Negative symptoms in bipolar disorder and schizophrenia: A psychometric evaluation of the brief negative symptom scale across diagnostic categories

Abstract Network analysis was used to examine how densely interconnected individual negative symptom domains are, whether some domains are more central than others, and whether sex influenced network structure. Participants included outpatients with schizophrenia (SZ; n = 201), a bipolar disorder (BD; n = 46) clinical comparison group, and healthy controls (CN; n = 27) who were rated on the Brief Negative Symptom Scale. The mutual information measure was used to construct negative symptom networks. Groups were compared on macroscopic network properties to evaluate overall network connectedness, and microscopic properties to determine which domains were most central. Macroscopic analyses indicated that patients with SZ had a less densely connected negative symptom network than BD or CN groups, and that males with SZ had less densely connected networks than females. Microscopic analyses indicated that alogia and avolition were most central in the SZ group, whereas anhedonia was most central in BD and CN groups. In addition, blunted affect, alogia, and asociality were most central in females with SZ, and alogia and avolition were most central in males with SZ. These findings suggest that negative symptoms may be highly treatment resistant in SZ because they are not very densely connected. Less densely connected networks may make treatments less likely to achieve global reductions in negative symptoms because individual domains function in isolation with little interaction. Sex differences in centralities suggest that the search for pathophysiological mechanisms and targeted treatment development should be focused on different sets of symptoms in males and females.

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Aberrant Frontostriatal Connectivity in Negative Symptoms of Schizophrenia

Schizophrenia Bulletin ◽

10.1093/schbul/sby165 ◽

2018 ◽

Vol 45 (5) ◽

pp. 1051-1059 ◽

Cited By ~ 10

Author(s):

Dinesh K Shukla ◽

Joshua John Chiappelli ◽

Hemalatha Sampath ◽

Peter Kochunov ◽

Stephanie M Hare ◽

...

Keyword(s):

Functional Connectivity ◽

Negative Symptom ◽

Negative Symptoms ◽

Imaging Study ◽

Anterior Cingulate ◽

Functional Magnetic Resonance ◽

Resting State Functional Connectivity ◽

Symptom Scale ◽

Distinct Component ◽

The Right

AbstractNegative symptoms represent a distinct component of psychopathology in schizophrenia (SCZ) and are a stable construct over time. Although impaired frontostriatal connectivity has been frequently described in SCZ, its link with negative symptoms has not been carefully studied. We tested the hypothesis that frontostriatal connectivity at rest may be associated with the severity of negative symptoms in SCZ. Resting state functional connectivity (rsFC) data from 95 mostly medicated patients with SCZ and 139 healthy controls (HCs) were acquired. Negative symptoms were assessed using the Brief Negative Symptom Scale. The study analyzed voxel-wise rsFC between 9 frontal “seed regions” and the entire striatum, with the intention to reduce potential biases introduced by predefining any single frontal or striatal region. SCZ showed significantly reduced rsFC between the striatum and the right medial and lateral orbitofrontal cortex (OFC), lateral prefrontal cortex, and rostral anterior cingulate cortex compared with HCs. Further, rsFC between the striatum and the right medial OFC was significantly associated with negative symptom severity. The involved striatal regions were primarily at the ventral putamen. Our results support reduced frontostriatal functional connectivity in SCZ and implicate striatal connectivity with the right medial OFC in negative symptoms. This task-independent resting functional magnetic resonance imaging study showed that medial OFC–striatum functional connectivity is reduced in SCZ and associated with severity of negative symptoms. This finding supports a significant association between frontostriatal connectivity and negative symptoms and thus may provide a potential circuitry-level biomarker to study the neurobiological mechanisms of negative symptoms.

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S71. CLINICAL, BEHAVIOURAL AND NEURAL VALIDATION OF THE POSITIVE AND NEGATIVE SYMPTOM SCALE (PANSS) AMOTIVATION FACTOR

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.137 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S61-S61

Author(s):

Mariia Kaliuzhna ◽

Matthias Kirschner ◽

Fabien Carruzzo ◽

Matthias Hartmann ◽

Bischof Martin ◽

...

Keyword(s):

Factor Structure ◽

Negative Symptom ◽

Negative Symptoms ◽

Symptom Assessment ◽

Symptom Scale ◽

New Approach ◽

Reward Anticipation ◽

Two Factors ◽

Highly Correlated ◽

Assessment Scales

Abstract Background Negative symptoms of schizophrenia are suggested to map onto two distinct factors – amotivation and diminished expression, which relate to different aspects of behaviour and neural activity. Most research in patients with schizophrenia is conducted with broad symptom assessment scales, such as the PANSS, for which factor solutions allowing the distinction between amotivation and diminished expression have only recently been reported. We aimed to establish whether the PANSS factor structure corresponds to the well-established two-factor structure of the Brief Negative Symptom Scale (BNSS) and whether it allows distinguishing specific behavioural and neuronal correlates of amotivation. Methods In study 1 (N=120) we examined the correlations between the PANSS factors and the BNSS factors. In study 2 (N=31) we examined whether PANSS amotivation is specifically associated with reduced willingness to work for reward in an effort-based decision making task. In study 3 (N=43) we investigated whether PANSS amotivation is specifically correlated with reduced ventral striatal activation during reward anticipation using functional magnetic resonance imaging. Results On the clinical level, the PANSS amotivation and diminished expression were highly correlated with their BNSS counterparts. On the behavioural level, PANSS amotivation factor but not the diminished expression factor was specifically associated with reduced willingness to invest effort to obtain a reward. On the neural level, PANSS amotivation was specifically associated with ventral striatal activation during reward anticipation. Discussion Our data confirm that the two domains of negative symptoms can be measured with the PANSS and are linked to specific aspects of behaviour and brain function. To our knowledge, this is the first study employing behavioural and neural measures to validate a new approach to clinical measurement of negative symptoms. Our results warrant a re-analysis of previous work that used the PANSS to further substantiate the distinction between the two factors in behavioural and neuroimaging studies.

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Network Analysis Reveals the Latent Structure of Negative Symptoms in Schizophrenia

Schizophrenia Bulletin ◽

10.1093/schbul/sby133 ◽

2018 ◽

Vol 45 (5) ◽

pp. 1033-1041 ◽

Cited By ~ 25

Author(s):

Gregory P Strauss ◽

Farnaz Zamani Esfahlani ◽

Silvana Galderisi ◽

Armida Mucci ◽

Alessandro Rossi ◽

...

Keyword(s):

Factor Analysis ◽

Network Analysis ◽

Negative Symptom ◽

Negative Symptoms ◽

Null Model ◽

Detection Algorithm ◽

Latent Structure ◽

Symptom Scale ◽

Mathematical Techniques ◽

Community Detection Algorithm

Abstract Prior studies using exploratory factor analysis provide evidence that negative symptoms are best conceptualized as 2 dimensions reflecting diminished motivation and expression. However, the 2-dimensional model has yet to be evaluated using more complex mathematical techniques capable of testing structure. In the current study, network analysis was applied to evaluate the latent structure of negative symptoms using a community-detection algorithm. Two studies were conducted that included outpatients with schizophrenia (SZ; Study 1: n = 201; Study 2: n = 912) who were rated on the Brief Negative Symptom Scale (BNSS). In both studies, network analysis indicated that the 13 BNSS items divided into 6 negative symptom domains consisting of anhedonia, avolition, asociality, blunted affect, alogia, and lack of normal distress. Separation of these domains was statistically significant with reference to a null model of randomized networks. There has been a recent trend toward conceptualizing the latent structure of negative symptoms in relation to 2 distinct dimensions reflecting diminished expression and motivation. However, the current results obtained using network analysis suggest that the 2-dimensional conceptualization is not complex enough to capture the nature of the negative symptom construct. Similar to recent confirmatory factor analysis studies, network analysis revealed that the latent structure of negative symptom is best conceptualized in relation to the 5 domains identified in the 2005 National Institute of Mental Health consensus development conference (anhedonia, avolition, asociality, blunted affect, and alogia) and potentially a sixth domain consisting of lack of normal distress. Findings have implications for identifying pathophysiological mechanisms and targeted treatments.

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48 – Psychometric evaluation of the Negative Symptom Assessment (NSA-16) scale in schizophrenic patients with predominant negative symptoms

Schizophrenia Research ◽

10.1016/j.schres.2007.12.115 ◽

2008 ◽

Vol 98 ◽

pp. 53 ◽

Cited By ~ 2

Author(s):

P. Cazorla ◽

L. Alphs ◽

C. Hill ◽

M. Stewart ◽

J. Wilson ◽

...

Keyword(s):

Negative Symptom ◽

Negative Symptoms ◽

Psychometric Evaluation ◽

Symptom Assessment ◽

Schizophrenic Patients

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The second-generation assessment scales: Brief negative symptom scale and clinical assessment interview for negative symptoms

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.980 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S70-S70

Author(s):

A. Mucci ◽

S. Galderisi

Keyword(s):

Negative Symptom ◽

Clinical Assessment ◽

Negative Symptoms ◽

Assessment Instruments ◽

Symptom Scale ◽

Assessment Interview ◽

Competing Interest ◽

Functional Outcome Measures ◽

Internal Experience ◽

Assessment Scales

The construct of negative symptoms has undergone significant changes since the introduction of first generation assessment scales, such as the Scale for the Assessment of Negative Symptoms or the Positive and Negative Syndrome Scale. Blunted affect, Alogia, Asociality, Anhedonia and Avolition are largely recognized as valid domains of the negative symptoms construct.Among the new assessment instruments, both the Brief Negative Symptom Scale (BNSS) and the Clinical Assessment Interview for Negative Symptoms (CAINS) are considered adequate in their coverage of the negative symptoms domains. They include the assessment of both behavior and internal experience for Anhedonia, Asociality and Avolition to avoid overlap with functional outcome measures, as well as consummatory and anticipatory components of anhedonia with an emphasis on the internal experience of pleasure.Strengths and limitations of these new assessment instruments will be reviewed in the light of some existing challenges, such as the distinction between primary and secondary negative symptoms and development of innovative treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Defining negative symptoms remission in schizophrenia using the Brief Negative Symptom Scale

Revista de Psiquiatría y Salud Mental ◽

10.1016/j.rpsm.2021.05.003 ◽

2021 ◽

Author(s):

Gurpreet Rekhi ◽

Mei San Ang ◽

Chan Yiong Huak ◽

Emilio Fernandez-Egea ◽

Brian Kirkpatrick ◽

...

Keyword(s):

Negative Symptom ◽

Negative Symptoms ◽

Symptom Scale

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Assessment of negative symptoms beyond schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.979 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S69-S70

Author(s):

S. Kaiser

Keyword(s):

Negative Symptom ◽

Negative Symptoms ◽

Rating Scales ◽

Full Range ◽

Skewed Distribution ◽

First Episode ◽

Measurement Instruments ◽

Symptom Scale ◽

Schizotypal Personality ◽

Competing Interest

IntroductionNegative symptoms have long been recognized as a hallmark of schizophrenia. Newer evidence suggests that negative symptoms can be observed in persons with other disorders or even in non-clinical populations. However, most negative symptom scales are designed to identify clinically relevant symptoms, which might lead to underappreciation of subclinical symptom expression.ObjectivesThe aim of the present study was to establish distributional properties of well-established negative symptom scales in comparison with the newly developed Zurich Negative Symptom Scale, which employs a fully dimensional and continuous approach.MethodsWe included participants with established schizophrenia (n = 65), first-episode psychosis (n = 25), schizotypal personality traits (n = 29) and remitted bipolar disorder (n = 20). Assessment of negative symptoms was conducted with the Zurich Negative Symptom Scale and compared to establish rating scales.ResultsIn this broad sample, measurement of negative symptoms with established negative symptom scales lead to a highly skewed distribution. In other words, established negative symptom scales were able to identify negative symptoms in some participants in the non-schizophrenia spectrum, but a differentiation of negative symptom severity in the subclinical range was not possible. In contrast, the distribution of negative symptoms measured with the Zurich Negative Symptom scale approached normality.ConclusionsNegative symptoms can be observed outside the schizophrenia diagnosis. However, in order to fully explore the continuity of negative symptoms, measurement instruments need to be designed to cover the full range of symptomatology starting at a subclinical level. We propose the newly developed Zurich Negative Symptom Scale as a useful tool in this respect.Disclosure of interestThe author has not supplied his declaration of competing interest.

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The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2015.01.014 ◽

2015 ◽

Vol 30 (5) ◽

pp. 641-647 ◽

Cited By ~ 48

Author(s):

A. Mucci ◽

S. Galderisi ◽

E. Merlotti ◽

A. Rossi ◽

P. Rocca ◽

...

Keyword(s):

Factor Structure ◽

Negative Symptom ◽

Negative Symptoms ◽

Discriminant Validity ◽

Intraclass Correlation ◽

Clinical Samples ◽

Symptom Scale ◽

Rater Reliability ◽

Independent Validation ◽

Validity Measures

AbstractBackgroundThe Brief Negative Symptom Scale (BNSS) was developed to address the main limitations of the existing scales for the assessment of negative symptoms of schizophrenia. The initial validation of the scale by the group involved in its development demonstrated good convergent and discriminant validity, and a factor structure confirming the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). However, only relatively small samples of patients with schizophrenia were investigated. Further independent validation in large clinical samples might be instrumental to the broad diffusion of the scale in clinical research.MethodsThe present study aimed to examine the BNSS inter-rater reliability, convergent/discriminant validity and factor structure in a large Italian sample of outpatients with schizophrenia.ResultsOur results confirmed the excellent inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the main sample (n = 912) and in a subsample without clinically significant levels of depression and extrapyramidal symptoms (n = 496). The BNSS factor structure was supported in both groups.ConclusionsThe study confirms that the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies.

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Neurophysiological correlates of negative symptom domains in patients with schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.687 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s265-s265

Author(s):

A. Vignapiano ◽

V. Montefusco ◽

G.M. Plescia ◽

G. Di Lorenzo ◽

C. Niolu ◽

...

Keyword(s):

Negative Symptom ◽

Negative Symptoms ◽

Negative Impact ◽

Real Life ◽

Event Related Potentials ◽

Central Feature ◽

Symptom Scale ◽

Symptom Domains ◽

Related Potentials ◽

Competing Interest

IntroductionNegative symptoms have long been recognized as a central feature of schizophrenia, which limit recovery, having a strong negative impact on real-life functioning. External validators of the negative symptoms domains might help refining hypotheses on their pathophysiological basis.AimsThe objective of this study was to evaluate, in the context of the multicenter study of the Italian Network for Research on Psychoses, the relationships between auditory event-related potentials (ERPs) components and negative symptom domains in patients with schizophrenia (SCZ).MethodsWe examined ERPs recorded during an auditory odd-ball task in 115 chronic stabilized SCZ (78% on second-generation antipsychotics) and 62 matched healthy controls (HC). Negative symptoms were assessed using the Brief Negative Symptom Scale.ResultsOur main findings included significant N100 and P3b amplitude reductions in SCZ compared to HC. P3b amplitude did not correlate with any negative symptom domain, while N100 amplitude correlated with both anhedonia and avolition domains.ConclusionsAvolition and anhedonia, often clustering in the same factor, are related to abnormalities of early components of the ERPs correlated with perceptual and automatic attention processes. None of the negative symptom domains is associated with abnormalities of the later stages indexed by P3 amplitude.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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