Negative symptoms in youths with psychosis spectrum features: Complementary scales in relation to neurocognitive performance and function

Abstract

Background Negative symptoms in schizophrenia are related to impaired functioning. The presence of negative symptoms in early phases of psychosis in individuals at clinical risk is receiving increased attention. Methods We evaluated comprehensively a sample of 92 young people (age range 15–25) applying the Clinical Assessment Interview for Negative Symptoms (CAINS), adapted for youth. Individuals at clinical high risk (CHR, n=29) were compared to individuals with schizophrenia (SZ, n=31) and normal controls (NC, n=32). In addition to the CAINS, participants were assessed with the Structured Interview for Prodromal Syndromes (SIPS), enabling examination of the relations among scales, as well as the Penn Computerized Neurocognitive battery (CNB), to examine association with cognitive performance, and the Global Assessment of Function (GAF) to assess overall functioning. Results The CHR group was intermediate to SZ and NC on nearly all clinical measures. Negative symptoms on the CAINS correlated better with negative than with other symptoms on the SIPS and were associated with neurocognitive deficits and poorer functioning. Conclusions This study illustrates the feasibility of in-depth evaluation of negative symptoms in youth and indicates that these symptoms are present already in the at-risk state and relate to impaired cognition and functioning.

The association of neurocognitive impairment with diminished expression and apathy in schizophrenia

“…Studies supporting the theory by Cohen et al in regard to schizophrenia have used a self-report measure (Cohen et al, 2012), a clinician rating scale (Chang et al, 2014), or a computerized acoustic analysis (Cohen et al, 2013) to assess symptoms of diminished expression. Recent studies have assessed diminished expression together with apathy in clinical rating scales, reporting mixed results regarding their link to neurocognitive deficits (Galderisi et al, 2014;Gur et al, 2015;Kring et al, 2013;Ventura et al, 2014). Critically, none of these studies investigated the independent relationship of the two negative symptom dimensions with cognitive function.…”

“…Ventura et al (2014) used the Scale for Assessment of Negative Symptoms (SANS; Andreasen, 1982) and reported that both dimensions correlated with neurocognitive deficits. Kring et al (2013) and Gur et al (2015) reported no significant correlations using the Clinical Assessment Interview for Negative Symptoms (CAINS; Kring et al, 2013). In a large-scale multicenter study by Galderisi et al (2014) apathy correlated weakly and diminished expression moderately with neurocognitive deficits using the Brief Negative Symptom Scale (BNSS; Kirkpatrick et al, 2011).…”

Initial development and preliminary psychometric properties of the Prodromal Inventory of Negative Symptoms (PINS)

“…It is our belief that the PINS-beta MAP items were not comprehensive enough to capture the range of hedonic, social, or goal-directed activities that occur in adolescence. The modified CHR version of the CAINS also appears subject to these limitations (Gur et al, 2015), suggesting that a novel approach to item selection may be warranted.…”

“…The CAINS and BNSS have demonstrated good psychometric properties, and factor analytic studies indicate that the five negative symptoms load onto two dimensions: motivation/pleasure (MAP) (anhedonia, avolition, asociality) and diminished expression (EXP) (blunted affect and alogia) (Horan et al, 2011; Kring et al, 2013; Strauss et al, 2012). Subsequently, the CAINS and BNSS are becoming widely used in experimental psychopathology and clinical trial studies examining the chronic phase of schizophrenia (Gur et al, 2015; Johnson et al, 2011; Wolf et al, 2014). …”

“…This is a significant issue, as it is not currently possible to assess negative symptoms in CHR youth in relation to the modern constructs delineated in the 2005 NIMH Consensus Meeting. Incorporating the CAINS or BNSS into an assessment battery for the prodromal syndrome is one potential option that has been done (Gur et al, 2015); however, these scales were developed for adults with formal psychosis already experiencing negative symptoms, and these scales may not pick up on the subtleties of newly emergent attenuated negative symptoms in CHR youth. Thus, there is still need for the development of a new negative symptom rating scale designed specifically for the prodromal phase of illness that incorporates modern conceptualizations of negative symptoms.…”