Effort-based decision-making impairment in patients with clinically-stabilized first-episode psychosis and its relationship with amotivation and psychosocial functioning

Chang, Wing Chung; Chu, Angel On Ki; Treadway, Michael T.; Strauss, Gregory P.; H, Lee; Hui, Christy Lai Ming; Suen, Yi Nam; Chen, Eric

doi:10.1016/j.euroneuro.2019.03.006

Cited by 40 publications

(59 citation statements)

References 63 publications

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“…Thus, they confirm the specific association shown on the clinical level and support the use of the PANSS for measuring the two symptom dimensions of amotivation and diminished expression. These results are in line with recent work showing an association of the PANSS amotivation factor with reduced ventral striatum activity and reduced effortful behaviour (Caravaggio et al, 2018, Chang et al, 2019. The fact that the observed effect size for the associations with PANSS amotivation is somewhat smaller than with the BNSS can be explained by the restriction of the PANSS to social amotivation, which does not cover the full range of amotivation symptoms.…”

Section: Discussionsupporting

confidence: 91%

Clinical, behavioural and neural validation of the PANSS amotivation factor

Kaliuzhna

Kirschner

Carruzzo

et al. 2020

Schizophrenia Research

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Negative symptoms in schizophrenia have been suggested to map onto two distinct factors-amotivation and diminished expression. Only recently, two-factor solutions for measuring negative symptoms have been proposed for the Positive and Negative Symptom Scale (PANSS), the most commonly used scale to assess the psychopathology of patients with schizophrenia. We aimed to validate the PANSS two-factor structure on a clinical, behavioural and neural level. For this multi-level validation, we reanalysed several datasets with patients for whom both the Brief Negative Symptom Assessment Scale (BNSS) and PANSS data were collected. We used a clinical dataset (n = 120) as well as behavioural data from an effort-based decision making task (n = 31) and functional neuroimaging data from a monetary incentive delay task (n = 41). Both tasks have previously been shown to be associated with BNSS amotivation. On the clinical level, the PANSS amotivation and diminished expression were highly correlated with their BNSS counterparts. On the behavioural level, we found that the PANSS amotivation factor but not the diminished expression factor specifically associated with willingness to invest effort to obtain a reward. On the neural level, PANSS amotivation was specifically related to reduced ventral striatal activation during reward anticipation. Our data confirm that the PANSS clearly allows distinguishing amotivation from diminished expression, as it relates selectively to specific aspects of behaviour and brain function. Our results will allow a re-analysis and sharing of existing datasets that used the PANSS to further substantiate the distinction between the two factors in neuroscientific studies and clinical trials.

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Section: Discussionsupporting

confidence: 91%

Clinical, behavioural and neural validation of the PANSS amotivation factor

Kaliuzhna

Kirschner

Carruzzo

et al. 2020

Schizophrenia Research

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“…Replication of our findings in other FEP samples using network analysis is necessary to affirm diminished motivation as a potentially important therapeutic target for promoting functional enhancement in the early course of psychotic illness. More research is also required to clarify the neurobiological underpinnings of amotivation in early psychosis, for instance impaired reward processing (Strauss et al ., 2014; Chang et al ., 2016 c ) and suboptimal effort-based decision-making (Gold et al ., 2015; Chang et al ., 2019), so as to facilitate development of effective treatments to ameliorate motivational deficits. Additionally, future research using time-series data to construct personal-level psychopathology networks (Epskamp et al ., 2018 b ) in FEP patients will help elucidate temporal dynamics between clinical, cognitive and functional variables on an individual basis, and hence facilitate provision of personalized treatment to improve illness prognosis.…”

Section: Discussionmentioning

confidence: 99%

Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: a network analysis approach

Chang

Wong

et al. 2019

Psychol. Med.

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BackgroundBetter understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP.MethodThis study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses.ResultsOur results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength.ConclusionOur results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.

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“…It is possible that younger patients with a shorter duration of reduced experience syndrome are still better able to modulate behaviors to seek rewards than older patients. For example, a study with first-episode psychotic patients did not demonstrate overall reduction in effort expenditure but displayed reduced willingness to expend effort for high-value/high-probability reward as compared to controls (44). Longitudinal studies are required to clarify the trajectory of effort allocation and its potential utility in predicting amotivation and functional outcomes with different durations of illness.…”

Section: Discussionmentioning

confidence: 99%

Impact of Positive Emotion Regulation Training on Negative Symptoms and Social Functioning in Schizophrenia: A Field Test

et al. 2019

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Background: The poor efficacy of drug or psychological treatments on the primary negative symptoms of schizophrenia has led to the development of new interventions. The Positive Emotions Program for Schizophrenia (PEPS) is an emotion regulation strategy training that aims to intensify positive emotions and develop positive performance beliefs. A randomized controlled trial showed that PEPS is effective in reducing the composite score of the reduction of experience syndrome (anhedonia and apathy). The present study is designed to evaluate its feasibility in natural conditions to measure external validity of PEPS. Materials and Methods: Twenty-one participants recruited through the French national network of expert centers followed eight sessions of PEPS and were assessed pre- and posttest with the Scale for Assessment of Negative Symptoms (SANS) and the Personal and Social Performance (PSP). The scales of the SANS were divided into a composite score of the reduction of the ability to experience and a composite score of the reduction of expression. Results: All participants followed the 8 sessions of PEPS, and both composite scores were significantly and clinically improved at posttest. Social functioning assessed with the PSP was also improved. Conclusions: This field test shows that participation in PEPS is accompanied by a reduction of negative symptoms and an improvement of social functioning. Both negative syndromes, reduction of expression and reduction of experience, are improved. Participants are younger than those in previous studies, which may explain this unexpected result. However, this calls for a controlled study with younger participants.

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Effort-based decision-making impairment in patients with clinically-stabilized first-episode psychosis and its relationship with amotivation and psychosocial functioning

Cited by 40 publications

References 63 publications

Clinical, behavioural and neural validation of the PANSS amotivation factor

Clinical, behavioural and neural validation of the PANSS amotivation factor

Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: a network analysis approach

Impact of Positive Emotion Regulation Training on Negative Symptoms and Social Functioning in Schizophrenia: A Field Test

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