Factor Analysis of Negative Symptom Items in the Structured Interview for Prodromal Syndromes

Abstract Background Negative symptoms occur early in the clinical high risk (CHR) state and indicate increased risk of conversion to psychotic disorder and poor functional outcome. However, while the negative symptom domain has shown to be parsimoniously explained by a 2-factor construct in schizophrenia, there has yet to be an established factor structure of negative symptoms in CHR. Methods 214 individuals meeting the Structured Interview for Psychosis-Risk Syndromes (SIPS) criteria for CHR were recruited through 3 active research programs in the United States. Exploratory Factor Analysis was conducted on the 6 negative symptom items of the SIPS, and factors were evaluated with respect to functional outcome and depression. Results Factor analysis indicated a 2-factor hierarchical model with 2 negative symptom dimensions reflecting volition (Occupational Functioning and Avolition) and emotion (Expression of Emotion, Experience of Emotion and Social Anhedonia). Linear Regression showed that the emotion factor was associated with poor social function, and the volition factor was associated with poor role function and depression. Conclusions Similar to factor solutions identified in adults diagnosed with psychotic disorders, results indicated that the SIPS negative symptom subscale is not a unidimensional construct. Rather, the SIPS negative subscale has 2 distinct factors that have different associations with clinical outcome and should be interpreted independently. Results have significant relevance for informing the valid assessment and conceptual interpretation of early clinical phenomenology in the psychosis prodrome.

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Multimodal prognosis of negative symptom severity in individuals at increased risk of developing psychosis

Translational Psychiatry ◽

10.1038/s41398-021-01409-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daniel J. Hauke ◽

◽

André Schmidt ◽

Erich Studerus ◽

Christina Andreou ◽

...

Keyword(s):

Risk Stratification ◽

Negative Symptom ◽

Symptom Severity ◽

Negative Symptoms ◽

Risk Groups ◽

Structured Interview ◽

Functional Impairments ◽

Recent Onset ◽

Increased Risk ◽

Therapeutic Consideration

AbstractNegative symptoms occur frequently in individuals at clinical high risk (CHR) for psychosis and contribute to functional impairments. The aim of this study was to predict negative symptom severity in CHR after 9 months. Predictive models either included baseline negative symptoms measured with the Structured Interview for Psychosis-Risk Syndromes (SIPS-N), whole-brain gyrification, or both to forecast negative symptoms of at least moderate severity in 94 CHR. We also conducted sequential risk stratification to stratify CHR into different risk groups based on the SIPS-N and gyrification model. Additionally, we assessed the models’ ability to predict functional outcomes in CHR and their transdiagnostic generalizability to predict negative symptoms in 96 patients with recent-onset psychosis (ROP) and 97 patients with recent-onset depression (ROD). Baseline SIPS-N and gyrification predicted moderate/severe negative symptoms with significant balanced accuracies of 68 and 62%, while the combined model achieved 73% accuracy. Sequential risk stratification stratified CHR into a high (83%), medium (40–64%), and low (19%) risk group regarding their risk of having moderate/severe negative symptoms at 9 months follow-up. The baseline SIPS-N model was also able to predict social (61%), but not role functioning (59%) at above-chance accuracies, whereas the gyrification model achieved significant accuracies in predicting both social (76%) and role (74%) functioning in CHR. Finally, only the baseline SIPS-N model showed transdiagnostic generalization to ROP (63%). This study delivers a multimodal prognostic model to identify those CHR with a clinically relevant negative symptom severity and functional impairments, potentially requiring further therapeutic consideration.

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Paliperidone to Treat Psychotic Disorders

Neurology International ◽

10.3390/neurolint13030035 ◽

2021 ◽

Vol 13 (3) ◽

pp. 343-358

Author(s):

Hormazd D. Minwalla ◽

Peter Wrzesinski ◽

Allison Desforges ◽

Joshua Caskey ◽

Brittany Wagner ◽

...

Keyword(s):

Cognitive Impairment ◽

Schizoaffective Disorder ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Drug Information ◽

The United States ◽

Mental Illnesses ◽

Positive Symptoms ◽

Review Of The Literature ◽

Second Generation Antipsychotics

Purpose of Review: This is a comprehensive review of the literature regarding the use of paliperidone in the treatment of schizophrenia and schizoaffective disorder. It covers the background and presentation of schizophrenia and schizoaffective disorder, as well as the mechanism of action and drug information for paliperidone. It covers the existing evidence of the use of paliperidone for the treatment of schizophrenia and schizoaffective disorder. Recent Findings: Schizophrenia and schizoaffective disorder lead to significant cognitive impairment. It is thought that dopamine dysregulation is the culprit for the positive symptoms of schizophrenia and schizoaffective disorder. Similar to other second-generation antipsychotics, paliperidone has affinity for dopamine D2 and serotonin 5-HT2A receptors. Paliperidone was granted approval in the United States in 2006 to be used in the treatment of schizophrenia and in 2009 for schizoaffective disorder. Summary: Schizophrenia and schizoaffective disorder have a large impact on cognitive impairment, positive symptoms and negative symptoms. Patients with either of these mental illnesses suffer from impairments in everyday life. Paliperidone has been shown to reduce symptoms of schizophrenia and schizoaffective disorder.

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The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study

Psychological Medicine ◽

10.1017/s0033291713003188 ◽

2014 ◽

Vol 44 (11) ◽

pp. 2419-2430 ◽

Cited By ~ 17

Author(s):

F. J. Oher ◽

A. Demjaha ◽

D. Jackson ◽

C. Morgan ◽

P. Dazzan ◽

...

Keyword(s):

Depressive Symptoms ◽

Population Density ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Urban Environments ◽

Psychotic Symptoms ◽

First Episode ◽

Multilevel Regression ◽

Symptom Dimensions ◽

Reality Distortion

BackgroundThe extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments.MethodWe collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10–F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation.ResultsReality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06–0.24] and depressive symptoms (EES 0.21, 95% CI 0.07–0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES –0.06, 95% CI –0.10 to –0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83–1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12–1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09–1.61).ConclusionsIn people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

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Frequent Indoor Tanners’ Beliefs About Indoor Tanning and Cessation

American Journal of Health Promotion ◽

10.1177/0890117118784235 ◽

2018 ◽

Vol 33 (2) ◽

pp. 293-299 ◽

Cited By ~ 3

Author(s):

Karen Glanz ◽

Amy Jordan ◽

DeAnn Lazovich ◽

Amy Bleakley

Keyword(s):

Skin Cancer ◽

White Women ◽

Social Acceptance ◽

The United States ◽

Structured Interview ◽

Indoor Tanning ◽

Psychological Benefits ◽

Structured Interviews ◽

Self Confidence ◽

Increased Risk

Purpose: Indoor tanning is associated with an increased risk of developing skin cancer. In the United States, nearly 1 in 5 white women aged 18 to 25 are indoor tanners. This study elicited beliefs about tanning indoors and quitting/cutting back on indoor tanning. Design: Semi-structured interviews. Participants and Setting: Forty 18- to 25-year-old white females who engaged in frequent indoor tanning participated in either in-person or telephone interviews. Most were college students from southeastern Pennsylvania and Delaware. Method: A semi-structured interview was used to elicit beliefs about indoor tanning and quitting or cutting back. Data analyses using NVivo and multiple coders identified key themes about going and quitting/cutting back on indoor tanning. Results: Key themes stated as reasons for indoor tanning included improving physical appearance, social acceptance, increased confidence, and happiness. The main themes identified as advantages of quitting/cutting back on indoor tanning were to decrease skin cancer risk and save money. Perceived disadvantages of quitting/cutting back included themes of concerns about being pale and a decline in self-confidence. The prospect of saving money and warm weather were seen as facilitating quitting/cutting back. Conclusion: Findings suggest the necessity of addressing appearance concerns, psychological benefits associated with feeling more attractive, and short-term gains such as saving money. These findings provide a foundation for developing effective anti-indoor tanning communication.

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The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors

European Psychiatry ◽

10.1016/j.eurpsy.2019.01.015 ◽

2019 ◽

Vol 58 ◽

pp. 1-9 ◽

Cited By ~ 14

Author(s):

Wolfgang Fleischhacker ◽

Silvana Galderisi ◽

István Laszlovszky ◽

Balázs Szatmári ◽

Ágota Barabássy ◽

...

Keyword(s):

Negative Symptom ◽

Repeated Measures ◽

Negative Symptoms ◽

Social Withdrawal ◽

Partial Agonist ◽

Factor Models ◽

Symptom Improvement ◽

Symptom Dimensions ◽

Intent To Treat ◽

Post Hoc

AbstractBackground:Negative symptoms in schizophrenia are heterogeneous and multidimensional; effective treatments are lacking. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, was significantly more effective than risperidone in treating negative symptoms in a prospectively designed trial in patients with schizophrenia and persistent, predominant negative symptoms.Methods:Using post hoc analyses, we evaluated change from baseline at week 26 in individual items of the Positive and Negative Syndrome Scale (PANSS) and PANSS-derived factor models using a mixed-effects model for repeated measures (MMRM) in the intent-to-treat (ITT) population (cariprazine = 227; risperidone = 227).Results:Change from baseline was significantly different in favor of cariprazine versus risperidone on PANSS items N1-N5 (blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking) (P <.05), but not on N6 (lack of spontaneity/flow of conversation) or N7 (stereotyped thinking). On all PANSS-derived negative symptom factor models evaluated (PANSS-Factor Score for Negative Symptoms, Liemburg factors, Khan factors, Pentagonal Structure Model Negative Symptom factor), statistically significant improvement was demonstrated for cariprazine versus risperidone (P <.01). Small and similar changes in positive/depressive/EPS symptoms suggested that negative symptom improvement was not pseudospecific. Change from baseline was significantly different for cariprazine versus risperidone on PANSS-based factors evaluating other relevant symptom domains (disorganized thoughts, prosocial function, cognition; P <.05).Conclusions:Since items representing different negative symptom dimensions may represent different fundamental pathophysiological mechanisms, significant improvement versus risperidone on most PANSS Negative Subscale items and across all PANSS-derived factors suggests broad-spectrum efficacy for cariprazine in treating negative symptoms of schizophrenia.

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The deficit syndrome in first-admission patients with psychotic and non-psychotic disorders

European Psychiatry ◽

10.1016/s0924-9338(97)89642-3 ◽

1997 ◽

Vol 12 (2) ◽

pp. 53-57 ◽

Cited By ~ 10

Author(s):

H Gerbaldo ◽

K Georgi ◽

D Pieschl

Keyword(s):

Negative Symptom ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Deficit Syndrome ◽

Schizophrenic Patients ◽

First Admission

SummaryThe authors study the frequency of primary enduring negative symptoms in first-admission patients with schizophrenic and non-schizophrenic disorders. Carpenter's criteria for distinguishing the primary, enduring negative symptoms from the more transient negative symptoms (secondary to different factors) were applied. Furthermore, they compare negative symptom complexes between first-admission patients and patients with recurrent hospitalizations (within 5 years after first admission). There was a trend for patients with recurrent admissions to show more frequently a deficit syndrome than first-admission patients. Nevertheless, this difference was not significant (χ2 = 0.90). First-admission patients with deficit syndrome had significantly higher affective blunting (P < 0.05) and anhedonia (P < 0.001) than those with recurrent admissions. First-admission subjects with psychotic disorders had significantly higher frequency of deficit syndrome than those first-admission patients with non-psychotic disorders (P < 0.05). These results show that negative symptoms observed in first-admitted non-schizophrenic patients can also be enduring and primary. Thereby this work does not contribute to support the specificity of primary enduring negative symptoms for schizophrenia. Moreover, data suggest, that primary anhedonia and affective blunting can decrease within the first 5 years after discharge.

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Long-Term Stability of Diagnosis and Symptom Dimensions in a Systematic Sample of Patients with Onset of Schizophrenia in Childhood and Early Adolescence. II: Positive/Negative Distinction and Childhood Predictors of Adult Outcome

The British Journal of Psychiatry ◽

10.1192/bjp.169.3.371 ◽

1996 ◽

Vol 169 (3) ◽

pp. 371-378 ◽

Cited By ~ 55

Author(s):

Michel Maziade ◽

Stéphane Bouchard ◽

Nathalie Gingras ◽

Liliane Charron ◽

Andrée Cardinal ◽

...

Keyword(s):

Factor Analysis ◽

Negative Symptoms ◽

Term Outcome ◽

Long Term Outcome ◽

Symptom Dimensions ◽

Developmental Problems ◽

Adult Outcome ◽

Longitudinal Factor Analysis ◽

Childhood Predictors

BackgroundThe aim of this study was to verify the presence and stability across life of the positive/negative distinction in early-onset schizophrenia (EO-SZ) through a longitudinal factor analysis of the schizophrenic dimensions, and to identify the factors predicting several indices of long-term outcome for EO-SZ.MethodForty children consecutively referred for DSM–III–R schizophrenia (SZ) in a specific catchment area comprised the sample.ResultsAcross a 14.8-year follow-up, longitudinal factor analysis identified two separate factors corresponding to the positive and negative symptom dimensions. We also observed that: the GAS rated over the last three years of adult illness and the severity of negative symptoms during the stabilised interepisode intervals in adulthood were the indices of adult outcome that were most easily predicted; and the best childhood predictors of adult outcome were premorbid functioning and severity of positive and negative symptoms during acute episodes.ConclusionsThe presence of premorbid non-psychotic behaviour disturbances (NPBD) and premorbid developmental problems was not related to severity of outcome, in contrast to the former variables.

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BDNF and S100B in psychotic disorders: evidence for an association with treatment responsiveness

Acta Neuropsychiatrica ◽

10.1017/neu.2013.59 ◽

2013 ◽

Vol 26 (4) ◽

pp. 223-229 ◽

Cited By ~ 3

Author(s):

Noortje W.A. van de Kerkhof ◽

Durk Fekkes ◽

Frank M.M.A. van der Heijden ◽

Willem M.A. Verhoeven

Keyword(s):

Negative Symptoms ◽

Psychotic Disorders ◽

Brain Plasticity ◽

Control Sample ◽

Serum Levels ◽

Response To Treatment ◽

Antipsychotic Treatment ◽

Specific Symptom ◽

Symptom Dimensions ◽

Symptom Profile

ObjectiveBrain-derived neurotrophic factor (BDNF) and S100B are involved in brain plasticity processes and their serum levels have been demonstrated to be altered in patients with psychoses. This study aimed to identify subgroups of patients with psychotic disorders across diagnostic boundaries that show a specific symptom profile or response to treatment with antipsychotics, by measuring serum levels of BDNF and S100B.MethodsThe study sample consisted of 58 patients with DSM-IV psychotic disorders. Comprehensive Assessment of Symptoms and History (CASH), Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression scale for severity and improvement (CGI-S/CGI-I) were applied at baseline and after 6 weeks of antipsychotic treatment. At both time points, serum levels of BDNF and S100B were measured and compared with a matched control sample.ResultsBaseline BDNF and S100B levels were significantly lower in patients as compared with controls and did not change significantly during treatment. Dividing the patient sample according to baseline biochemical parameters (low and high 25% and middle 50%), no differences in symptom profiles or outcome were found with respect to BDNF. However, the subgroups with low and high S100B levels had higher PANSS scores than the middle subgroup. In addition, the high subgroup still showed significantly more negative symptoms after treatment, whereas the low subgroup showed more positive symptoms compared with the other subgroups.ConclusionSerum levels of BDNF and S100B are lowered in patients with psychotic disorders across diagnostic boundaries. The differences between high and low S100B subgroups suggest a relationship between S100B, symptom dimensions and treatment response, irrespective of diagnostic categories.

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Negative Symptom Domains Are Associated With Verbal Learning in Adolescents With Early Onset Psychosis

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.825681 ◽

2022 ◽

Vol 12 ◽

Author(s):

Lynn Mørch-Johnsen ◽

Runar Elle Smelror ◽

Dimitrios Andreou ◽

Claudia Barth ◽

Cecilie Johannessen ◽

...

Keyword(s):

Factor Analysis ◽

Negative Symptom ◽

Early Onset ◽

Negative Symptoms ◽

Factor Model ◽

Verbal Learning ◽

Confirmatory Factor ◽

Symptom Domains ◽

Symptom Scores ◽

Early Onset Psychosis

Background: Early-onset psychosis (EOP) is among the leading causes of disease burden in adolescents. Negative symptoms and cognitive deficits predicts poorer functional outcome. A better understanding of the association between negative symptoms and cognitive impairment may inform theories on underlying mechanisms and elucidate targets for development of new treatments. Two domains of negative symptoms have been described in adult patients with schizophrenia: apathy and diminished expression, however, the factorial structure of negative symptoms has not been investigated in EOP. We aimed to explore the factorial structure of negative symptoms and investigate associations between cognitive performance and negative symptom domains in adolescents with EOP. We hypothesized that (1) two negative symptom factors would be identifiable, and that (2) diminished expression would be more strongly associated with cognitive performance, similar to adult psychosis patients.Methods: Adolescent patients with non-affective EOP (n = 169) were included from three cohorts: Youth-TOP, Norway (n = 45), Early-Onset Study, Norway (n = 27) and Adolescent Schizophrenia Study, Mexico (n = 97). An exploratory factor analysis was performed to investigate the underlying structure of negative symptoms (measured with the Positive and Negative Syndrome Scale (PANSS)). Factor-models were further assessed using confirmatory factor analyses. Associations between negative symptom domains and six cognitive domains were assessed using multiple linear regression models controlling for age, sex and cohort. The neurocognitive domains from the MATRICS Consensus Cognitive Battery included: speed of processing, attention, working memory, verbal learning, visual learning, and reasoning and problem solving.Results: The exploratory factor analysis of PANSS negative symptoms suggested retaining only a single factor, but a forced two factor solution corroborated previously described factors of apathy and diminished expression in adult-onset schizophrenia. Results from confirmatory factor analysis indicated a better fit for the two-factor model than for the one-factor model. For both negative symptom domains, negative symptom scores were inversely associated with verbal learning scores.Conclusion: The results support the presence of two domains of negative symptoms in EOP; apathy and diminished expression. Future studies on negative symptoms in EOP should examine putative differential effects of these symptom domains. For both domains, negative symptom scores were significantly inversely associated with verbal learning.

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M95. DSM-5 CLINICIAN-RATED DIMENSIONS OF PSYCHOSIS SYMPTOM SEVERITY: PSYCHOMETRIC PROPERTIES

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.407 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S170-S171

Author(s):

Edith Liemburg ◽

Fokko Nienhuis ◽

Wim Veling

Keyword(s):

Factor Analysis ◽

Internal Consistency ◽

Symptom Severity ◽

Convergent Validity ◽

Negative Symptoms ◽

The Other ◽

Symptom Dimensions ◽

Recent Onset ◽

Dsm 5 ◽

Impaired Cognition

Abstract Background In DSM-5, a number of “emerging measures” are included for further research and clinical evaluation. These patient assessment measures were developed to be administered at the initial patient interview and to monitor treatment progress. One of these instruments is the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS). Using this instrument, a clinician can rate the severity of eight symptom dimensions of psychotic disorders. The psychometric properties and the applicability of the instrument in clinical practice have not yet been investigated. The current study aims to investigate the internal consistency, factor structure and external validity with other assessment instruments. Methods The CRDPSS measures eight symptom dimensions, namely Hallucinations, Delusions, Disorganized speech, Abnormal psychomotor behavior, Negative Symptoms, Impaired Cognition, Depression and Mania. Items are scored on a five-point scale ranging from “Not present” to “Present and Severe”. This interview has been applied in the Psychosis Recent Onset GRoningen Survey (PROGR-S), a diagnostic protocol for patients with a suspected recent-onset psychotic disorder (n = 164 in the current analysis). Besides the CRDPSS, scores on the Positive and Negative Syndrome Scale (PANSS), Health of Nations Outcome Measure (HoNOS), the Mongomery Asberg Depression Rating Scale (MADRS), Cambridge Cambridge Neuropsychological Test Automated Battery (CANTAB) and mini-Structural Clinical Assessment in Neuropsychiatry (mini-SCAN) were used for current analyses. The Crohnbach Alpha was calculated to investigate internal consistency, exploratory factor analysis was applied, and the convergent validity was investigated by calculating non-parametric correlations of the CRDPSS with similar items or subscales of the other instruments. Results The Cronbach’s alpha of the CRDPSS was 0.36, indicating low internal consistency. Factor analysis resulted in three Factors: 1. Delusions/Mania, 2. Abnormal psychomotor behavior/Negative Symptoms/Impaired cognition, 3. Hallucinations/Depression. For hallucinations, Delusions, and Depression a Kendall’s tau of 0.35 – 0.45 was observed with the other instrument scores and for Impaired cognition tau = 0.6, indicating a weak to moderate association. Negative symptoms resulted in tau < 0.2 and for the other instruments tau < 0.1, but in these cases the measure of the other instruments was of questionable quality. Discussion The internal consistency of the CRDPSS was poor and factor analysis resulted in factors that differed to some extent from previous findings. Moreover, the convergent validity with other instruments was poor to moderate. In conclusion, based on first analyses the reliability and clinical applicability of the CRDPSS appears limited. Future studies should investigate inter-rater reliability, test-retest reliability, use more optimal measures to investigate convergent validity and use larger samples.

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