Defeatist performance beliefs in individuals at clinical high‐risk for psychosis and outpatients with chronic schizophrenia

Abstract

Aim: Prior studies indicate that defeatist performance beliefs (DPBs) are elevated in those in the chronic phase of schizophrenia (SZ) and associated with negative symptoms, functional outcome and neurocognitive impairment. However, it is unclear whether these same patterns of results hold in participants at clinical high-risk (CHR) for psychosis.Methods: Two studies were conducted to determine whether prior results in SZ could be replicated and extended to CHR. Participants included 184 healthy controls (CN) and 186 outpatients with chronic SZ for Study 1, and 30 CN and 35 CHR in Study 2. In both studies, participants completed the DPB scale and measures of negative symptoms, psychosocial functioning and neurocognition.Results: Both chronic SZ and CHR participants had elevated DPBs compared to CN (p's < .01). In SZ, higher DPBs were associated with greater negative symptoms (r's = .31-.37, p's < .01), poorer social functioning and impaired social cognition (r = −.40, P < .001). In CHR, greater DPBs were associated with poorer social functioning (r = −.52, P < .05) and impairments in the neurocognitive domains of reasoning (r = −.48, P < .05) and processing speed (r = −.41, P < .05). Models testing whether DPBs mediated links between negative symptoms and functioning, negative symptoms and cognition and cognition and functioning were nonsignificant in SZ and CHR samples.Conclusions: Findings generally provide support for the cognitive model of negative symptoms and functioning and suggest that DPBs are an important clinical target across phases of psychotic illness.

The impact of the COVID-19 pandemic on negative symptoms in individuals at clinical high-risk for psychosis and outpatients with chronic schizophrenia

“…However, it is unclear whether these mechanisms also contribute to negative symptoms in CHR. Preliminary evidence has implicated defeatist performance beliefs [11], reward processing impairments [3,4,43,63], and inflammatory abnormalities [16] in CHR, however, it is unclear whether those abnormalities are more pronounced in CHR converters than non-converters or those with persistent negative symptom profiles. Preliminary evidence does suggest some important differences between SZ and CHR, such as the presence of true hedonic deficits in CHR that are not present in SZ [63].…”

“…Participants included 32 outpatients meeting DSM5 criteria for schizophrenia or schizoaffective disorder (SZ) and 31 healthy controls (CN). Participants with SZ were originally recruited for studies investigating mechanisms of negative symptoms that occurred prior to the COVID-19 pandemic [3,11,12,51]. Original recruitment occurred at outpatient mental health clinics in northeast Georgia, USA and online or printed advertisements.…”

“…Participants included 25 CHR participants and 30 healthy controls (CN) who were originally recruited for studies examining reward processing mechanisms underlying negative symptoms and psychosis risk [3,4,11]. CHR participants were recruited from the Georgia Psychiatric Risk Evaluation Program (G-PREP), which receives referrals from local clinicians to perform diagnostic assessment and monitoring evaluations for youth displaying psychotic experiences.…”

Psychological Dimensions Relevant to Motivation and Pleasure in Schizophrenia

“…Defeatist performance beliefs are one type of negative self-beliefs, and are characterized by overgeneralized, negative conclusions about one’s ability to execute goal-directed behaviors (e.g., “why even try, I always fail”). While historically conceptualized in the context of depression, research shows elevated defeatist performance beliefs in people with schizophrenia ( Grant and Beck, 2009 ; Bentall et al, 2010 ; Horan et al, 2010 ), people with schizotypy ( Luther et al, 2016 ), and CHR participants ( Clay et al, 2021 ). A meta-analysis found that defeatist performance beliefs predict a small, but significant proportion of variance in negative symptoms ( Campellone et al, 2016b ), with many (although not all, McGovern et al, 2020 ) studies directly linking defeatist performance beliefs with motivation deficits in schizophrenia ( Horan et al, 2010 ; Couture et al, 2011 ; Green et al, 2012 ; Ventura et al, 2014 ; Granholm et al, 2016 ; Lee and Yu, 2021 ).…”

The effects of the COVID-19 pandemic on hallucinations and delusions in youth at clinical high-risk for psychosis and outpatients with schizophrenia

“…Participants included 25 CHR participants and 30 healthy controls (CN) who were originally recruited for studies examining reward processing mechanisms underlying negative symptoms and psychosis risk [ 47 , 48 , 54 , 55 ]. CHR participants were recruited from the Georgia Psychiatric Risk Evaluation Program (G-PREP), which receives referrals from local clinicians to perform diagnostic assessment and monitoring evaluations for youth displaying psychotic experiences.…”