Negative Symptom Rating Scale Research Articles

Assessment and Treatment of Negative Symptoms in Schizophrenia-A Regional Perspective.

Clinicians and researchers consider that there are a variety of symptoms that constitute negative symptoms in schizophrenia, and they may use different definitions for the same symptoms. These differences are also reflected in a variety of negative symptom rating scales. Both research and clinical work are negatively affected by the lack of consensus regarding the symptoms that constitute negative symptoms in schizophrenia. Leading research groups have investigated ways to reduce heterogeneity in the domain of negative symptoms in schizophrenia; however, little attention has been paid to regional differences in the concepts of negative symptoms in schizophrenia. The objective of this review was to collect and summarize information about the assessment and treatment of negative symptoms of schizophrenia in Central and Eastern Europe (CEE). Nineteen experts from 17 countries in CEE participated in this project. The participants collected information about their countries, including the following: (1) the most important publications about negative symptoms in schizophrenia (irrespective of the time of their publication); (2) the most frequently used negative symptom of schizophrenia in clinical practice; (3) definitions of frequently used negative symptoms; and (4) treatment of negative symptoms in schizophrenia. The participating experts/countries most frequently reported the following five negative symptoms: avolition, blunted affect, alogia, asociality, and anhedonia. Several experts also considered other symptoms as belonging to the negative symptom domain, such as a decrease in energy level and changes in personality. The importance of evaluating the long-term course and the relationship between negative symptoms and other symptom domains was also noted. No noticeable differences were reported in the treatment of negative symptoms compared to currently published guidelines and algorithms. The most frequently reported negative symptoms included those defined by the NIMH-MATRICS consensus statement on negative symptoms and recently endorsed in a guidance paper of the European Psychiatric Association. The main differences in the concepts, names, and definitions of primary negative symptoms, especially those related to personality changes, and to the evaluation of the long-term course and relationship between different symptom domains in CEE compared to the current English language literature deserve the attention of psychiatrists and other professionals in this field.

Reduction of phonetic mismatch negativity may depict illness course and predict functional outcomes in schizophrenia

Schizophrenia (SZ) is characterized by a series of cognitive impairments, including automatic processing impairment of basic auditory information, indexed by mismatch negativity (MMN). Existing studies mainly focus on MMN induced by deviant of single acoustic features, and relatively few studies have focused on complex acoustic stimuli, especially speech-induced MMN. Many cognitive impairments in SZ are related to speech function. Thus, the present study aimed to examine the reduction of phonetic MMN in SZ as a potential biomarker and its relationship with illness course and functional outcomes. Electroencephalogram (EEG) signals were recorded from 32 SZ and 32 healthy controls (HC) in a double oddball paradigm, with /da/ as the standard stimulus and /ba/ and /du/ as the deviant stimuli. MMN was computed for vowel and consonant deviants separately. Clinical symptoms were assessed using the Positive and Negative Symptom Rating Scale (PANSS). Illness duration and illness relapse were acquired by combining clinical interviews and electronic medical records. Functional outcomes were assessed using the Global Assessment of Functioning scale (GAF). Compared with HC, SZ showed lower amplitudes of phonetic MMN, especially for vowel deviants. In addition, the MMN amplitude of the vowel deviant was significantly correlated with illness duration, illness relapse, and functional outcomes among patients with SZ. These findings indicate that the pre-attentive automatic phonetic processing of SZ was impaired for both consonants and vowels, while the vowel processing deficit may be the key speech processing deficit in SZ, which could depict the illness course and predict the functional outcomes.

ECT augmentation of antipsychotics in severely ill schizophrenia: a naturalistic, observational study

Objectives There is positive evidence to support the role of electroconvulsive therapy (ECT) in the treatment of schizophrenia; however, it is unclear to what extent this growing evidence reflects the actual situation in clinical practice. The aim of this study was to explore the efficacy of ECT augmentation to antipsychotics in individuals with schizophrenia in a naturalistic-observational environment. Methods Eighty-one patients diagnosed with schizophrenia, hospitalised due to acute psychotic exacerbation were included in the study. We compared changes in Positive and Negative Symptom Rating Scale (PANSS) scores between patients treated only with APs and those in the ECT augmentation group. Results A statistically significant decrease in symptom severity was observed in all PANSS subscales in both groups. In the ECT group, 95% of the patients (n = 39) responded to treatment compared to 75% of the non-ECT group (n = 30) (χ2=6.496, df = 1, p = 0.011). We found that combining ECT with AP significantly increased treatment response, which was defined as at least 25% PANSS symptom reduction, in patients with acute exacerbation of schizophrenia, compared to AP alone. Conclusions Augmentation of ECT seems to increase responsiveness during acute treatment of severely ill schizophrenia patients. The mean percentage reduction in PANSS scores by 25% following antipsychotic treatment can help identify patients that will benefit from ECT after psychotic relapse in future. Key points There is positive evidence to support the role of ECT in the treatment of schizophrenia; however, it remains unclear to what extent this growing evidence reflects the actual situation in clinical practice. Augmentation of ECT seems to increase responsiveness during acute treatment of severely ill schizophrenia patients. The addition of ECT to antipsychotic treatment may only be beneficial in patients with antipsychotic responses below 50%. The mean percentage reduction in PANSS scores by 25% following antipsychotic treatment can help identify patients that will benefit from ECT after psychotic relapses in the future.

Neurophysiological correlates of Avolition-apathy in schizophrenia: A resting-EEG microstates study

BackgroundThe “Avolition-apathy” domain of the negative symptoms was found to include different symptoms by factor analytic studies on ratings derived by different scales. In particular, the relationship of anhedonia with this domain is controversial. Recently introduced negative symptom rating scales provide a better assessment of anhedonia, allowing the distinction of anticipatory and consummatory aspects, which might be related to different psychopathological dimensions. The study of associations with external validators, such as electrophysiological, brain imaging or cognitive indices, might shed further light on the status of anhedonia within the Avolition-apathy domain.ObjectivesWe used brain electrical microstates (MSs), which represent subsecond periods of quasi-stable scalp electrical field, associated with resting-state neural networks (and thus with global patterns of functional connectivity), to test whether the component symptoms of Avolition-apathy share the same correlates.MethodWe analyzed multichannel resting EEGs in 142 individuals with schizophrenia (SCZ) and in 64 healthy controls (HC), recruited within the add-on EEG study of the Italian Network for Research on Psychoses. Relative time contribution, duration and occurrence of four MS classes (MS-A/-B/-C/−D) were calculated. Group differences on MS parameters (contribution and duration) and their associations with negative symptom domains (assessed using the Brief Negative Symptoms Scale) were investigated.ResultsSCZ, in comparison to HC, showed increased contribution and duration of MS-C. The contribution of MS-A positively correlated with Avolition-apathy, but not with Expressive deficit. Within the Avolition-apathy domain, anticipatory anhedonia, avolition and asociality, but not consummatory anhedonia, showed the same correlations with MS-A contribution.ConclusionOur findings support the existence of distinct electrophysiological correlates of Avolition-apathy with respect to Expressive deficit, and lend support to the hypothesis that only the anticipatory component of anhedonia shares the same pathophysiological underpinnings of the Avolition-apathy domain.

Assessment of Negative Symptoms

Negative symptoms are a fundamental dimension of schizophrenia despite of their limited role in the international diagnostic classifications. Eighteen instruments are identified of which 11 assess specifically the negative symptoms. The assessment of subjective experience is neglected in most of these negative symptom rating scales. Consequently, we present a new scale, the Self-report of Negative Symptoms (SNS), assessing the 5 consensual negative dimensions (emotional blunting, alogia, social withdrawal, anhedonia and avolition). This scale is an auto-evaluation constituted of 20 questions with a score ranging from 0 to 40. Forty nine patients with schizophrenia and schizoaffective disorders (DSMIV) were evaluated in order to demonstrate three components of the scale’s validity: face and content validities and reliability. No item was judged inappropriate or poorly formulated (face validity). According to experts, the universe of items clearly covers all the negative symptoms (content validity). The Cronbach’s coefficient (α=0.784) showed a good internal consistency (reliability). Factor analysis extracted 1 factor which accounted for 56.75% of the variance. Moreover, the SNS scores were significantly correlated with the SANS scores (r=0.526, p In conclusion, self-report of negative symptoms should be more used in clinical practice since it might allow the patients with schizophrenia to develop appropriate coping strategies.

Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials.

Existing treatments for schizophrenia can improve positive symptoms, but it is unclear if they have any impact on negative symptoms. This meta-analysis was conducted to assess the efficacy of available treatments for negative symptoms in schizophrenia. All randomized-controlled trials of interventions for negative symptoms in schizophrenia until December 2013 were retrieved; 168 unique and independent placebo-controlled trials were used. Negative symptom scores at baseline and follow-up, duration of illness, doses of medication, type of interventions, and sample demographics were extracted. Heterogeneity was addressed with the I (2) and Q statistic. Standardized mean difference in values of the Negative Symptom Rating Scale used in each study was calculated as the main outcome measure. 6503 patients in the treatment arm and 5815 patients in the placebo arm were included. No evidence of publication biases found. Most treatments reduced negative symptoms at follow-up relative to placebo: second-generation antipsychotics: -0.579 (-0.755 to -0.404); antidepressants: -0.349 (-0.551 to -0.146); combinations of pharmacological agents: -0.518 (-0.757 to -0.279); glutamatergic medications: -0.289 (-0.478 to -0.1); psychological interventions: -0.396 (-0.563 to -0.229). No significant effect was found for first-generation antipsychotics: -0.531 (-1.104 to 0.041) and brain stimulation: -0.228 (-0.775 to 0.319). Effects of most treatments were not clinically meaningful as measured on Clinical Global Impression Severity Scale. Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement.

Imaging Emotion in Schizophrenia: Not Finding Feelings in All the Right Places

Imaging Emotion in Schizophrenia: Not Finding Feelings in All the Right Places

Social Cognition and Symptom Dimensions

This study used the Picture Arrangement subtest of the Wechsler Adult Intelligence Scale to assess social cognitive functioning of psychotic patients diagnosed with bipolar, schizophrenia, or schizoaffective disorder. All participants were rated on positive and negative symptom rating scales, from which three symptom dimensions were obtained. Symptom dimensions were not significantly related to ratings of symptom severity or mental status examination scores. Disorganized symptoms were correlated with a wide range of impairments on nearly all subscale measures of social cognition. Negative symptoms were correlated with lower ratings of capacity for emotional investment, complexity of representations, and integration of episodes. Psychoticism was associated with negative affect tone. Diagnostic categories were not related to social cognitive impairments independent of estimates of premorbid level of cognitive function. Evidence of syndromal differences suggests that heterogeneity of variance in studies of functioning of schizophrenic patients can be reduced by inclusion of symptom dimensions.

Rightward cerebral asymmetry in subtypes of schizophrenia according to Leonhard's classification and to DSM-IV: a structural MRI study

Although well documented, brain structural abnormalities in schizophrenia are non-specific, and morphometric parameters show significant overlap between patients and healthy controls. Such inconsistencies in neuroimaging findings could represent different levels of severity along a single pathogenic process or distinct clinical and etiopathological psychoses within a schizophrenic spectrum. The aim of the present study was the investigation of distinct brain abnormalities in different subtypes of schizophrenia. Forty patients were classified according to DSM-IV and Leonhard's classifications. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS) and the Negative Symptom Rating Scale (NSRS). Patients were compared to 20 healthy volunteers on volumetric measures of cerebral structures (hemisphere, hippocampus and planum temporale) and ventricular–brain ratio (VBR) obtained by magnetic resonance imaging. Patients showed rightward asymmetry of cerebral hemispheres and increased VBR. Rightward asymmetry correlated with severity of negative symptoms and prevailed in the systematic forms of Leonhard, suggesting a distinct pattern of left hemisphere abnormality in this subgroup of psychoses. Increased VBR values showed a single normal distribution in the subgroups, indicating that ventricular enlargement is not restricted to a subgroup but is present to a certain degree in all cases.

Discrepancy between subjective and objective ratings for negative symptoms

A better knowledge of the schizophrenic patients' awareness of negative symptoms may lead to a more empathic approach of these patients, especially within the context of rehabilitation programs. In order to examine the awareness of these symptoms, we have developed a self-rating scale, the Subjective Experience of Negative Symptoms scale (SENS; Selten et al., 1993). Since the items of this scale were taken from the Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1989), the patient's rating can be compared to the psychiatrist's rating for the corresponding SANS item. Evidence for validity of the SENS was provided by a study that compared schizophrenic patients to patients with a depressive disorder and to normal subjects. Since the schizophrenic patients were found to report more impairments than the normal subjects did, it was inferred that they are at least `somewhat' aware of their negative symptoms. On the other hand, as they reported fewer impairments than did the patients with a depressive disorder, the results implied that the schizophrenic patients are less aware of their impairments than are patients with a depressive disorder (Selten et al., 1998). The aim of this letter is to describe the proportions of schizophrenic patients who participated in the above study and failed to report negative symptoms that were assessed as present by a psychiatrist. The patients (DSM-III-R criteria; 60 men and 26 women) were recruited from the mediumand long-stay wards of two mental hospitals. Patients who had a physical handicap that explained their impaired functioning were excluded. Other reasons for exclusion were the presence of mental subnormality (de®ned as the failure to complete primary education or having repeated more than one class at primary school), an organic mental disorder (DSM-III-R), recent or current substance abuse (DSM-III-R) and a current manic or major depressive episode (DSM-IIIR). Their mean age was 44.4 years (range 20±65). The length of admission varied greatly: less than a year in 26 patients and more than 5 years in 35 patients (median: 44.5 months). In one session the patient assessed himself with help of an interviewer. The interviewer gave a standardized explanation of the item in everyday language and asked a prescribed question, for instance: ``How much energy do you have?'' Next, he handed the patient a card that listed ®ve alternative answers: ``very little'' (1), ``little'' (2), ``average'' (3), ``a lot'' (4) and ``very much'' (5). Thus, the patient could indicate the presence of the symptom with a rating of ``1'' or ``2''. The patient was instructed to compare himself to other people of his age outside the hospital and had to choose one answer. In another session a psychiatrist (J.P.S.) assessed the patient using the SANS. His interrater reliability was sucient (ICC for SANS summary score: 0.81). The interval between both sessions was limited to a maximum of one week. In order to provide the psychiatrist with detailed information about the patient's daily activities, nurses completed the REHAB, a scale for the assessment of psychiatric disability which shows large overlap with negative symptom rating scales (Baker and Hall, 1988). The psychiatrist and the patient were blind to each other's ratings. After 2 months the measurements were repeated in 80 patients. SANS ratings of at least `2' (``mild, but de®nite'') were taken as scores indicating the presence of the symptom. Journal of Psychiatric Research 34 (2000) 11±13

Negative symptoms, depression and parkinsonian symptoms in chronic, hospitalised schizophrenic patients

Background: Negative symptoms of schizophrenia are often confounded by overlapping depressive and parkinsonian symptoms. The role of medication as an aetiological factor in the development of these symptoms is an important issue for prevention and treatment. Methods: A total of 45 inpatients in chronic wards who met RDC criteria for schizophrenia were assessed with the Hamilton depression rating scale (HDRS) and negative symptom rating scale (NSRS) and the targeting abnormal kinetic effect scale (TAKE). Results: No significant correlation was found between the total scores on the vegetative superfactor of the HDRS and the NSRS. Duration of neuroleptic treatment was positively correlated with depressive symptoms ( r=0.299, P<0.05) and negative symptoms ( r=0.443, P<0.001). Dose of antipsychotic was also correlated positively with negative symptoms ( r=0.260, P<0.05). Age was negatively correlated with depressive symptoms as assessed by the HDRS ( r=0.306, P<0.05). Conclusion: The data suggest that depressive and negative symptoms can be separated in chronic schizophrenia, while pointing to a possible role of antipsychotic medication in the aetiology. Limitations: The study was conducted in a small chronically hospitalised population treated with relatively high doses of antipsychotics. It is not clear that the results obtained here would be applicable to an acute patient population.

Construct validity of negative symptoms: An empirical and conceptual review

The construct validity of negative symptoms is reviewed, and findings on deficit negative symptoms are also incorporated. A valid negative symptom construct should: (a) have replicable relationships with observable phenomena and other constructs; (b) have good reliability, temporal stability, and homogeneity; and (c) predict prognosis and response to treatment, possess convergent and discriminant validity, and be useful to clinicians. Although a number of well-replicated findings provide support for the validity of the construct, modification is warranted. Specifically, the data suggest that there is a highly correlated set of negative symptoms, which includes flat affect, alogia, anhedonia, and avolition. Primary and enduring symptoms from this set have good predictive and discriminant validity and can be studied in the context of the deficit syndrome, as well as with current negative symptom rating scales. Future studies should examine whether deficit negative symptoms are better conceptualized as a dimension or a category, elucidate the relationship between deficit symptoms and additional clinical and behavioral variables (e.g., response to newer neuroleptic medications and diminished emotional responding), and explore differences between the pattern of correlates of deficit symptoms and those of the positive and thought disorder symptoms.

Negative symptoms, cognitive dysfunction, tardive akathisia and tardive dyskinesia.

This study examined the relationship of neuropsychological deficits and negative symptoms with tardive akathisia in chronic schizophrenic patients. Consecutive volunteers (n = 100) were recruited from Community Health Centres with a DSM-III-R diagnosis of schizophrenic disorder, chronic and on stable medication. Subjects were subgrouped into tardive akathisia (TA), tardive dyskinesia (TD) and control groups using four sets of criteria. Detailed single examinations were performed using the following measures: sociodemographic, illness-related and treatment-related variables, Negative Symptom Rating Scale (NSRS), Abnormal Involuntary Movement Scale (AIMS), Rating Scale for Extrapyramidal Side-Effects (EPSE), Akathisia Rating Scale, Barnes Akathisia Rating Scale, and a brief neuropsychological test battery. Group comparisons and logistic regression analyses were performed in order to test the significance of findings. TA ratings showed a significant association with NSRS subscale scores, and with some neuropsychological test scores (Symbol Digits Modalities Test, and to a lesser extent Trail Making Test and Finger Tapping Test). TD scores showed a consistent association with age, and a less consistent association with gender, and their association with NSRS subscale scores and neuropsychological dysfunction was positive but less significant. Higher EPSE scores predicted TA and limb truncal (LT) dyskinesia. In conclusion, TA showed a more significant association with some clinical indices of organic brain dysfunction than the oral-lingual-buccal-facial dyskinetic syndrome. Prospective studies are necessary to determine whether organicity is a vulnerability factor for TA. Both our data and the published literature suggest that the movement disorder seen in TA and TD is but one feature of complex syndromes that include motor and cognitive features.

Normal planum temporale asymmetry in familial schizophrenia: A volumetric MRI study

Although well documented, brain structural abnormalities in schizophrenia are non-specific, and morphometric parameters show significant overlap between patients and healthy controls. Such inconsistencies in neuroimaging findings could represent different levels of severity along a single pathogenic process or distinct clinical and etiopathological psychoses within a schizophrenic spectrum. The aim of the present study was the investigation of distinct brain abnormalities in different subtypes of schizophrenia. Forty patients were classified according to DSM-IV and Leonhard's classifications. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS) and the Negative Symptom Rating Scale (NSRS). Patients were compared to 20 healthy volunteers on volumetric measures of cerebral structures (hemisphere, hippocampus and planum temporale) and ventricular–brain ratio (VBR) obtained by magnetic resonance imaging. Patients showed rightward asymmetry of cerebral hemispheres and increased VBR. Rightward asymmetry correlated with severity of negative symptoms and prevailed in the systematic forms of Leonhard, suggesting a distinct pattern of left hemisphere abnormality in this subgroup of psychoses. Increased VBR values showed a single normal distribution in the subgroups, indicating that ventricular enlargement is not restricted to a subgroup but is present to a certain degree in all cases.

A negative symptom rating scale

Renewed interest in the role of negative symptoms in “defect state” schizophrenia calls for the design of a standardized, easy to use, reliable, and valid instrument to assess these aspects of psychopathology. In order to measure negative symptoms, we developed the Negative Symptom Rating Scale (NSRS). We report on the design, interrater reliability, and construct-validation of NSRS against the most frequently used negative symptom scales or subscales. In summary, the NSRS is a short, sensitive, highly specific, reliable, and apparently valid instrument for measuring negative symptoms in schizophrenia.