Shoulder Proprioception: A Review.

The purpose of this review is to provide a comprehensive resource for shoulder proprioception assessment and its integration into clinical decision making as well as targeted rehabilitation protocols. Data for this review were acquired from peer-reviewed articles from computerized online databases, namely PubMed and Medline, published between 1906 and 2021. The development of digital/smart phone goniometers can improve shoulder joint range of motion (ROM) measurements and demonstrate comparable measurement accuracy to the universal standard goniometer. The inclinometer offers a portable and cost-effective method for measuring shoulder joint angles and arcs of motion in the vertical plane. Two types of dynamometers, the computerized isokinetic machine and the handheld hydraulic dynamometer, are reliable tools for objective shoulder rotator cuff strength assessment. Motion analysis systems are highly advanced modalities that create three-dimensional models of motion arcs using a series of cameras and reflective beads, offering unparalleled precision in shoulder proprioception measurement; however, they require time-consuming calibration and skilled operators. Advancements in wearable devices and compact mobile technology such as iPhone applications may make three-dimensional motion analysis more affordable and practical for outpatient settings in the future. The complex interplay between proprioception and shoulder dysfunction is not fully understood; however, shoulder proprioception can likely both contribute to and be caused by shoulder pathology. In patients with rotator cuff tears, glenohumeral osteoarthritis, and shoulder instability, clinicians can track proprioception to understand a patient's disease progression or response to treatment. Finally, rehabilitation programs targeting shoulder proprioception have shown promising initial results in restoring function and returning athletes to play.

Empathy and Schizotypy: A Network Comparison of the Interpersonal Reactivity Index in High and Low Schizotypy Groups.

Empathy is a multifaceted concept that is vital to effective social functioning; yet, it is impaired in high schizotypy groups. Furthermore, empathy has been found to be a mediator in the relationship between schizotypy and social functioning, highlighting the importance of empathy as a driver in social outcomes. Despite this, the four-factor structure of a widely-used measure of empathy-the Interpersonal Reactivity Index (IRI)-has been found to be psychometrically weak in high schizotypy samples. As such, this study aimed to assess differences in the item-level network of the IRI between high (n = 427) and low schizotypy groups (n = 470). The results reveal that there are significant differences in the structure of these networks, though they evidence similar strengths. Within the high schizotypy group, the network structure was consistent with the four-factor structure of the IRI subscales; items from each subscale clustered together and were distinct from those in the other subscales. By contrast, the low schizotypy group evidenced six clusters that did not mirror the IRI subscales. These results suggest that the item-level structure of the IRI is dependent upon the level of schizotypy of the sample, with the high schizotypy group's network functioning similarly to what would be expected from the original four-factor structure.

Distal Fibular Metastasis of Colorectal Carcinoma: A Case Report.

Case: A 62-year-old woman presenting with ankle pain was initially treated for a non-displaced fracture. Persistent pain despite months of conservative management for her presumed injury prompted repeat radiographs which demonstrated the progression of a lytic lesion and led to an orthopedic oncology referral. Following a complete work-up, including biopsy and staging, she was diagnosed with colorectal carcinoma metastatic to the distal fibula. Conclusion: Secondary tumors of the fibula are uncommon but an important diagnosis to consider for intractable lower extremity pain especially in patients with history of malignancy or lack of age-appropriate cancer screening.

Global reward processing deficits predict negative symptoms transdiagnostically and transphasically in a severe mental illness-spectrum sample.

Reward processing impairments are a key factor associated with negative symptoms in those with severe mental illnesses. However, past findings are inconsistent regarding which reward processing components are impaired and most strongly linked to negative symptoms. The current study examined the hypothesis that these mixed findings may be the result of multiple reward processing pathways (i.e., equifinality) to negative symptoms that cut across diagnostic boundaries and phases of illness. Participants included healthy controls (n = 100) who served as a reference sample and a severe mental illness-spectrum sample (n = 92) that included psychotic-like experiences, clinical high-risk for psychosis, bipolar disorder, and schizophrenia participants. All participants completed tasks measuring four RDoC Positive Valence System constructs: value representation, reinforcement learning, effort-cost computation, and hedonic reactivity. A k-means cluster analysis of the severe mental illness-spectrum samples identified three clusters with differential reward processing profiles that were characterized by: (1) global reward processing deficits (22.8%), (2) selective impairments in hedonic reactivity alone (40.2%), and (3) preserved reward processing (37%). Elevated negative symptoms were only observed in the global reward processing cluster. All clusters contained participants from each clinical group, and the distribution of these groups did not significantly differ among the clusters. Findings identified one pathway contributing to negative symptoms that was transdiagnostic and transphasic. Future work further characterizing divergent pathways to negative symptoms may help to improve symptom trajectories and personalized treatments.

Revision Total Knee Arthroplasty for Catastrophic Tibial Post Failure: Rare Complication of Total Knee Replacement.

Tibial post failure is a rare but serious complication of posterior-stabilized total knee arthroplasty that requires revision surgery. Although tibial post fracture has previously been reported, this case involves an implant with a design feature that may predispose patients to the complication. The fracture also occurred later than observed in most other reports. A 72-year-old male who had undergone a posterior stabilized total knee arthroplasty seven years prior presented with knee pain and instability after a fall from standing. Although plain radiographs were not diagnostic, history and physical exam suggested failure of the tibial polyethylene post. This was confirmed during surgery when the fractured component was identified in the suprapatellar pouch. Given absence of malrotation or malalignment of the well-fixed femoral and tibial components, a polyethylene liner exchange was performed. Postoperatively, the patient had complete resolution of pain and instability with 0-120 degrees of stable ROM, which has persisted to latest follow-up at 6 months.

Comparing a Computerized Digit Symbol Test to a Pen-and-Paper Classic.

Background and Hypothesis: Processing speed dysfunction is a core feature of psychosis and predictive of conversion in individuals at clinical high risk (CHR) for psychosis. Although traditionally measured with pen-and-paper tasks, computerized digit symbol tasks are needed to meet the increasing demand for remote assessments. Therefore we: (1) assessed the relationship between traditional and computerized processing speed measurements; (2) compared effect sizes of impairment for progressive and persistent subgroups of CHR individuals on these tasks; and (3) explored causes contributing to task performance differences. Study Design: Participants included 92 CHR individuals and 60 healthy controls who completed clinical interviews, the Brief Assessment of Cognition in Schizophrenia Symbol Coding test, the computerized TestMyBrain Digit Symbol Matching Test, a finger-tapping task, and a self-reported motor abilities measure. Correlations, Hedges' g, and linear models were utilized, respectively, to achieve the above aims. Study Results: Task performance was strongly correlated (r = 0.505). A similar degree of impairment was seen between progressive (g = -0.541) and persistent (g = -0.417) groups on the paper version. The computerized task uniquely identified impairment for progressive individuals (g = -477), as the persistent group performed similarly to controls (g = -0.184). Motor abilities were related to the computerized version, but the paper version was more related to symptoms and psychosis risk level. Conclusions: The paper symbol coding task measures impairment throughout the CHR state, while the computerized version only identifies impairment in those with worsening symptomatology. These results may be reflective of sensitivity differences, an artifact of existing subgroups, or evidence of mechanistic differences.

Investigating the relationship between specific negative symptoms and metacognitive functioning in psychosis: A systematic review.

BACKGROUND: Disrupted metacognition is implicated in development and maintenance of negative symptoms, but more fine-grained analyses would inform precise treatment targeting for individual negative symptoms. AIMS: This systematic review identifies and examines datasets that test whether specific metacognitive capacities distinctly influence negative symptoms. MATERIALS & METHODS: PsycINFO, EMBASE, Medline and Cochrane Library databases plus hand searching of relevant articles, journals and grey literature identified quantitative research investigating negative symptoms and metacognition in adults aged 16+ with psychosis. Authors of included articles were contacted to identify unique datasets and missing information. Data were extracted for a risk of bias assessment using the Quality in Prognostic Studies tool. RESULTS: 85 published reports met criteria and are estimated to reflect 32 distinct datasets and 1623 unique participants. The data indicated uncertainty about the relationship between summed scores of negative symptoms and domains of metacognition, with significant findings indicating correlation coefficients from 0.88 to -0.23. Only eight studies investigated the relationship between metacognition and individual negative symptoms, with mixed findings. Studies were mostly moderate-to-low risk of bias. DISCUSSION: The relationship between negative symptoms and metacognition is rarely the focus of studies reviewed here, and negative symptom scores are often summed. This approach may obscure relationships between metacognitive domains and individual negative symptoms which may be important for understanding how negative symptoms are developed and maintained. CONLCLUSION: Methodological challenges around overlapping participants, variation in aggregation of negative symptom items and types of analyses used, make a strong case for use of Individual Participant Data Meta-Analysis to further elucidate these relationships.

The role of defeatist performance beliefs on cognitive effort-cost decision-making in schizophrenia.

Impairments in effort-cost decision-making have been consistently observed in people with schizophrenia (SZ) and may be an important mechanism of negative symptoms. However, the processes that give rise to impairments in effort-cost decision-making are unclear, leading to limited progress in identifying the most relevant treatment targets. Drawing from cognitive models of negative symptoms and goal-directed behavior, this study aimed to examine how and under what type of task conditions defeatist performance beliefs contribute to these decision-making processes. Outpatients with SZ (n = 30) and healthy controls (CN; n = 28) completed a cognitive effort allocation task, the Cognitive Effort-Discounting (COGED) task, which assesses participants' willingness to exert cognitive effort for monetary rewards based on parametrically varied working memory demands (completing N-back levels). Results showed that although participants with SZ demonstrated reduced willingness to work for rewards across N-back levels compared to CN participants, they showed less choice modulation across different N-back conditions. However, among SZ participants with greater defeatist performance beliefs, there was a reduced willingness to choose the high effort option at higher N-back levels (N-back levels 3, 4, and 5 versus 2-back). Results suggest that compared to CN, the SZ group's subjective willingness to expend effort largely did not dynamically adjust as cognitive load increased. However, defeatist beliefs may undermine willingness to expend cognitive effort, especially when cognitive task demands are high. These beliefs may be a viable treatment target to improve effort-cost decision-making impairments in people with SZ.

Ecological Momentary Assessment Of State Fluctuations In Mindfulness And Symptoms In Psychotic Disorders.

Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness. To address these limitations, the current study used ecological momentary assessment (EMA) to evaluate state levels of two mindfulness skills, acceptance and monitoring, and their association with state fluctuations in symptoms. Participants included individuals with affective and non-affective psychotic disorders (PD; n = 49) and healthy controls (CN; n = 53) who completed six days of EMA. Results indicated that the PD group endorsed lower state acceptance than CN; however, the groups did not significantly differ in monitoring. Further, greater state mindfulness skills in both acceptance and monitoring were associated with greater positive affect, reduced negative affect, and reduced negative symptoms. However, participants with a predominantly affective psychosis presentation showed differential effects compared to those with non-affective presentations. These findings suggest that mindfulness training for people with psychotic disorders may benefit from focusing on improving acceptance in order to improve emotional experience and build on existing monitoring skills. Further, mindfulness based psychosocial interventions may offer a novel means of treating negative symptoms in people with PD, which are currently stalled and largely unresponsive to other treatments.

Investigating the relationship between negative symptoms and metacognitive functioning in psychosis: An individual participant data meta-analysis.

PURPOSE: Negative symptoms are a persistent, yet under-explored problem in psychosis. Disturbances in metacognition are a potential causal factor in negative symptom development and maintenance. This meta-analysis uses individual participant data (IPD) from existing research to assess the relationship between negative symptoms and metacognition treated as summed scores and domains. METHODS: Data sets containing individuals with negative symptoms and metacognition data, aged 16+ with psychosis, were identified according to pre-specific parameters. IPD integrity and completeness were checked and data were synthesized in two-stage meta-analyses of each negative symptoms cluster compared with metacognition in seemingly unrelated regression using restricted maximum likelihood estimation. Planned and exploratory sensitivity analyses were also conducted. RESULTS: Thirty-three eligible data sets were identified with 21 with sufficient similarity and availability to be included in meta-analyses, corresponding to 1301 participants. The strongest relationships observed were between summed scores of negative symptoms and metacognition. Metacognitive domains of self-reflectivity and understanding others' minds, and expressive negative symptoms emerged as significant in some meta-analyses. The uncertainty of several effect estimates increased significantly when controlling for covariates. CONCLUSIONS: This robust meta-analysis highlights the impact of using summed versus domain-specific scores of metacognition and negative symptoms, and relationships are not as clear-cut as once believed. Findings support arguments for further differentiation of negative symptom profiles and continued granular exploration of the relationship between metacognition and negative symptoms.

Markov chain analysis indicates that positive and negative emotions have abnormal temporal interactions during daily life in schizophrenia.

Abnormalities in positive and negative emotional experience have been identified in laboratory-based studies in schizophrenia (SZ) and associated with poorer clinical outcomes. However, emotions are not static in daily life-they are dynamic processes that unfold across time and are characterized by temporal interactions. Whether these temporal interactions are abnormal in SZ and associated with clinical outcomes is unclear (i.e., whether the experience of positive/negative emotions at time t increases or decreases the intensity of positive/negative emotions at time t+1). In the current study, participants with SZ (n = 48) and healthy controls (CN; n = 52) completed 6 days of ecological momentary assessment (EMA) surveys that sampled state emotional experience and symptoms. The EMA emotional experience data was submitted to Markov chain analysis to evaluate transitions among combined positive and negative affective states from time t to t+1. Results indicated that: (1) In SZ, the emotion system is more likely to stay in moderate or high negative affect states, regardless of positive affect level; (2) SZ transition to co-activated emotional states more than CN, and once emotional co-activation occurs, the range of emotional states SZ transition to is more variable than CN; (3) Maladaptive transitions among emotional states were significantly correlated with greater positive symptoms and poorer functional outcome in SZ. Collectively, these findings clarify how emotional co-activation occurs in SZ and its effects on the emotion system across time, as well as how negative emotions dampen the ability to sustain positive emotions across time. Treatment implications are discussed.

Negative symptoms in the clinic: we treat what we can describe.

Recent research has led to important changes in the concepts and assessment of negative symptoms in schizophrenia. We review current negative symptom concepts and their clinical implications, as well as new methods of assessing these symptoms. These changes hold promise for improving our understanding and treatment of negative symptoms.

Temporal Interactions Between Social Motivation and Behavior In Daily Life Among Individuals at Clinical High-Risk for Psychosis.

BACKGROUND AND HYPOTHESES: Poor social functioning is common among individuals at clinical high-risk (CHR) for psychosis and is associated with greater likelihood of conversion. Unfortunately, processes contributing to social impairment are unclear, making social functioning difficult to improve via treatment. The current study examined whether abnormalities in social functioning result from aberrant temporal interactions between social motivation and behavior. STUDY DESIGN: Participants included 105 individuals at CHR and 62 healthy controls (CN) who completed 6 days of ecological momentary assessment. Multilevel models examined time-lagged interactions between social behavior and motivation. STUDY RESULTS: CHR and CN did not differ in social motivation; however, CHR were less likely to interact with family and coworkers and more likely to engage in interactions via phone and text/social media. Autocorrelations indicated that social behavior and motivation were generally consistent across time in CHR and CN groups. Time-lagged analyses indicated that both groups had an increase in social motivation across time when they were alone and a decrease in social motivation across time when they were with others. However, the relative decrease when with others and increase when alone were less robust in CHR than CN, particularly for in-person interactions. Social motivation at time t did not differentially impact social partner or modality at time t+1 in the groups. CONCLUSIONS: Findings suggest that social behavior and motivation have different temporal interactions in CHR and CN. Psychosocial interventions may benefit from targeting the frequency of social behavior with specific partners and modalities to change social motivation.

Network analysis of discrete emotional states measured via ecological momentary assessment in schizophrenia.

Prior studies demonstrate that schizophrenia (SZ) is associated with abnormalities in positive and negative emotional experience that predict clinical presentation. However, it is unclear whether specific discrete emotions within the broader positive/negative categories are driving those symptom associations. Further, it is also unclear whether specific emotions contribute to symptoms in isolation or via networks of emotional states that dynamically interact across time. The current study used network analysis to evaluate temporally dynamic interactions among discrete emotional states experienced in the real world as assessed via Ecological Momentary Assessment (EMA). Participants included 46 outpatients with chronic SZ and 52 demographically matched healthy controls (CN) who completed 6 days of EMA that captured reports of emotional experience and symptoms derived from monetary surveys and geolocation based symptom markers of mobility and home location. Results indicated that less dense emotion networks were associated with greater severity of negative symptoms, whereas more dense emotion networks were associated with more severe positive symptoms and mania. Additionally, SZ evidenced greater centrality for shame, which was associated with greater severity of positive symptoms. These findings suggest that positive and negative symptoms are associated with distinct profiles of temporally dynamic and interactive emotion networks in SZ. Findings have implications for adapting psychosocial therapies to target specific discrete emotional states in the treatment of positive versus negative symptoms.

Negative Symptom Inventory-Self-Report (NSI-SR): Initial development and validation.

Negative symptoms (i.e., anhedonia, avolition, asociality, blunted affect, alogia) are frequently observed in the schizophrenia-spectrum (SZ) and associated with functional disability. While semi-structured interviews of negative symptoms represent a gold-standard approach, they require specialized training and may be vulnerable to rater biases. Thus, brief self-report questionnaires measuring negative symptoms may be useful. Existing negative symptom questionnaires demonstrate that this approach may be promising in schizophrenia, but no measure has been devised for use across stages of psychotic illness. The present study reports initial psychometric validation of the Negative Symptom Inventory-Self-Report (NSI-SR), the self-report counterpart of the Negative Symptom Inventory-Psychosis Risk clinical interview. The NSI-SR is a novel transphasic negative symptoms measure assessing the domains of anhedonia, avolition, and asociality. The NSI-SR and related measures were administered to two samples: 1) undergraduates (n = 335), 2) community participants, including: SZ (n = 32), clinical-high risk for psychosis (CHR, n = 25), and healthy controls matched to SZ (n = 31) and CHR (n = 30). The psychometrically trimmed 11-item NSI-SR showed good internal consistency and a three-factor solution reflecting avolition, asociality, and anhedonia. The NSI-SR demonstrated convergent validity via moderate to large correlations with clinician-rated negative symptoms and related constructs in both samples. Discriminant validity was supported by lower correlations with positive symptoms in both samples; however, correlations with positive symptoms were still significant. These initial psychometric findings suggest that the NSI-SR is a reliable and valid brief questionnaire capable of measuring negative symptoms across phases of psychotic illness.

Environmental context predicts state fluctuations in negative symptoms in youth at clinical high risk for psychosis.

BACKGROUND: Negative symptoms (avolition, anhedonia, asociality) are a prevalent symptom in those across the psychosis-spectrum and also occur at subclinical levels in the general population. Recent work has begun to examine how environmental contexts (e.g. locations) influence negative symptoms. However, limited work has evaluated how environments may contribute to negative symptoms among youth at clinical high risk for psychosis (CHR). The current study uses Ecological Momentary Assessment to assess how four environmental contexts (locations, activities, social interactions, social interaction method) impact state fluctuations in negative symptoms in CHR and healthy control (CN) participants. METHODS: CHR youth (n = 116) and CN (n = 61) completed 8 daily surveys for 6 days assessing negative symptoms and contexts. RESULTS: Mixed-effects modeling demonstrated that negative symptoms largely varied across contexts in both groups. CHR participants had higher negative symptoms than CN participants in most contexts, but groups had similar symptom reductions during recreational activities and phone call interactions. Among CHR participants, negative symptoms were elevated in several contexts, including studying/working, commuting, eating, running errands, and being at home. CONCLUSIONS: Results demonstrate that negative symptoms dynamically change across some contexts in CHR participants. Negative symptoms were more intact in some contexts, while other contexts, notably some used to promote functional recovery, may exacerbate negative symptoms in CHR. Findings suggest that environmental factors should be considered when understanding state fluctuations in negative symptoms among those at CHR participants.

Development and Validation of the Negative Symptom Inventory-Psychosis Risk.

BACKGROUND AND HYPOTHESES: Early identification and prevention of psychosis is limited by the availability of tools designed to assess negative symptoms in those at clinical high-risk for psychosis (CHR). To address this critical need, a multi-site study was established to develop and validate a clinical rating scale designed specifically for individuals at CHR: The Negative Symptom Inventory-Psychosis Risk (NSI-PR). STUDY DESIGN: The measure was developed according to guidelines recommended by the NIMH Consensus Conference on Negative Symptoms using a transparent, iterative, and data-driven process. A 16-item version of the NSI-PR was designed to have an overly inclusive set of items and lengthier interview to support the ultimate intention of creating a new briefer measure. Psychometric properties of the 16-item NSI-PR were evaluated in a sample of 218 CHR participants. STUDY RESULTS: Item-level analyses indicated that men had higher scores than women. Reliability analyses supported internal consistency, inter-rater agreement, and temporal stability. Associations with measures of negative symptoms and functioning supported convergent validity. Small correlations with positive, disorganized, and general symptoms supported discriminant validity. Structural analyses indicated a 5-factor structure (anhedonia, avolition, asociality, alogia, and blunted affect). Item response theory identified items for removal and indicated that the anchor range could be reduced. Factor loadings, item-level correlations, item-total correlations, and skew further supported removal of certain items. CONCLUSIONS: These findings support the psychometric properties of the NSI-PR and guided the creation of a new 11-item NSI-PR that will be validated in the next phase of this multi-site scale development project.

Success in Accessing Fertility Preservation Appointments for Egg-Producing Transgender and Gender-Diverse Patients: A Mystery Caller Study.

Purpose: This study aimed to evaluate access to fertility preservation appointments for egg-producing transgender and gender-diverse patients. Methods: Fertility clinics nationwide were identified through the 2018 National Assisted Reproductive Technology Surveillance System dataset of the Centers for Disease Control and Prevention. Using a mystery caller approach with a standardized, community-developed script, three researchers called 456 clinics between July and December 2020 identifying themselves as a transgender man seeking oocyte cryopreservation. Information was collected regarding access to fertility preservation for the caller. Univariate and multivariable logistic regression analysis were used to compare call outcomes by geographic region and clinic demographics. Results: Of 369 clinics included in the final analysis, 90.2% of clinics offered an initial appointment. A clinic that offered an appointment was four times more likely to be located on the West Coast (95% confidence interval [CI] 1.33-12.7; p = 0.014). Notably, endorsement of prior experience caring for transgender patients was most strongly associated with an appointment being offered (odds ratio = 7.31; 95% CI: 3.44-15.5; p < 0.001). Themes across some calls included a lack of knowledge about transgender identities and care models (e.g., requiring a letter of support) leading to additional steps (e.g., having to explain anatomy or being transferred to another staff member) before accessing an appointment. Conclusion: The majority of clinics offered an initial appointment to a caller identifying as a transgender man seeking oocyte cryopreservation, suggesting access to an initial appointment is not a major barrier.

The association between early traumatic experiences and the five domains of negative symptoms in participants at clinical high risk for psychosis.

AIM: Youth at clinical high risk (CHR) for psychosis have high rates of early life trauma, but it is unclear how trauma exposure impacts later negative symptom severity in CHR. The current study examined the association between early childhood trauma and the five domains of negative symptoms (anhedonia, avolition, asociality, blunted affect, alogia). METHOD: Eighty nine participants completed interviewer-rated measures of childhood trauma and abuse experienced before age 16, psychosis risk, and negative symptoms. RESULTS: Higher global negative symptom severity was associated with greater exposure to childhood psychological bullying, physical bullying, emotional neglect, psychological abuse, and physical abuse. Greater severity of avolition and asociality was associated with physical bullying. Greater severity of avolition was associated with emotional neglect. CONCLUSION: Early adversity and childhood trauma is associated with negative symptoms during adolescence and early adulthood among participants at CHR for psychosis.

Negative symptoms in schizophrenia differ across environmental contexts in daily life.

A recent environmental theory of negative symptoms posits that environmental contexts (e.g., location, social partner) play a significant-yet often unaccounted for-role in negative symptoms of schizophrenia (SZ). "Gold-standard" clinical rating scales offer limited precision for evaluating how contexts impact symptoms. To overcome some of these limitations, Ecological Momentary Assessment (EMA) was used to determine whether there were state fluctuations in experiential negative symptoms (anhedonia, avolition, and asociality) in SZ across contexts (locations, activities, social interaction partner, social interaction method). Outpatients with SZ (n = 52) and healthy controls (CN: n = 55) completed 8 daily EMA surveys for 6 days assessing negative symptom domains (anhedonia, avolition, and asociality) and contexts. Multilevel modeling demonstrated that negative symptoms varied across location, activity, social interaction partner, and social interaction method. For the majority of contexts, SZ and CN did not report significantly different levels of negative symptoms, with SZ only reporting higher negative symptoms than CN while eating, resting, interacting with a significant other, or being at home. Further, there were several contexts where negative symptoms were similarly reduced (e.g., recreation, most social interactions) or elevated (e.g., using the computer, working, running errands) in each group. Results demonstrate that experiential negative symptoms dynamically change across contexts in SZ. Some contexts may "normalize" experiential negative symptoms in SZ, while other contexts, notably some used to promote functional recovery, may increase experiential negative symptoms.