Dysfunctional Attitudes and Expectancies in Deficit Syndrome Schizophrenia

Abstract

The deficit syndrome was proposed over 20 years ago as a separate negative symptom syndrome within schizophrenia with a distinct neurobiological pathophysiology and etiology. Recent research, however, has indicated that psychological factors such as negative attitudes and expectancies are significantly associated with the broad spectrum of negative symptoms. Specifically, defeatist beliefs regarding performance mediate between neurocognitive impairment and both negative symptoms and functional outcome. Additionally, asocial beliefs predict asocial behavior and negative expectancies regarding future pleasure are associated with negative symptoms. The present study explored whether these dysfunctional beliefs and negative expectancies might also be a feature of the deficit syndrome. Based on a validated proxy method, 22 deficit and 72 nondeficit patients (from a pool of 139 negative symptom patients) were identified and received a battery of symptom, neurocognitive, and psychological measures. The deficit group scored significantly worse on measures of negative symptoms, insight, emotion recognition, defeatist attitudes, and asocial beliefs but better on measures of depression, anxiety, and distress than the nondeficit group. Moreover, the deficit group showed a trend for higher scores on self-esteem. Based on these findings, we propose a more comprehensive formulation of deficit schizophrenia, characterized by neurobiological factors and a cluster of psychological attributes that lead to withdrawal and protect the self-esteem. Although the patients have apparently opted-out of participation in normal activities, we suggest that a psychological intervention that targets these negative attitudes might improve their functioning and quality of life.

Anxiety does not contribute to social withdrawal in the subchronic phencyclidine rat model of schizophrenia

“…Overall, social withdrawal in the sub-chronic PCP rat model of schizophrenia did not improve with interventions for anxiety and this behavioral deficit cannot be attributed to increased anxiety. Interestingly, despite their poorer social function and greater social isolation (Kirkpatrick, 2014), schizophrenic patients with deficit syndrome are less anxious than non-deficit schizophrenia patients (Beck et al, 2013; Tek et al, 2001) and do not differ from healthy subjects in this regard (Subotnik et al, 2000). Furthermore, social withdrawal in deficit patients does not result from social anxiety or avoidance of others, but is due to a primary lack of social interest (Subotnik et al, 2000).…”

“…As a matter of fact, there is a strong relationship between negative symptoms and anxiety, which interact with and exacerbate each other (Huppert et al, 2001), and, social withdrawal in schizophrenic patients has been correlated to their anxiety level (Lysaker and Salyers, 2007). On the other hand, patients with deficit syndrome, which is characterized by negative symptoms that are both enduring and primary (Kirkpatrick and Galderisi, 2008), are less anxious than non-deficit schizophrenia patients (Beck et al, 2013; Subotnik et al, 2000; Tek et al, 2001), and their anxiety level does not differ from that of healthy subjects (Subotnik et al, 2000). This contrasts with their poorer social function and greater social isolation (Kirkpatrick, 2014a), and emphasizes the importance of differentiating primary from secondary negative symptoms and understanding the role played anxiety in this context (Kirkpatrick, 2014b).…”

Using Self-Determination Theory to Understand Motivation Deficits in Schizophrenia: The ‘Why’ of Motivated Behavior

“…We propose that, as people with schizophrenia experience repeated episodes of failure achieving autonomy and competence, perhaps in conjunction with a deficit in reward representation, that they enter what Ryan and Deci label as an enduring “impersonal-amotivated” state. It is also possible that repeated failure experiences early in the course of illness lead to withdrawal from potentially rewarding experiences and a heightened sensitivity to punishment—creating a self-defeatist position that in turn leads to negative symptoms (Beck et al, 2013). If this is shown to be the case successful behavioral treatments should be initiated early to help people with schizophrenia to articulate and focus on actionable goals that meet psychological needs and that lead to success in obtaining extrinsic rewards (Medalia and Brekke, 2010).…”

Additional support for the cognitive model of schizophrenia: evidence of elevated defeatist beliefs in schizotypy

“…Defeatist performance beliefs have been assessed in inpatients and outpatients with schizophrenia [13,16], older adults with schizophrenia [19], individuals with deficit syndrome schizophrenia [20], those with recent on-set schizophrenia [15], and veterans with schizophrenia [14]. Despite considerable research in schizophrenia samples, there is a dearth of research investigating defeatist performance beliefs in individuals with schizotypy.…”