Social anhedonia and clinical outcomes in early adulthood: A three-year follow-up study within a community sample.

Social anhedonia has been employed in psychometric high risk studies to identify putative schizotypes. The current study reports three-year longitudinal results from a community study of social anhedonia: the Maryland Longitudinal Study of Schizotypy (MLSS). The initial recruitment for the MLSS involved mailed questionnaire screening of 2434 18-year olds. Baseline and three-year follow-up laboratory assessments were subsequently conducted with individuals identified as being high in social anhedonia (N = 79) and a comparison sample (N = 79). Across the assessments both groups showed maturational improvement on all clinical symptom measures with declining symptom severity at the follow-up compared to baseline and there were no group differences in personality disorder diagnoses at follow-up. However, compared to the control group, over the three-year follow-up individuals in the social anhedonia group were found to have elevated schizophrenia-spectrum personality disorder (Cluster A) characteristics, greater negative symptom characteristics, and lower global functioning. The social anhedonia group also had lower educational attainment, higher unemployment, and higher rates of mental health service utilization than did the control group. Within the social anhedonia group, social support and family relationships were cross-sectionally related to symptom severity at follow-up, although social support and family variables from baseline were not predictive of clinical symptom outcomes at follow-up. Results indicate that social anhedonia is associated with persistent schizophrenia-spectrum symptoms and functional impairment in early adulthood.

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.

Internalized stigma in schizophrenia: relations with dysfunctional attitudes, symptoms, and quality of life.

Internalized stigma refers to the process by which individuals with mental illness apply negative stereotypes to themselves, expect to be rejected by others, and feel alienated from society. Though internalized stigma has been hypothesized to be associated with maladaptive cognitions and expectations of failure, this relationship with dysfunctional attitudes has not been fully examined. In the present study, 49 individuals with schizophrenia or schizoaffective disorder completed the Internalized Stigma of Mental Illness Scale (ISMI; Ritsher et al., 2003) in addition to measures tapping defeatist performance beliefs, beliefs regarding low likelihood of success and limited resources, negative symptoms, depression, and quality of life. Consistent with prior research, internalized stigma was correlated with depression and quality of life but not with negative symptoms. Further, internalized stigma was correlated with both measures of dysfunctional attitudes. After controlling for depressive symptomatology, the relationship between internalized stigma and beliefs regarding low likelihood of success and limited resources remained significant, and though the correlation between defeatist performance beliefs and internalized stigma was no longer significant, it was of a similar magnitude. Overall, these data suggest that dysfunctional attitudes play a role in internalized stigma in individuals with schizophrenia, indicating a possible point of intervention.

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.

Neuropsychological functioning and social anhedonia: three-year follow-up data from a longitudinal community high risk study.

Social anhedonia is a promising vulnerability marker for schizophrenia-spectrum pathology. Prior research has demonstrated that individuals with psychometrically-defined social anhedonia show a range of "schizophrenia-like" neurocognitive abnormalities. However, this research is limited in that it is based largely on the study of college students. The present article reports findings from a longitudinal study of social anhedonia recruited from a community sample. As part of this study, a neurocognitive battery was administered at baseline and at three-year follow-up sessions to participants with (n = 78) versus without (n = 77) social anhedonia. Additional measures of global functioning and schizotypal, schizoid and paranoid schizophrenia-spectrum symptoms were also administered. Across groups, subjects showed significant improvement in neurocognitive functioning over time. Compared to controls, at follow-up, individuals with social anhedonia showed significantly poorer attentional vigilance and simple processing speed, but failed to evidence impairments in immediate or delayed verbal memory, immediate or delayed visual memory, visual or verbal working memory, olfaction or executive abilities. At follow-up, within the social anhedonia group, schizoid (and to a lesser extent, schizotypal) symptom severity was associated with a range of neurocognitive impairments. Neurocognitive impairments were generally not associated with paranoid symptoms or global functioning. Baseline neurocognitive performance was not significantly predictive of follow-up symptom severity or functioning. Collectively, these findings suggest that neurocognitive dysfunctions only characterize a subset of individuals with social anhedonia.

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.

Negative expectancy appraisals and defeatist performance beliefs and negative symptoms of schizophrenia.

Negative symptoms have clear functional implications in schizophrenia and are typically unresponsive to current treatments. The cognitive model of negative symptoms suggests that dysfunctional beliefs are influential in the development and maintenance of negative symptoms and schizophrenia. The current study reports on a preliminary investigation of a new measure of Negative Expectancy Appraisals (specifically beliefs about limited probability of success and perception of limited cognitive resources), and also evaluates whether dysfunctional beliefs are more closely linked to particular subdomains of negative symptoms. Sixty two individuals with schizophrenia completed measures of dysfunctional beliefs and were rated on negative symptoms. Analyses indicated that the endorsement of beliefs regarding low expectations for success and perception of limited resources (Negative Expectancy Appraisals) are robustly associated with diminished experience negative symptoms (avolition, asociality, and anhedonia), but are not associated with negative symptoms reflecting diminished expressivity (blunted affect, alogia). Similarly, Defeatist Performance Beliefs are modestly related to diminished experience, but not diminished expression, negative symptoms. Negative Expectancy Appraisals were also robustly linked to depressive symptoms. Results from the current study provide evidence that dysfunctional beliefs are clearly relevant to consider in relation to negative symptoms, and may represent a fruitful treatment target.

A path model investigation of neurocognition, theory of mind, social competence, negative symptoms and real-world functioning in schizophrenia.

Problems in real-world functioning are pervasive in schizophrenia and much recent effort has been devoted to uncovering factors which contribute to poor functioning. The goal of this study was to examine the role of four such factors: social cognition (theory of mind), neurocognition, negative symptoms, and functional capacity (social competence). 178 individuals with schizophrenia or schizoaffective disorder completed measures of theory of mind, neurocognition, negative symptoms, social competence, and self-reported functioning. Path models sought to determine the relationships among these variables. Theory of mind as indexed by the Hinting Task partially mediated the relationship between neurocognition and social competence, and negative symptoms and social competence demonstrated significant direct paths with self-reported functioning. Study results suggest theory of mind serves as an important mediator in addition to previously investigated social cognitive domains of emotional and social perception. The current study also highlights the need to determine variables which mediate the relationship between functional capacity and real-world functioning.

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.

Assessment of social judgments and complex mental states in the early phases of psychosis.

OBJECTIVES: Social cognition plays an important role in the functioning of individuals with psychosis. In this study, we explored two areas of social cognition not previously investigated early in the course of psychosis. METHOD: Eighty-eight clinical high risk participants, 26 participants diagnosed with schizophrenia for less than 5 years, and 41 non-clinical control participants completed two measures of social cognition. RESULTS: Clinical high risk participants demonstrated biased responses to untrustworthy faces compared to both of the other groups. Early schizophrenia participants performed more poorly on an advanced theory of mind task compared to the clinical high risk and control groups. CONCLUSIONS: There are different patterns of performance on social cognitive tasks in these groups, which require further examination in longitudinal studies.

Orienting to social stimuli differentiates social cognitive impairment in autism and schizophrenia.

Both autism and schizophrenia feature deficits in aspects of social cognition that may be related to amygdala dysfunction, but it is unclear whether these are similar or different patterns of impairment. We compared the visual scanning patterns and emotion judgments of individuals with autism, individuals with schizophrenia and controls on a task well characterized with respect to amygdala functioning. On this task, eye movements of participants are recorded as they assess emotional content within a series of complex social scenes where faces are either included or digitally erased. Results indicated marked abnormalities in visual scanning for both disorders. Controls increased their gaze on face regions when faces were present to a significantly greater degree than both the autism or schizophrenia groups. While the control and the schizophrenia groups oriented to face regions faster when faces were present compared to when they were absent, the autism group oriented at the same rate in both conditions. The schizophrenia group, meanwhile, exhibited a delay in orienting to face regions across both conditions, although whether anti-psychotic medication contributed to this effect is unclear. These findings suggest that while processing emotional information in social scenes, both individuals with autism and individuals with schizophrenia fixate faces less than controls, although only those with autism fail to orient to faces more rapidly based on the presence of facial information. Autism and schizophrenia may therefore share an abnormality in utilizing facial information for assessing emotional content in social scenes, but differ in the ability to seek out socially relevant cues from complex stimuli. Impairments in social orienting are discussed within the context of evidence suggesting the role of the amygdala in orienting to emotionally meaningful information.

The functional significance of social cognition in schizophrenia: a review.

Deficits in a wide array of functional outcome areas (eg, social functioning, social skills, independent living skills, etc) are marked in schizophrenia. Consequently, much recent research has attempted to identify factors that may contribute to functional outcome; social cognition is one such domain. The purpose of this article is to review research examining the relationship between social cognition and functional outcome. Comprehensive searches of PsycINFO and MEDLINE/PUBMED were conducted to identify relevant published manuscripts to include in the current review. It is concluded that the relationship between social cognition and functional outcome depends on the specific domains of each construct examined; however, it can generally be concluded that there are clear and consistent relationships between aspects of functional outcome and social cognition. These findings are discussed in light of treatment implications for schizophrenia.

Do baseline client characteristics predict the therapeutic alliance in the treatment of schizophrenia?

This study examined clinical predictors of client and therapist alliance ratings early in therapy, the relationship between client and therapist alliance ratings, and the psychometric properties of the Working Alliance Inventory in individuals with schizophrenia receiving manual-based treatment. Assessment of clinical symptoms and social functioning were conducted at baseline, and alliance ratings were obtained at 5 weeks. The Working Alliance Inventory had high internal consistency, but there were low correlations between client and therapist ratings. Results also indicated that social functioning and the activation and autistic preoccupation factors on the Positive and Negative Syndrome Scale were significant predictors of therapists' alliance ratings. There were no significant relationships between clinical predictors and clients' therapeutic alliance ratings. The findings indicate that client interpersonal factors are significant predictors of the therapist-rated alliance in the treatment of schizophrenia. Low correlations between clients' and therapists' ratings of the alliance should be examined in future research.