Subdomains Of Negative Symptoms Research Articles

Predominant negative symptoms: views of patients vs. doctors in a 1-year observational study

IntroductionNegative symptoms are a key aspect of schizophrenia, significantly impacting a patient’s functioning and quality of life. These symptoms are deemed predominant when they dominate the clinical picture and positive symptoms are only minimally present. As articulated in the most recent guidance by the European Psychiatric Association, including self-report measures is encouraged in negative symptom studies as they can further complement the observer-rated scales when assessing negative symptoms of schizophrenia.ObjectivesThe objective of the poster is to compare the views of patients vs. doctors regarding predominant negative symptoms during a 1-year observational study.MethodsThis was a 1-year-long, prospective, multicentric cohort study with three visits after baseline at 3, 6 and 12 months. Adult outpatients with a schizophrenia diagnosis according to the International Classification of Diseases 10th edition who exhibited predominant negative symptoms according to clinical judgement were included. Patients received pharmacological and some non-pharmacological treatment as usual.The primary outcome measure was the modified Short Assessment of Negative Domains (m-SAND), an anamnesis-based scale that is composed of 7 items: two positive items (delusions and hallucinations) which make the m-SAND Positive sub-scale (m-SAND-P) and five negative items (anhedonia, alogia, avolition, asociality and affective flattening) which make the m-SAND Negative sub-scale (m-SAND-N) Each item is rated from 0 to 5 (not observed; mild; moderate; moderately severe; severe; and extreme). Other measurements included the Self-evaluation of Negative Symptoms (SNS), a validated scale that provides meaningful information regarding the patients’ own perception of their negative symptoms.Least squares (LS) means were calculated for the change from baseline to final visit using a mixed model for repeated measures (MMRM).Results188 patients were included in the study. The mean age was 39.8 years and 65% of patients were men. The mean duration of illness was 12 years. At baseline, patients rated alogia and apathy (mean SNS score: 5.7) to be the most severe and then asociality (5.5). In contrast, doctors found affective blunting (mean m-SAND total score: 4.3), apathy (4.2) and anhedonia (4.0) to be the most severe.After the end of the observational period all negative symptom sub-domains improved significantly according to both the patients’ and doctors’ views. The latter group reported -1.9 LS mean change from baseline in apathy, -1.8 in anhedonia, and -1.7 in asociality (all p-value <0.0001). Patients felt most change in alogia and asociality (-2.7), and apathy and anhedonia (-2.4).ConclusionsIn summary, both patients and doctors reported significant improvement in predominant negative symptoms. Nonetheless, there were some differences how they perceived severity and change in the specific domains.Disclosure of InterestJ. Dragasek: None Declared, Z. Dombi Employee of: Gedeon Richter Plc., K. Acsai: None Declared, V. Dzurilla Employee of: Gedeon Richter Plc., Á. Barabássy Employee of: Gedeon Richter Plc.

Negative symptoms in drug-naive patients with a first-episode psychosis (FEP)

Negative symptoms are nuclear features of schizophrenia that may be present from the onset of the disease. In recent years, it has been described 2 subdomains of negative symptoms: experiential and expressive deficits. The aim of the study is to examine the relationship between negative symptoms and demographic and clinical variables in patients with first-episode psychosis. Also, to explore whether there are differences in the association among these variables and negative symptoms when divided into both subdomains. A cross-sectional study was performed in 160 patients (52 females and 108 males) with a diagnosis of a first episode psychosis. A questionnaire was administered to collect demographic and clinical variables. A backward stepwise linear regressions analysis was performed in order to observe potential associations between demographic and clinical variables and the presence of negative symptoms. All three models are predicted by worse PSP score, a higher CDSS, a higher disorganized factor score and a lower excited factor score. A longer duration of untreated psychosis (DUP) is associated to a higher score in the experiential deficit subdomain only. Our work highlights some clinical and phenomenological differences between experiential and expressive deficits. We think that taking into account both subdomains in future studies may lead to more accurate clinical assessment and interventions.

Longitudinal changes of cognitive function and its relationship with subdomains of negative symptoms in patients with adult-onset first-episode schizophrenia: A 4-year follow up study

BackgroundsThis study explores the longitudinal changes and trajectories of cognitive functions in patients with adult-onset first-episode schizophrenia (FES) over four years and their relationships with the baseline subdomains of negative symptoms. MethodsA total of 177 patients of age 25–55 with FES were recruited. Baseline demographics, clinical, social and cognitive functions were assessed. Diminished expression and diminished motivation of negative symptoms were assessed with Scale for the Assessment of Negative Symptoms (SANS). Patients had yearly follow-up of cognitive function assessments over four years. Latent class growth analysis (LCGA) and mixed linear regression model were used to explore the longitudinal changes of cognitive functions and the effect of baseline negative symptoms on the longitudinal cognitive function changes. Relationships of baseline negative symptoms subdomains and cognitive functions were also explored. ResultsTwo trajectories of cognitive functions were identified. Longitudinal improvements were found in most cognitive functions apart from the logical memory. One trajectory of patients had significant deterioration of logical memory while the other group had significant improvement. Baseline diminished expression was associated with baseline and longitudinal changes of processing speed and verbal fluency while diminished motivation was associated with baseline and longitudinal changes of processing speed. ConclusionsAdult-onset FES patients had a homogeneous longitudinal improvement in most cognitive functions but not for logical memory suggesting the unique nature of verbal memory. The distinct relationship between baseline subdomains of negative symptoms with baseline and longitudinal cognitive functions suggesting the presence of differential overlapping etiology between negative symptom subdomains and cognitive functions.

A study of the association between polymorphisms in the genes for interleukins IL-6 and IL-10 and negative symptoms subdomains in schizophrenia.

Schizophrenia is a severe mental illness manifested by various symptoms. Negative symptoms (NS) are associated with disability and poor function of patients. The study of NS neurobiology is complicated by their heterogeneity. Factor analysis revealed two distinct NS subdomains with different pathophysiological mechanisms: volitional pathology, including avolition and apathy (AA), and diminished expression (DE). Inflammation is one mechanism that may underlie NS, including their heterogeneity. To search for the association between genes for interleukins (IL-6 -174 G/C, IL-10 -592 C/A, and IL-10 -1082 G/A) and NS subdomains. The study included 275 patients with schizophrenia. NS factors were calculated based on the Positive and Negative Syndromes Scale. There was a significant main effect of IL-10 polymorphisms on the AA, but not the DE subdomain. Mean score on the AA subdomain was higher in the IL-10 -592 AA compared to the CC genotype. Differences between IL-10 -1082 G/A genotypes were dose dependent. The lowest score was observed for the IL-10 -1082 GG genotype. The association between the IL-6 -174 G/C polymorphism and AA scores was close to the level of significance. Patients with the IL-6 -174 GG genotype had higher score compared to the AA genotype. The results provide further neurobiological evidence for the validity of the NS factor categorization. An imbalance between pro-inflammatory and anti-inflammatory cytokines because of genetic variations is associated with the AA NS subdomain that is supposed to be a more severe aspect of psychopathology compared to the DE.

The relationship between the recognition of specific basic emotions and negative symptom domains in patients with schizophrenia spectrum disorders

IntroductionCurrent research suggests emotion recognition to be significantly impaired in individuals with schizophrenia spectrum disorders (SSD), whereby negative symptoms are theorised to play a crucial role. Emotion recognition deficits are assumed to be predictors of transition from clinical high risk to schizophrenia. So far, little attention has been given hereby to the subdomains of negative symptoms and recognizing the individual basic emotions.ObjectivesOur study aimed to explore the relationship between the recognition of the basic emotions and each negative symptom domain.Methods66 patients with a SSD diagnosis were recruited at the Charité – Universitätsmedizin Berlin. Correlational and regression analyses to control for the covariates (age, education, sex) were conducted between the recognition of the six basic emotions (anger, disgust, fear, happiness, sadness, surprise) using the Emotion Recognition Task of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the seven different subdomains of negative symptoms of the Positive and Negative Syndrome Scale (PANSS).Results revealed significantly negative correlations of blunted affect with the recognition of happiness, fear, and disgust. Difficulties in abstract thinking, also correlated positively with the recognition of fear. Additionally, we found a significant positive correlation between stereotyped thinking and difficulties in abstract thinking with the response latency in emotion recognition.ConclusionsIndividuals with SSD and domains of negative symptoms showed specific impairments in recognizing the representation of basic emotions. A longitudinal design to make causality statements would be useful for future research. Moreover, emotion recognition should be considered for early detection and individualized treatment.DisclosureNo significant relationships.

Immune-related genes are differentially associated with negative symptoms subdomains in patients with schizophrenia

IntroductionNegative symptoms (NS) are a core feature of schizophrenia. NS show heterogeneity proven by factor analysis, which revealed two distinct negative symptoms subdomains: diminished expression (DE) and avolition/apathy (AA) (Marder et al. 2017, Fleischhacker et al. 2019). Some studies showed the different effects of these subdomains on clinical features of schizophrenia that suggest different pathophysiological mechanisms for their development (Stanculete 2021). It has been also shown that the levels of peripheral interleukins (IL) specifically correlate with NS (Enache et al. 2021), in particular, increased IL levels were determined in patients with deficit syndrome compared to non-deficit schizophrenia (Goldsmith et al. 2018).ObjectivesTo search for the association of genes for IL-4, IL-6, IL-10 and C-reactive protein (CRP) with NS subdomains.MethodsThe total sample included 551 patients (women 51,4%, aged 18-72 years) with ICD-10 diagnosis of schizophrenia. NS were assessed by PANSS. PANSS-derived factors include AA (items N2, N4, G16) and DE (N1, N3, N6, G5, G7, G13). Genotyping was performed for the following polymorphisms: C-589T IL-4, C-174G IL-6, C-592A IL-10, G-1082A IL-10, CRP (rs2794521).ResultsThere are effects of C-592A IL-10 (p=0.017) and G-1082A IL-10 (p=0.012) on AA subdomain. Post-hoc Bonferroni corrected comparisons show that carriers of the haplotype AA (C-592A)- AA (G-1082A) have the highest AA score. A significant effect of CRP (rs2794521) on AA is identified (p=0.007). There is a trend towards the association of C-589T IL-4 and C-174G IL-6 with AA. No association of these polymorphisms with DE was found.ConclusionsAA and DE may have different genetic background.DisclosureNo significant relationships.

The Relationship Between the Recognition of Basic Emotions and Negative Symptoms in Individuals With Schizophrenia Spectrum Disorders - An Exploratory Study.

Current research suggests that emotion recognition is impaired in individuals affected by schizophrenia spectrum disorders (SSD). However, the specific impact of negative symptoms on the ability to recognize single basic emotions has not yet been explored sufficiently and is the aim of the present study. A sample of N = 66 individuals diagnosed with SSD was recruited at the Charité – Universitätsmedizin Berlin. In a first step, correlation analyses were conducted between seven different negative symptom subdomains of the Positive and Negative Syndrome Scale (PANSS) and the accuracy and latency in recognizing the six basic emotions (anger, disgust, fear, happiness, sadness, surprise) using the Emotion Recognition Task (ERT) of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The significant correlations were subjected to linear regression models that controlled for the significant covariates diagnoses, age, sex, and education. Results revealed that in individuals with SSD the negative symptom domain of blunted affect significantly predicted the accuracy of emotion recognition performance (p < 0.05), particularly, when recognizing happiness (p < 0.05). Additionally, we found that stereotyped thinking also predicted the performance of emotion recognition, especially the response latency (p < 0.05) and difficulty in abstract thinking predicted the recognition of fear (p < 0.05). However, the nominal significances did not withstand correction for multiple tests and therefore need to be followed up in further studies with a larger sample.

Social skills, negative symptoms and real-world functioning in individuals at ultra-high risk of psychosis.

Impairment in real-world social functioning is observed in individuals at Ultra-High Risk (UHR) of psychosis. Both social skills and negative symptoms appear to influence real-world functioning. This study aims to examine the psychometric properties of a social skills measure, the High-Risk Social Challenge task (HiSoC), and evaluate the relationship between social skills, negative symptoms, and real-world functioning in UHR individuals. HiSoC data was analysed in 87 UHR individuals and 358 healthy controls. Exploratory factor analysis (EFA) was used to evaluate the factor structure of the HiSoC task. Convergent and divergent validity were assessed. Negative symptoms were assessed on the Positive and Negative Syndrome Scale (PANSS) and real-world functioning was indexed by the Global Assessment of Functioning (GAF). Commonality analysis was used to partition unique and shared variance of HiSoC and negative symptoms with real-world functioning. EFA yielded a three-factor structure of HiSoC consisting of Affect, Odd behaviour and language, and Social-interpersonal. The HiSoC task discriminated UHR and healthy controls (p<0.001, Cohen's d=0.437-0.598). Commonality analysis revealed that the unique variance of the social amotivation subdomain of negative symptoms was the strongest predictor of GAF (p<.001, R2 =.480). Shared variance of 3.7% between HiSoC Social-interpersonal and social amotivation was observed in relation to functioning. The HiSoC is a psychometrically valid task that is sensitive to identify social skill deficits in UHR. While social skills are related to functioning, experiential negative symptoms appear to be an important target for improving real-world functional outcomes.

The trajectories and correlates of two negative symptom subdomains in first-episode schizophrenia

BackgroundRecent studies suggest a two-factor structure for negative symptoms as assessed by the Positive and Negative Syndrome Scale (PANSS) in schizophrenia, namely experiential and expressive subdomains. Little is known about their clinical correlates and treatment trajectories. ObjectivesWe sought to replicate the two factor-analysis derived subdomains for PANSS negative symptoms in schizophrenia and to assess their independent demographic, premorbid and treatment-related characteristics. MethodsThis was a longitudinal study of 106 minimally treated participants with a first episode of a schizophrenia spectrum disorder who received treatment with flupenthixol decanoate 2-weekly injections over two years. Factor analysis was used to characterize the PANSS negative symptom subdomains and linear mixed-effect models for continuous repeated measures were constructed to assess the temporal relations between the negative symptom subdomains and premorbid and treatment related variables. ResultsFactor analysis confirmed a two-factor solution for experiential and expressive subdomains of negative symptoms, although they were strongly correlated. The treatment response trajectories for the two subdomains did not differ significantly, and neither subdomain was significantly associated with our premorbid variables. We found significant main effects for disorganised symptoms and extrapyramidal symptoms on the expressive subdomain, and for disorganised symptoms and depressive symptoms on the experiential subdomain. Post-hoc testing indicated that reductions in HDL-cholesterol levels were associated with less improvement in both expressive and experiential subdomain scores. ConclusionThe two negative symptom subdomains are closely related, have similar premorbid correlates and respond similarly to antipsychotic treatment. Depression affects the experiential subdomain, whereas extrapyramidal symptoms affect the expressive subdomain.

Relationship of subjective quality of life with symptomatology, neurocognition and psychosocial functioning in first-episode psychosis: a structural equation modelling approach.

Subjective quality of life (SQoL) represents an important outcome of psychotic disorders. However, determinants of SQoL and their complex inter-relationships in the early course of illness remain to be clarified. Association between neurocognitive impairment and SQoL in first-episode psychosis (FEP) is understudied. This study employed structural equation modeling (SEM) to examine relationships among SQoL, depressive, positive and negative symptoms, neurocognition, and psychosocial functioning in FEP patients. Three hundred and forty-seven patients aged 25-55years presenting with FEP to early intervention program in Hong Kong were recruited. Assessment encompassing symptom profiles, psychosocial functioning and a battery of neurocognitive tests were conducted. SF-12 mental component summary scores were computed as the primary measure of SQoL. Our correlation analyses revealed differential relationships between negative symptom subdomains and SQoL, with amotivation, but not diminished expression, being related to SQoL. Final SEM model yielded a good model fit (comparative fix index = 0.94; root mean square error of approximation = 0.05; standardized root mean square residuals = 0.07) and demonstrated that depression, positive symptoms and psychosocial functioning were directly associated with SQoL, with depression showing the strongest effect. Amotivation, neurocognition and positive symptoms had an indirect effect on SQoL via the mediation of psychosocial functioning. This study affirms depression as a critical determinant of subjective mental wellbeing, and underscores an intermediary role of psychosocial functioning in linking amotivation, neurocognitive impairment and positive symptoms to SQoL in FEP patients. Depression and functional impairment thus constitute as crucial therapeutic targets for improvement of SQoL in the early illness stage.

Resting-state functional connectivity of the ventral tegmental area and negative symptom domains in subjects with schizophrenia

IntroductionNegative symptoms (NS) represent a core aspect of schizophrenia with a huge impact on real life functioning. Dysfunctions within the dopaminergic cortico-striatal circuits have been documented in subjects with schizophrenia (SCZ) and hypothesized as possible neurobiological mechanisms underlying some domains of NS.ObjectivesWe investigated relationships between the resting-state functional connectivity (RS-FC) of the ventro-tegmental area (VTA) and NS.MethodsResting-state fMRI data were recorded in 35 SCZ, recruited within the Italian Network for Research on Psychoses. We performed partial correlations between RS-FC and NS (evaluated with the Brief Negative Symptom Scale) controlling for possible sources of secondary negative symptoms.ResultsWe found that the experiential domain correlated with the RS-FC of the VTA with the left ventro-lateral prefrontal cortex (lVLPFC) (r=0.372, p=0.039), while the Expressive deficit domain correlated with the RS-FC of the VTA with the left dorso-lateral prefrontal cortex (lDLPFC) (r= 0.470, p .008). Looking at subdomains, only the avolition (r= 0.418, p=0.019) and the blunted affect (r= 0.465, p=.008) showed the same correlations of the domains to which they belong.ConclusionsAccording to our findings, separate dysfunctional neuronal circuits could underpin distinct negative symptom subdomains. A better understanding of neurobiological dysfunctions underlying NS could help to design new treatments, targeting different NS subdomains.

Association between negative symptom domains and happiness in schizophrenia

ObjectiveThe study aimed to examine the association between levels of self-reported happiness and different domains and subdomains of negative symptoms (NS), as well as symptomatic remission in schizophrenia. Methods274 individuals with schizophrenia were assessed on the Subjective Happiness Scale (SHS), Positive and Negative Syndrome Scale and Clinical Assessment Interview for Negative Symptoms (CAINS). Multiple linear regressions were used to examine the association between levels of happiness and increasingly specific CAINS NS domains and subdomains, as well as symptomatic remission. Results177 (64.6%) participants rated themselves as happy. NS, specifically motivation and pleasure related to social activities (MAP Social) (B=-0.402, t=−4.805, p<0.001), and depressive symptoms (B=-0.760, t=−7.102, p<0.001) were significantly associated with levels of happiness. Individuals in symptomatic remission rated themselves happier than those who were not in remission (mean composite SHS: 5.10 [SD=1.18] versus 4.61 [SD=1.16], p=0.002). ConclusionsIn this largest study on happiness in schizophrenia, we found that the MAP domain of NS, MAP social subdomain and depressive symptoms were significantly associated with levels of happiness. Additionally, individuals in symptomatic remission rated themselves happier than those who were not in remission. Symptom management remains important in the holistic care plan for individuals with schizophrenia.

Associations between duration of untreated psychosis and domains of positive and negative symptoms persist after 10 years of follow-up: A secondary analysis from the OPUS trial

BackgroundLong duration of untreated psychosis (DUP) has been linked with more severe psychotic and negative symptoms. However, it is uncertain which specific psychotic and negative domains that are affected over time and if these are stable over the course of illness. ObjectiveTo examine whether DUP is associated with psychotic and negative symptoms measured longitudinally up to 10 years after initial assessment. MethodPsychopathology of participants from the OPUS I trial, aged 18–45 years with a baseline ICD-10 schizophrenia spectrum diagnosis, excluding schizotypal disorder (468 participants left), was assessed at baseline and 2, 5 and 10 years after initial assessment. The associations between DUP and domains of positive and negative symptoms were calculated using linear regression analysis. ResultsLonger DUP was significantly associated with the severity of hallucinations, delusions and anhedonia-asociality at baseline. Longer DUP remained significantly associated with hallucinations, delusions and anhedonia-asociality after 2 years. DUP was significantly associated with hallucinations, delusions, avolition-apathy and anhedonia-asociality after 5 years. Longer DUP was still significantly associated with hallucinations and delusions but not with any of the negative symptom subdomains after 10 years. Results were not substantially changed after adjusting for treatment with antipsychotic medication at each point in time. ConclusionWe demonstrated associations between DUP and the severity of hallucinations and delusions which persist after at least 10 years of follow-up and an association between longer DUP and anhedonia-asociality which persist until 5 years of follow-up. Further, DUP was associated with avolition-apathy after 5 years.

Different subdomains of negative symptoms in clinically stable patients with schizophrenia: Determining the nature of their relationships with emotion recognition, theory of mind and neurocognition

Despite the increasing emphasis on negative symptoms and social cognition impairments in patients with schizophrenia, the nature of the relationship between subdomains of negative symptoms and soci...

Deconstructing depression and negative symptoms of schizophrenia; differential and longitudinal immune correlates, and response to minocycline treatment

BackgroundImmune dysfunction has been implicated in negative symptoms of schizophrenia and also in depression. These disorders are frequently co-morbid, with some symptoms such as anhedonia and apathy common to both. The anti-inflammatory agent minocycline may be ineffective in schizophrenia, but more positive effects have been seen in depression. Our aim was to investigate the role of immune dysfunction in depression and sub-domains of negative symptoms in schizophrenia by investigating their intercorrelation and the influence of treatment with minocycline. MethodsWe analysed longitudinal data from 207 patients within 5 years of onset of schizophrenia, from the randomised double-blind, placebo-controlled trial of minocycline (BeneMin). Symptom ratings and circulating IL-6, C-reactive protein (CRP) and TNF-α concentrations were collected at baseline and repeated over twelve months. The sample was not stratified by CRP prior to randomisation. Positive and Negative Syndrome Scale composite ratings of avolition-apathy and diminished expression, Calgary Depression Scale total scores, and immune markers were examined cross-sectionally using Spearman’s rank, and longitudinally by linear mixed effect models that included body mass index and minocycline. Additionally, post hoc analysis of the sample stratified by elevated CRP (>1 mg/l and <10 mg/l at baseline) was carried out to assess whether minocycline had any effect on specific symptoms in an immune active sub-group of patients. ResultsDepression and avolition-apathy were significantly positively related, and depression correlated weakly with IL-6 at baseline. Diminished expression was associated with increased TNF-α both cross-sectionally and longitudinally. CRP was unrelated to any symptom domain. Minocycline did not affect any individual symptom or sub-domain in the full sample or in the immune active sub-group. DiscussionIL-6 may have some specificity to depression in early schizophrenia. TNF-α may be an indicator of immune dysfunction relevant to negative symptoms, and our longitudinal findings add to this evidence. However, minocycline continues to show very little promise as a treatment for any symptom dimension of early schizophrenia.

T119. NO DIFFERENCE BETWEEN VOLITIVE AND EXPRESSIVE NEGATIVE SYMPTOMS FOR EARLY TREATMENT RESPONSE IN FIRST EPISODE OF PSYCHOSIS ANTIPSYCHOTIC NAïVE PATIENTS

BackgroundNegative symptoms are associated with a range of poor clinical and real-life functioning outcomes in people with schizophrenia. The division of negative symptoms into two separate factors, named “expressive deficits” and “social amotivation” could enable more accurate analysis and the development of new therapeutic tools. We aim to investigate whether the different symptoms that make up the negative dimension at baseline differently predict treatment response in first episode psychosis (FEP) antipsychotic naïve patients.MethodsPatients with FEP (n=80), without previous use of antipsychotics, were recruited at an emergency service in São Paulo, Brazil, between 2014 and 2019. Individuals were assessed at admission and after 10 weeks of follow-up. Patients with schizophrenia, schizoaffective disorder and schizophreniform disorder were included. The diagnosis was confirmed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I). Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at the baseline and after 10 weeks of treatment. The “expressive deficits” factor was defined as the sum of the six following items of the PANSS: N1 (blunted affect), N3 (poor rapport), N6 (lack of spontaneity and flow of conversation), G5 (mannerisms and posturing), G7 (motor retardation), G13 (disturbance of volition). The “social amotivation” factor was defined as the sum of N2 (emotional withdrawal), N4 (passive/apathetic social withdrawal) and G16 (active social avoidance). To evaluate treatment response, we used the difference between the PANSS score at baseline and after ten weeks of follow-up (delta-PANSS). We performed three linear regressions, one using the “expressive deficits” factor, one using the “social amotivation” factor and another using the total negative symptom score at baseline.ResultsThe mean age was 26.01 years old (SD ± 7.2), and the majority was male (58.75%). “Expressive deficits” (p=0.005, R-squared=0.084, F-test=8.28, β=8.24, df=78), “social amotivation” (p=0.009, R-squared=0,072, F-test=7.14, β=5.59, df=78); and negative symptoms (p=0.002, R-squared=0.105, F-test=10.23, β=9.08, df=78) at baseline behaved similarly in relation to delta-PANSS. All measures of negative symptoms are highly correlated to PANSS total at both time points.DiscussionThe results were different from our initial hypothesis of worse outcome for patients with higher expressive negative symptoms. We found that negative symptoms overall and both subdomains are highly correlated to PANSS total in acute phase in early stages, what can explain the association to better outcomes with antipsychotic treatment. Longer follow-up can help us to investigate whether differences between the subdomains of negative symptoms can be observed in more stable patients.

Expressive deficits and amotivation as mediators of the associations between cognitive problems and functional outcomes: Results from two independent cohorts

Many individuals with severe mental disorders have difficulties in vocational and social functioning, which are regarded the most important outcomes, together with clinical symptoms. To understand the underlying mechanisms, research is increasingly focused on factors influencing functional outcomes. One established association has been shown between cognition and community functioning with negative symptoms as a possible mediator. Although it has been shown that negative symptoms consist of two subdomains, thus far negative symptoms have been assessed as one unitary construct. This study considers for the first time subdomains of negative symptoms as putative mediators (expressive deficits, amotivation) of the association between cognition (neuro- and social cognition) and functional outcome (living situation, occupation, social functioning). We expected that specific subdomains of negative symptoms (e.g. amotivation) would mediate the effect of cognition on specific functional outcomes (e.g. social functioning) independently from illness duration. To assess this, we included two independent cohorts, consisting of participants with different illness duration.These two independent cohorts consisted of patients with a recent-onset psychotic disorder: PROGR-S (first time treated; N = 1129) and GROUP (illness duration preferably <5 years; N = 1200). Using linear regression, mediation analyses were performed with two cognition domains (neurocognition and social cognition) as predictors, negative symptoms (Expressive deficits and Amotivation as indexed with items from the Positive and Negative Syndrome Scale) as mediators and three measures of functional outcomes (living situation, occupation and social functioning) as outcome measures. The analyses were repeated with the same outcome measures three years later.Three main results were obtained. I) Both in the cross-sectional and longitudinal analyses, the associations of neurocognition (both cohorts) and social cognition (GROUP) with social functioning were mediated by amotivation. II) The association between cognition and living situation was mediated by Expressive deficits in one cohort (GROUP) but not in the cohort assessing first-episode psychosis (PROGR-S). III) The association between cognition and occupation was mediated by Amotivation in PROGR-S and by Expressive deficits in GROUP. ConclusionThe current results show a less robust mediating role for specific negative symptom domains regarding the associations of cognition with occupation and living situation that may depend on the duration of psychotic illness. However, Amotivation, mediates the association between cognition and social functioning, which holds true for patients experiencing a first-onset and patients with a longer illness duration alike. The results may have implications for the development of therapeutic approaches focusing on amotivation to improve social functioning. General scientific summaryThis study stresses the importance of distinguishing subdomains of negative symptoms, cognition and functioning. Our results show that specific negative symptom dimensions mediate the effects of cognition on specific functional outcomes.

Predicting mentalizing deficits in first-episode schizophrenia from different subdomains of negative symptoms

Predicting mentalizing deficits in first-episode schizophrenia from different subdomains of negative symptoms

Depression and reduced emotional experience in schizophrenia: Correlations with self-reported and informant-rated everyday social functioning

Negative symptoms and depression persist in one third of patients with schizophrenia. Previous studies suggested that depression has more impact on self-perceived compared to observer-rated social functions. Reduced emotional experience, a subdomain of negative symptoms, predicts social functioning deficits, although its role in self-assessment is unclear. We examined depression and reduced emotional experience and self-reports and informant ratings of social functioning and social cognitive abilities in 135 patients with schizophrenia. Discrepancies between sources were used to index the accuracy and bias in self-assessment. Less severe depression was associated with self-reports of reduced impairments in social functioning and better social cognitive abilities. Reduced emotional experience was related to informant ratings and self-reports of social functioning. Neither reduced emotional experience nor depression was correlated with discrepancies between sources, despite the bias of patients with lower depression to report that they were higher functioning and more competent. These findings suggest that patients with schizophrenia make global judgments about functioning based on current mood states. There was minimal association between the depression severity and the accuracy of self-assessment, despite positive biases associated with lower depression severity. The determinants of accuracy and bias in self-assessment requires more detailed examination and subdivision of patients based on their depression.

Compensatory Cognitive Training for psychosis: Effects on negative symptom subdomains

Research identifying the effects of cognitive training on negative symptoms of psychosis is limited. We examined the effects of Compensatory Cognitive Training (CCT) on expressive deficits and social amotivation in a randomized controlled trial comparing CCT to standard pharmacotherapy alone in 43 individuals with psychosis. ANCOVA analyses demonstrated significant CCT-associated effects on both expressive deficits and social amotivation. Moreover, improvements in both sub-domains were associated with improvements in global life satisfaction, with improvements in social amotivation also related to increased social contact. CCT appears to be a beneficial treatment approach for improving multiple aspects of negative symptoms.