Reconsidering the Latent Structure of Negative Symptoms in Schizophrenia: A Review of Evidence Supporting the 5 Consensus Domains

Strauss, Gregory P.; Ahmed, Anthony O.; Young, Jared W.; Kirkpatrick, Brian

doi:10.1093/schbul/sby169

Cited by 61 publications

(56 citation statements)

References 38 publications

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“…Given the hypothesized relationship between effort allocation and experiential impairment, the CAINS-MAP was the focus of the current report. A recent structural report has suggested a five-factor model of negative symptoms (i.e., anhedonia, avolition, asociality, alogia, and blunted affect; Strauss, Ahmed, Young, & Kirkpatrick, 2018). Although such a model was not used in the current report, future studies may benefit from examining relationships between the willingness to expend effort and the specific factors of this model (particularly avolition and anhedonia).…”

Section: Discussionmentioning

confidence: 99%

Effort, Avolition, and Motivational Experience in Schizophrenia: Analysis of Behavioral and Neuroimaging Data With Relationships to Daily Motivational Experience

Culbreth

Moran²,

Kandala³

et al. 2020

Clinical Psychological Science

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Recent research suggests that schizophrenia is associated with reduced effort allocation. We examined the willingness to expend effort, neural correlates of effort allocation, and the relationship of effort to daily motivational experience in individuals with schizophrenia. We recruited 28 individuals with schizophrenia and 30 control participants to perform an effort task during functional MRI. Individuals with schizophrenia also completed a protocol involving ecological momentary assessment (EMA). Individuals with schizophrenia with severe negative symptoms were less willing to expend effort for rewards. Daily EMAs of motivation were positively associated with effort allocation on a trend level. Individuals with schizophrenia and control participants displayed similar increases in blood-oxygen-level-dependent (BOLD) activation in frontal, cingulate, parietal, and insular regions during effort-based decision making. However, negative symptoms were associated with reduced BOLD activation in the bilateral ventral striatum. These results replicate previous reports of reduced effort allocation in patients with severe negative symptoms and provide evidence for the role of the ventral striatum in effort impairments.

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Section: Discussionmentioning

confidence: 99%

Effort, Avolition, and Motivational Experience in Schizophrenia: Analysis of Behavioral and Neuroimaging Data With Relationships to Daily Motivational Experience

Culbreth

Moran²,

Kandala³

et al. 2020

Clinical Psychological Science

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“…Negative symptoms represent a heterogeneous dimension, including symptoms with different causes and course, and, therefore, possibly requiring different treatment management [4,5,14,22,[31][32][33][34][35][36][37][38][39][40][41]. Different approaches to the negative symptom classification have been pursued in order to reduce their heterogeneity, not only in the research context, but also in the context of clinical trials.…”

Section: Classification Of Negative Symptomsmentioning

confidence: 99%

EPA guidance on assessment of negative symptoms in schizophrenia

et al. 2021

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Background. During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods. In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results. Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use secondgeneration scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions. The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.

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“…Overreliance on potentially multi-determined behavioral indicators is apparent in the SANS and PANSS, which focus on the behavioral/functional consequences of avolition-apathy, but not the subjective, internal experience and emotional aspect of avolition, understood to be the very core of the schizophrenic illness 32 . The SANS, for instance, defines several elements of real-world functioning as negative symptoms, rather than as a potential behavioral consequence of these symptoms (e.g., impersistence in work and school).…”

Section: The Current Measurement Of Negative Symptoms: Instruments Anmentioning

confidence: 99%

Avolition as the core negative symptom in schizophrenia: relevance to pharmacological treatment development

2021

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Negative symptoms have long been considered a core component of schizophrenia. Modern conceptualizations of the structure of negative symptoms posit that there are at least two broad dimensions (motivation and pleasure and diminished expression) or perhaps five separable domains (avolition, anhedonia, asociality, blunted affect, alogia). The current review synthesizes a body of emerging research indicating that avolition may have a special place among these dimensions, as it is generally associated with poorer outcomes and may have distinct neurobiological mechanisms. Network analytic findings also indicate that avolition is highly central and interconnected with the other negative symptom domains in schizophrenia, and successfully remediating avolition results in global improvement in the entire constellation of negative symptoms. Avolition may therefore reflect the most critical treatment target within the negative symptom construct. Implications for targeted treatment development and clinical trial design are discussed.

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Reconsidering the Latent Structure of Negative Symptoms in Schizophrenia: A Review of Evidence Supporting the 5 Consensus Domains

Cited by 61 publications

References 38 publications

Effort, Avolition, and Motivational Experience in Schizophrenia: Analysis of Behavioral and Neuroimaging Data With Relationships to Daily Motivational Experience

Effort, Avolition, and Motivational Experience in Schizophrenia: Analysis of Behavioral and Neuroimaging Data With Relationships to Daily Motivational Experience

EPA guidance on assessment of negative symptoms in schizophrenia

Avolition as the core negative symptom in schizophrenia: relevance to pharmacological treatment development

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