The Motivation and Pleasure Scale-Self-Report (MAP-SR): reliability and validity of a self-report measure of negative symptoms.

The Clinical Assessment Interview for Negative Symptoms (CAINS) is an empirically developed interview measure of negative symptoms. Building on prior work, this study examined the reliability and validity of a self-report measure based on the CAINS-the Motivation and Pleasure Scale-Self-Report (MAP-SR)-that assesses the motivation and pleasure domain of negative symptoms. Thirty-seven participants with schizophrenia or schizoaffective disorder completed the 18-item MAP-SR, the CAINS, and other measures of functional outcome. Item analyses revealed three items that performed poorly. The revised 15-item MAP-SR demonstrated good internal consistency and convergent validity with the clinician-rated Motivation and Pleasure scale of the CAINS, as well as good discriminant validity, with little association with psychotic symptoms or depression/anxiety. MAP-SR scores were related to social anhedonia, social closeness, and clinician-rated social functioning. The MAP-SR is a promising self-report measure of severity of negative symptoms.

Auditory and Visual Oddball Stimulus Processing Deficits in Schizophrenia and the Psychosis Risk Syndrome: Forecasting Psychosis Risk With P300.

Identification of neurophysiological abnormalities associated with schizophrenia that predate and predict psychosis onset may improve clinical prediction in the psychosis risk syndrome (PRS) and help elucidate the pathogenesis of schizophrenia. Amplitude reduction of the P300 event-related potential component reflects attention-mediated processing deficits and is among the most replicated biological findings in schizophrenia, making it a candidate biomarker of psychosis risk. The relative extent to which deficits in P300 amplitudes elicited by auditory and visual oddball stimuli precede psychosis onset during the PRS and predict transition to psychosis, however, remains unclear. Forty-three individuals meeting PRS criteria, 19 schizophrenia patients, and 43 healthy control (HC) participants completed baseline electroencephalography recording during separate auditory and visual oddball tasks. Two subcomponents of P300 were measured: P3b, elicited by infrequent target stimuli, and P3a, elicited by infrequent nontarget novel stimuli. Auditory and visual target P3b and novel P3a amplitudes were reduced in PRS and schizophrenia participants relative to HC participants. In addition, baseline auditory and visual target P3b, but not novel P3a, amplitudes were reduced in 15 PRS participants who later converted to psychosis, relative to 18 PRS non-converters who were followed for at least 22 months. Furthermore, target P3b amplitudes predicted time to psychosis onset among PRS participants. These results suggest that P300 amplitude deficits across auditory and visual modalities emerge early in the schizophrenia illness course and precede onset of full psychosis. Moreover, target P3b may represent an important neurophysiological vulnerability marker of the imminence of risk for psychosis.

Clinical and cognitive correlates of unsheltered status in homeless persons with psychotic disorders.

Homeless persons with psychosis are particularly susceptible to unsheltered homelessness, which includes living on the streets, in cars, and other places not meant for human habitation. Homeless persons with psychosis have distinct barriers to accessing care and comprise a high-need and hard-to-serve homeless subpopulation. Therefore, this study sought to understand unsheltered homelessness in persons with psychosis and its relationship to cognitive impairment, clinical symptoms, and community functioning, examined both categorically and dimensionally. This study included 76 homeless participants with a history of a psychotic diagnosis who were enrolled in a supported housing program but had not yet received housing. This study used two different housing stability thresholds (literally homeless at any point vs. literally homeless >20% of days) for comparing homeless Veterans with psychosis living in sheltered versus unsheltered situations on cognition, clinical symptoms, and community integration. Dimensional analyses also examined the relationship between percentage of days spent in unsheltered locations and cognition, clinical symptoms, and community integration. Sheltered and unsheltered Veterans with psychosis did not differ on clinical symptoms or community integration, but there was an inconsistent group difference on cognition depending on the threshold used for determining housing stability. In the unsheltered group, cognitive deficits in overall cognition, visual learning, and social cognition were related to more days spent in unsheltered locations. Rehabilitation efforts targeting specific cognitive deficits may be useful to facilitate greater access to care and successful interventions in this population.

The role of experiential and expressive negative symptoms on job obtainment and work outcome in individuals with schizophrenia.

Unemployment rates for schizophrenia are high across all age groups compared to the general population. Past studies have focused on neurocognition as a key determinant of unemployment and poor work outcome in schizophrenia. However, several recent studies suggest that clinical symptoms may be equally or more important than cognitive dysfunction for understanding employment difficulties. An enhanced understanding of the domains of negative symptoms that hinder job obtainment and work outcomes in people with schizophrenia is vital for developing treatments that translate into better employment outcomes. The purpose of this study was to determine whether 112 participants with schizophrenia or schizoaffective disorder receiving supported employment services differed on experiential and expressive negative symptoms based on whether they obtained a job or remained unemployed. Further, in a subset of workers, this study examined the relationship of experiential "motivational" negative symptoms with work outcomes (weeks worked, hours worked, wages earned). Neurocognition was assessed using the MATRICS Consensus Cognitive Battery and clinical symptoms were assessed using the Scale for the Assessment of Negative Symptoms and the Brief Psychiatric Rating Scale. Experiential, but not expressive, negative symptoms were related to job obtainment, hours worked, and wages earned. However, these findings were attenuated and non-significant after controlling for age. These results suggest that experiential negative symptoms are potentially key to better understanding employment outcomes of individuals with schizophrenia receiving supported employment services, but further work is needed to untangle its significance vis-à-vis other individual, environmental, and program factors.

Predictors of employment in schizophrenia: The importance of intrinsic and extrinsic motivation.

Unemployment is a primary functional deficit for the majority of adults with schizophrenia. Research indicates that over two-thirds of adults living in the community with schizophrenia are unemployed. Despite effective programs to assist with job identification and placement, the ability to attain and maintain employment remains a pressing concern. A contributing factor that may be relevant but has received little attention in the work rehabilitation literature is motivation. People with schizophrenia show marked deficits in both intrinsic and extrinsic motivation but these deficits have not been directly examined in relation to work outcomes. The present study sought to examine the relationship between intrinsic and extrinsic motivation and work outcome among a sample of 65 adults with schizophrenia enrolled in a supported employment program. One-third of the participants in the study obtained work. Intrinsic motivation related to valuing and feeling useful in a work role significantly predicted who would obtain employment. Extrinsic motivation related to gaining rewards and avoiding obstacles showed a non-significant trend-level relationship such that workers had higher extrinsic motivation than nonworkers. These findings highlight the importance of considering both intrinsic and extrinsic motivation in work-related interventions and supported employment for individuals with schizophrenia. The results are discussed in terms of clinical implications for improving rehabilitation and occupational outcomes in schizophrenia.

Patterns and reliability of EEG during error monitoring for internal versus external feedback in schizophrenia.

BACKGROUND: Accurately monitoring one's performance on daily life tasks, and integrating internal and external performance feedback are necessary for guiding productive behavior. Although internal feedback processing, as indexed by the error-related negativity (ERN), is consistently impaired in schizophrenia, initial findings suggest that external performance feedback processing, as indexed by the feedback negativity (FN), may actually be intact. The current study evaluated internal and external feedback processing task performance and test-retest reliability in schizophrenia. METHODS: 92 schizophrenia outpatients and 63 healthy controls completed a flanker task (ERN) and a time estimation task (FN). Analyses examined the ΔERN and ΔFN defined as difference waves between correct/positive versus error/negative feedback conditions. A temporal principal component analysis was conducted to distinguish the ΔERN and ΔFN from overlapping neural responses. We also assessed test-retest reliability of ΔERN and ΔFN in patients over a 4-week interval. RESULTS: Patients showed reduced ΔERN accompanied by intact ΔFN. In patients, test-retest reliability for both ΔERN and ΔFN over a four-week period was fair to good. CONCLUSION: Individuals with schizophrenia show a pattern of impaired internal, but intact external, feedback processing. This pattern has implications for understanding the nature and neural correlates of impaired feedback processing in schizophrenia.

The "Right Stuff" Revisited: What Have We Learned About the Determinants of Daily Functioning in Schizophrenia?

It has been about 15 years since we published our article asking whether we are measuring the "Right Stuff" as we search for predictors and determinants of functional outcome in schizophrenia. At that time, we raised the question as to whether the neurocognitive assessments used to study outcome in schizophrenia were too narrow to capture the wide variability in factors that determine daily functioning. While the study of the determinants of functioning in schizophrenia has grown and matured, we are struck by 3 aspects of the article that evolved in different directions. First, the selection of outcome domains in the Right Stuff meta-analysis reflects a focus at that time on predictors of psychiatric rehabilitation. Second, expansion beyond traditional neurocognitive domains occurred in one suggested area (social cognition), but not another (learning potential). Third, the field has responded assertively to the recommendation to evaluate more informed and informative theoretical models.

The processing of emotional stimuli during periods of limited attentional resources in schizophrenia.

When participants are asked to attend to two target stimuli in a rapid serial visual presentation sequence, the successful identification of the 1st target (T1) leads to transient impairment in reporting the 2nd target (T2)--this effect is known as the attentional blink (AB). In healthy individuals, this AB effect is either diminished or accentuated when emotional stimuli are presented in the T2 or T1 positions, respectively, suggesting that affective content influences bottom-up (i.e., exogenous) attention. In the current study, we conducted two separate experiments using the Emotional Attentional Blink paradigm where emotional words were presented in the T2 or T1 position to determine whether schizophrenia patients with high and low negative symptoms differ from controls in the extent to which emotional stimuli influence bottom-up attentional processes. Participants included 33 schizophrenia patients and 28 controls in Experiment 1 (T2 Task), and 30 schizophrenia patients and 24 controls in Experiment 2 (T1 Task). In both experiments, patients were divided into high (HI-NEG) and low (LOW-NEG) negative symptom subgroups using the Scale for the Assessment of Negative Symptoms. Results of Experiment 1 indicated that controls and LOW-NEG patients displayed the typical pattern of AB sparing at early lags for emotional relative to neutral words; however, HI-NEG patients showed no difference in T2 accuracy between emotional and neutral stimuli. Results of Experiment 2 indicated that controls and LOW-NEG patients displayed reduced T2 accuracy following unpleasant T1 stimuli, while HI-NEG patients showed no decrement in T2 accuracy after emotional T1s. Across both experiments, findings suggest that emotional stimuli have a bottom-up competitive advantage in LOW-NEG patients and controls; however, this bottom-up advantage is absent in HI-NEG patients.

Looking at the other side of the coin: a meta-analysis of self-reported emotional arousal in people with schizophrenia.

Abnormalities in emotional experience have long been viewed as core features of schizophrenia. Numerous studies indicate that people with schizophrenia report less pleasure than controls when reporting non-current feelings using trait, hypothetical, prospective, and retrospective emotional self-report formats; however, current research has demonstrated that schizophrenia patients and controls do not differ in their subjective reactions to emotional stimuli in most laboratory studies. Although substantial attention has been paid to studies examining self-reported valence in schizophrenia, subjective reports of arousal in response to affective stimuli have been neglected. Understanding the role of arousal in schizophrenia is imperative given that valence and arousal are differentially associated with physiological and behavioral responses. To understand the role of self-reported arousal, a meta-analysis of 26 published studies employing laboratory emotion induction paradigms in patients with schizophrenia and healthy controls was conducted. Medline, PsycINFO, Web of Science, and PubMed electronic databases and reference lists from identified articles were used as data sources. Using a random effects model, analyses demonstrated that controls and people with schizophrenia reported similar levels of subjective arousal in response to pleasant and unpleasant stimuli; however, people with schizophrenia reported experiencing greater arousal than controls in response to neutral stimuli. Furthermore, moderator analyses suggested that gender and methodological factors, such as rating scale and stimulus type, may affect these patterns of results and play a key role in determining whether patients and controls differ in self-reported arousal.

Social anhedonia and affiliation: examining behavior and subjective reactions within a social interaction.

Social anhedonia is a promising indicator for the vulnerability towards developing schizophrenia-spectrum disorders and is an important determinant of the social impairment associated with these disorders. It is unknown if social anhedonia is associated with true deficits in experiential reactions or if lower social functioning in social anhedonia reflects behavioral deficits in social skill or initiation of social contact. Using a novel social interaction task, the current study compared controls (n=60) to individuals elevated on social anhedonia (n=49) on observer-rated social skill and facial affect and participant self-reports of their experiential reactions to an affiliative interaction. Compared to the control group, the social anhedonia group was rated as behaviorally less affiliative and less socially skilled during the affiliative interaction. In response to the social interaction, the social anhedonia group reported less change in positive affect, less willingness to engage in future social interactions with the interaction partner, and less positive reactions toward the interaction partner compared to controls. There were no group differences in facial displays of emotion. Using a standardized affiliative stimulus, it was demonstrated that individuals high in social anhedonia have alterations in both their social skill and in their self-reported experiential reactions during a social interaction.

Screening for negative symptoms: preliminary results from the self-report version of the Clinical Assessment Interview for Negative Symptoms.

Though negative symptoms in schizophrenia are associated with a host of deleterious outcomes (e.g., White et al., 2009), not all individuals with schizophrenia suffer from negative symptoms (e.g., Blanchard et al., 2005). Thus, methods to quickly screen and identify patients for more intensive clinical interview assessments may have significant clinical and research utility. The present study is a preliminary examination of the reliability and validity of a self-report version of the newly developed Clinical Assessment Interview for Negative Symptoms (CAINS; Blanchard et al., 2011; Forbes et al., 2010; Horan et al., 2011). The CAINS-SR is a 30-item self-report measure that assesses Experiential (avolition, anhedonia, asociality) and Expressive (blunted affect, alogia) domains of negative symptoms. Participants (N = 69) completed the CAINS-SR questionnaire and were evaluated with symptom interviews using the CAINS and other non-negative symptom interviews that assessed psychotic, affective, and other symptoms. The Experience subscale of the CAINS-SR demonstrated good internal consistency, convergent validity, and discriminant validity, while the poorer psychometric properties of the Expression subscale suggest that self-report of negative symptoms should focus on the experiential domain. Overall, preliminary findings indicate that the CAINS-SR (addressing experiential deficits) may be a useful complement to the clinician-rated interview measure. Future research on the sensitivity and specificity of the CAINS-SR will determine its suitability as a screening measure.

Attentional disengagement from emotional stimuli in schizophrenia.

Previous research indicates that abnormal attention-emotion interactions are related to symptom presentation in individuals with schizophrenia. However, the individual components of attention responsible for this dysfunction are unclear. In the current study we examined the possibility that schizophrenia patients with higher levels of negative symptoms (HI-NEG: n=14) have greater difficulty disengaging attention from unpleasant stimuli than patients with low negative symptoms (LOW-NEG: n=18) or controls (CN: n=27). Participants completed an exogenous emotional cueing task that required them to focus on an initial emotional or neutral cue and subsequently shift attention to a separate location outside of foveal vision to detect a target stimulus (letter). Results indicated that HI-NEG patients had greater difficulty disengaging attention from unpleasant stimuli than CN or LOW-NEG patients; however, behavioral performance did not differ among the groups for pleasant stimuli. Higher self-reported trait negative affect was also associated with greater difficulty disengaging attention from unpleasant stimuli. Abnormalities in disengaging attention from unpleasant stimuli may thus play a critical role in the formation and maintenance of both negative symptoms and trait negative affect in individuals with schizophrenia.

Is social anhedonia related to emotional responsivity and expressivity? A laboratory study in women.

Social anhedonia is an important feature of schizophrenia and it is a promising indicator of schizotypy. Although social anhedonia is defined as an affective construct (less pleasure derived from social encounters), little is known about the emotional responsivity and expressivity of individuals with high levels of social anhedonia. After screening a large sample of female undergraduate students (N = 1 085), a cohort of psychometrically identified individuals with high levels of social anhedonia (n = 34) and normally hedonic controls (n = 45) participated in laboratory assessments involving trait affectivity, self-reported dispositional emotional expressiveness, and the expression and experience of emotion in response to neutral, non-affiliative (i.e., comedy) and affiliative film clips. Results revealed that individuals with high levels of social anhedonia are characterized by lower positive affect, both as a trait and in response to emotionally evocative stimuli, and are less facially expressive, both by their own self-report and in response to film clips. Attenuated positive affect was observed across film stimuli, indicating a general reduction in affective response rather than a specific decrease in responsivity for affiliative stimuli. Future work should continue to investigate whether there is a unique role for social stimuli in the emotional lives of individuals with high levels of social anhedonia or whether these individuals tend to experience anhedonia more broadly regardless of social context.