificant reductions in demand avoidance, relative to controls. In a control experiment, patients showed significantly reduced ability to detect the effort demands associated with different response alternatives. In both groups, the ability to detect effort demands was associated with increased effort avoidance. In both groups, increased cognitive effort avoidance was associated with higher IQ and general neuropsychological ability. No significant correlations between demand avoidance and negative symptom severity were observed. Thus, it appears that individual differences in general intellectual ability and effort detection are related to cognitive effort avoidance and likely account for the subtle reduction in effort avoidance observed in schizophrenia.

Gender differences in first-episode psychosis at 5-year follow-up – two different courses of disease? Results from the OPUS study at 5-year follow-up

ObjectiveGender differences in psychosis have been investigated, and the results have contributed to a better understanding of the disease, but many questions are unanswered. In clinical terms, women and men with psychosis differ in terms of access to social support, tendency of substance abuse, level of functioning and symptom patterns. We aimed to investigate how gender differences at onset of psychosis develop during the first 5years of treatment. MethodA total of 578 patients with a first-episode psychosis in the schizophrenia spectrum were included in the Danish OPUS trial – a randomized clinical trial comparing 2years of intensive early-intervention programme with standard treatment. All patients were assessed with validated instruments at inclusion, and after 2 and 5years. Data were analysed for significant gender differences. ResultsMales have significantly higher levels of negative symptoms at all times, and are more likely to live alone and suffer from substance abuse. Females reach higher levels of social functioning at follow-up, and show a greater tendency to be employed or in education than males. Markedly more women than men live with children. More women than men reach a state of recovery and are more compliant with medication. ConclusionThere are significant gender differences at 2- and 5-year follow-up in this large cohort of first-episode psychotic patients. Males and females show different symptomatology and different levels of social functioning.

Comparing the Clinical Presentation of First-Episode Psychosis across Different Migrant and Ethnic Minority Groups in Montreal, Quebec

To explore differences in severity and nature of symptoms of first-episode psychosis (FEP) according to ethnic group and migrant status. We administered rating scales to assess positive and negative symptoms, as well as general psychopathology, to 301 consecutive patients presenting with an FEP within a defined catchment area in Montreal, Quebec, classified according to ethnicity and migrant status. Symptom scores of Euro-Canadian patients without a recent history of migration, that is, the reference group (n = 145), were compared with those of African and Afro-Caribbean (n = 39), Asian (n = 27), Central and South American (n = 15), Middle Eastern and North African (n = 24), and European and North American (n = 39) patients. Except for referral source, there were no significant differences between ethnic groups on any demographic variables. The African and Afro-Caribbean group had a higher level of negative symptoms (especially alogia) and general psychopathology scores on the Positive and Negative Syndrome Scale (especially, uncooperativeness, preoccupation, and poor attention), compared with the reference group. Ethnic groups did not differ on the Scale for the Assessment of Positive Symptoms scores. A comparison of FEP patients from different ethnic groups and native-born Euro-Canadians revealed no significant differences in the nature of positive symptoms at first presentation or in age at onset, suggesting that there was no evidence for the hypothesis that ethnic minorities are misdiagnosed as psychotic. Increased severity of negative symptoms and general psychopathology, specifically among the black ethnic minority group, may have implications for the role of ethnicity for the treatment and outcome of the initial episode of psychotic disorders.

Frontal delta power associated with negative symptoms in ultra-high risk individuals who transitioned to psychosis

It has recently been shown that treatment with long-chain omega-3 polyunsaturated fatty acids (PUFAs) could decrease the rate of transition to psychosis, and improve psychiatric symptoms and global functioning in people at ultra-high risk (UHR) for psychosis. Previous studies have suggested that resting state brain activity measured with electroencephalography (EEG) may represent an objective biomarker of changes in neural function associated with supplementation with omega-3 PUFAs. It has also been proposed that although resting state EEG cannot, by itself, predict transition to psychosis in UHR individuals, the combination of resting state EEG with negative symptoms may be a valid predictor of transition. The present study investigated whether treatment with omega-3 PUFAs influenced resting state EEG in UHR participants, and whether or not the association of the participants' resting state EEG with their levels of negative symptoms was dependent on their transition status. The brain activity of 73 UHR participants was recorded in the context of a randomized, placebo-controlled trial of the effects of supplementation with omega-3 PUFAs. The UHR participants who subsequently transitioned to psychosis (UHR+) did not differ from those who did not transition (UHR−) in terms of resting state EEG power in any frequency band. However, negative symptom scores were associated with increased delta activity in the frontal region of the UHR+ participants, but not in the UHR− participants. Treatment with omega-3 PUFAs did not induce changes in resting state EEG in either group. The results suggest that decreased frontal delta activity, in combination with high levels of negative symptoms, may be a risk factor for subsequent transition to psychosis in UHR individuals.

Emotional Experience in Negative Symptoms of Schizophrenia—No Evidence for a Generalized Hedonic Deficit

Deficits in emotion processing are thought to underlie the key negative symptoms flat affect and anhedonia observed in psychotic disorders. This study investigated emotional experience and social behavior in the realm of daily life in a sample of patients with schizophrenia and schizoaffective disorder, stratified by level of negative symptoms. Emotional experience and behavior of 149 patients with schizophrenia and schizoaffective disorder and 143 controls were explored using the Experience Sampling Method. Patients reported lower levels of positive and higher levels of negative affect compared with controls. High negative symptom patients reported similar emotional stability and capacity to generate positive affect as controls, whereas low negative symptom patients reported increased instability. All participants displayed roughly comparable emotional responses to the company of other people. However, in comparison with controls, patients showed more social withdrawal and preference to be alone while in company, particularly the high negative symptom group. This study revealed no evidence for a generalized hedonic deficit in patients with psychotic spectrum disorders. Lower rather than higher levels of negative symptoms were associated with a pattern of emotional processing which was different from healthy controls.