Negative symptoms in the clinical high‐risk state for psychosis: Connection with cognition and primacy in impacting functioning

Abstract

Aim In the clinical high‐risk (CHR) state for psychosis, both negative symptoms and lower cognitive function have been associated with poorer daily functioning. Recent evidence suggests that negative symptoms share overlapping variability with cognition and may partially mediate the relationship between cognition and functioning. However, the nature of this overlap is unknown, and the reverse mediation model remains untested leaving the precise nature of these associations unclear. Methods In order to clarify these relationships, a sample of community‐dwelling youth meeting CHR criteria was collected from a specialty CHR clinic (n = 91, mean age = 21, 63% male). Bootstrapping methods were then applied in a mediation analysis to test both negative symptoms and cognition as independent variables and mediating variables predicting social and role functioning in CHR individuals. Canonical correlation analysis was used to characterize the overlapping variability between negative symptoms and cognition. Results Support for a primary role of negative symptoms in predicting functioning and cognition was observed. Canonical correlation revealed a single dimension of overlap between the two symptom types (r = .62), represented by a strong correlation between negative symptoms in general and tasks involving verbal working memory, vigilance and social cognition specifically. A single cognitive factor composed primarily of these tasks was found to predict role functioning (adjusted R 2 = .04). Conclusions The results highlight the importance of considering specific cognitive mechanisms overlapping with negative symptoms in research and rehabilitative practice in CHR populations, as well as the primary importance of targeting negative symptoms.

Stopping cannabis use benefits outcome in psychosis: findings from 10‐year follow‐up study in the PAFIP‐cohort

“…Often, these two variables have been related , however, never in 10‐year follow‐up studies. On the other hand, another aspect frequently related to cognition and functionality is the negative symptomatology, a large literature shows that a greater severity of negative symptoms is related to greater cognitive deficits and worse social functioning . In this sense, our results are partially in agreement with the literature, since our groups show no differences in either cognition or negative symptoms.…”

Associations of psychotic-like experiences, related symptoms, and working memory with functioning

“…As reviewed above, research has shown that working memory and negative symptoms are associated with one another and both contribute individually to functioning, supporting the hypothesis of an additive model. Further, engagement of working memory capacity requires cognitive effort [42]. Given that motivation and effort are often diminished in people high in negative symptoms, the combination of high negative symptoms and low working memory is expected to be associated with even worse functioning, consistent with the hypothesis of a moderation model.…”

“…Instrumental activities of daily living such as managing food preparation, household chores, and finances are complex tasks that involve keeping goals in mind and remembering details while planning and executing multi-step processes [67]. Not surprisingly, these tasks are associated with executive functions such as working memory [67,68], which require cognitive effort [42]. Social interactions similarly involve a complex set of processes.…”

Negative Symptoms and Functioning in Youth at Risk of Psychosis: A Systematic Review and Meta-analysis

“…13,14 CHR youth also present with deficits in global functioning, 15 deficits in social functioning 16 (i.e., level of social contact, friendships ) and deficits in role functioning (i.e., level of functioning at school or work) when compared to their non-psychiatric peers. 16 Moreover, negative symptoms have been shown to predict poor functioning in CHR more so than positive symptoms and despite established relationships between cognition and functioning in CHR, negative symptoms both mediate and are primary in this relationship [17][18][19][20] Both negative symptoms and functioning have been shown to reduce quality of life and impact long-term outcomes in CHR individuals, [21][22][23][24] thus a greater understanding of the association between negative symptoms and functioning in CHR youth may help with the development of more precise treatment targets.…”