Modeling the role of negative symptoms in determining social functioning in individuals at clinical high risk of psychosis

Abstract

A priority for improving outcome in individuals at clinical high risk (CHR) is enhancing our understanding of predictors of psychosis as well as psychosocial functioning. Social functioning, in particular, is a unique indicator of risk as well as an important outcome in itself. Negative symptoms are a significant determinant of social functioning in CHR individuals; yet, it is unclear which specific negative symptoms drive functional outcome and how these symptoms function relative to other predictors, such as neurocognition and mood/anxiety symptoms. In a sample of 85 CHR individuals, we examined whether a two-factor negative symptom structure that is found in schizophrenia (experiential vs expressive symptoms) would be replicated in a CHR sample; and tested the degree to which specific negative symptoms predict social functioning, relative to neurocognition and mood/anxiety symptoms, which are known to predict functioning. The two-factor negative symptom solution was replicated in this CHR sample. Negative symptom severity was found to be uniquely predictive of social functioning, above and beyond depression/anxiety and neurocognition. Experiential symptoms were more strongly associated with social functioning, relative to expression symptoms. In addition, experiential symptoms mediated the relationship between expressive negative symptoms and social functioning. These results suggest that experiences of motivational impairment are more important in determining social functioning, relative to affective flattening and alogia, in CHR individuals, thereby informing the development of more precise therapeutic targets. Developing novel interventions that stimulate goal-directed behavior and reinforce rewarding experiences in social contexts are recommended.

Impaired Social and Role Function in Ultra-High Risk for Psychosis and First-Episode Schizophrenia: Its Relations with Negative Symptoms

“…At first, depressive symptoms and psychosocial functioning seemed to have association with simple correlation, but it turned out to be not primarily related when we did the regression analysis. These findings were generally compatible to those of previous studies in first-episode schizophrenia1519 and UHR individuals 21222324. There were a few reports of correlations of psychosocial dysfunction with depressive symptoms in first-episode schizophrniea patients131620 and UHR individuals 252627.…”

Modeling Deficits From Early Auditory Information Processing to Psychosocial Functioning in Schizophrenia

“…Fourth, the omission of constructs such as social cognition and defeatist beliefs limits the completeness of our EAP-to-outcome interpretive framework (cf. 9,46,54,82 ). Unfortunately, we lacked a sufficient number of social cognitive measures to be used in structural equation modeling.…”

Social Cognition, Negative Symptoms and Psychosocial Functioning in Schizophrenia

“…Accordingly, in the early stages of the disease, at the first-ep-isode [89] and during the proceeding years [98,99], the presence of this symptom cluster is one of the greatest barriers to the achievement of functional recovery. Moreover, before full blown psychosis occurs, during the so-called high-risk (HR) or prodromal state, negative symptoms and impaired social cognition have been associated with marked impairment in psychosocial function [100,101] which appears to be a core feature of the HR state and tends to be resistant to all types of treatment [102]. The presence of negative symptoms of "avolition" and "poor emotional expression" in the prodrome is in agreement with the notion of their primary nature and suggests that negative symptoms and their neural substrates may even be a driver (like impaired social cognition) of transition to psychosis [85].…”

“…In line with this, several studies examined the prevalence of motivational deficits in patients throughout the different stages of the illness, and the impact these deficits have on psychosocial functioning, both cross-sectionally and longitudinally. Current research into the determinants of social functioning impairments in HR individuals suggests that motivational impairment is more important in determining level of social functioning relative to expression symptoms of affective flattening and alogia [101]. Correspondingly, it may be hypothesized that treatments alleviating negative symptoms in HR young subjects would both alleviate suffering and reduce the risk of transition to schizophrenia [85,102].…”

“…This underscores the need to better understand the underlying mechanisms of motivational deficits [92,93] in order to provide the opportunity to personalize treatment and therefore establish effective interventions that will curb longer-term poor functioning [98]. In agreement, such interventions may benefit from focusing on strategies to enhance engagement in one's life, increasing goal-directed behavior, supporting greater effort expenditure, and harnessing intact consummatory pleasure to improve quality of life [101].…”