Negative Symptoms and Cognitive Deficits: What Is the Nature of Their Relationship?

Department of Psychiatry, Mt. Sinai School of Medicine, New York, NY, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 05/2006; 32(2):250-8. DOI: 10.1093/schbul/sbj011
Source: PubMed

ABSTRACT Negative symptoms and cognitive deficits in schizophrenia share many features and are correlated in their severity on a cross-sectional basis. The question arises as to the nature of this relationship: are these symptoms the same, caused by the same factor (or factors); or is the nature of their relationship determined by other factors, such as definitional issues and common correlates? In this article we provide a conceptual overview for addressing this question and provide a selective review of the literature on the cross-sectional and longitudinal relationships between these two features of the illness. We describe 4 different models of the "true" relationship between these variables. Some data suggest that the relationship between these variables is determined by the definition of negative symptoms employed and that, in general, the correlation is moderate at the most. Further, path modeling suggests the possibility, to be addressed with later research, that correlations between negative and cognitive symptoms and everyday functional outcomes may influence the observed correlations between these variables. Thus, we conclude that negative and cognitive symptoms may be separable, if not conceptually independent, domains of the illness and that it might be possible to develop treatments that target negative symptoms and cognitive deficits independently.

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Available from: Christopher Bowie, Dec 24, 2014
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    • "The evidence is mounting that, even in first episode patients, negative symptoms are often a core feature. Like cognitive deficits, negative symptoms have prognostic importance, are associated with poor functioning, and have been shown to have their onset prior to the emergence of positive symptoms (Harvey et al., 2006). Despite their central role in the illness, negative symptoms have proven to be resistant to psychopharmalogical treatment with currently available medications. "
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    ABSTRACT: Understanding the longitudinal course of negative symptoms, especially in relationship to functioning, in the early phase of schizophrenia is crucial to developing intervention approaches. The course of negative symptoms and daily functioning was examined over a 1-year period following a recent onset of schizophrenia and at an 8-year follow-up point. The study included 149 recent-onset schizophrenia patients who had a mean age of 23.7 (SD=4.4)years and mean education of 12.9 (SD=2.2)years. Negative symptom (BPRS and SANS) and functional outcome (SCORS) assessments were conducted frequently by trained raters. After antipsychotic medication stabilization, negative symptoms during the first outpatient year were moderately stable (BPRS ICC=0.64 and SANS ICC=0.66). Despite this overall moderate stability, 24% of patients experienced at least one period of negative symptoms exacerbation. Furthermore, entry level of negative symptoms was significantly associated with poor social functioning (r=-.34, p<.01) and work/school functioning (r=-.25, p<.05) at 12months, and with negative symptoms at the 8-year follow-up (r=.29, p<.05). Early negative symptoms are fairly stable during the first outpatient year, are predictors of daily functioning at 12months, and predict negative symptoms 8years later. Despite the high levels of stability, negative symptoms did fluctuate in a subsample of patients. These findings suggest that negative symptoms may be an important early course target for intervention aimed at promoting recovery. Copyright © 2014 Elsevier B.V. All rights reserved.
    Schizophrenia Research 12/2014; 161(2-3). DOI:10.1016/j.schres.2014.10.043 · 3.92 Impact Factor
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    • "This conclusion would also suggest that the cognitive deficits observed in psychotic disorders such as SZ may be independent from the positive and negative symptoms characteristic of the illness. This is consistent with several lines of research suggesting that psychotic and cognitive symptoms may be separable and perhaps independent characteristics of SZ (see Harvey et al., 2006 for a review). It is also possible, however, that there is a direct causative link between subclinical psychosis and increased cognitive function. "
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    ABSTRACT: Considerable data support the phenomenological and temporal continuity between subclinical psychosis and psychotic disorders. In recent years, neurocognitive deficits have increasingly been recognized as a core feature of psychotic illness but there are few data seeking to elucidate the relationship between subclinical psychosis and neurocogntive deficits in non-clinical samples. The goal of the present study was to examine the relationship between subclinical positive and negative symptoms, as measured by the Community Assessment of Psychic Experiences (CAPE) and performance on the MATRICS Consensus Cognitive Battery (MCCB) in a large (n=303) and demographically diverse non-clinical sample. We found that compared to participants with low levels of subclinical positive symptoms, participants with high levels of subclinical positive symptoms performed significantly better in the domains of working memory (p<.001), verbal learning (p=.007) and visual learning (p=.014). Although comparison of participants with high and low levels of subclinical negative symptoms revealed no differences in MCCB performance, we found that individuals with high levels of subclinical negative symptoms performed significantly better on a measure of estimated IQ (WRAT-3 Reading subtest; p=.02) than those with low levels of subclinical negative symptoms. These results are at odds with prior reports that have generally shown a negative relationship between neurocognitive functioning and severity of subclinical psychotic symptoms, and suggest some potential discontinuities between clinically significant psychotic symptoms and sub-syndromal manifestations of psychosis.
    Schizophrenia Research: Cognition 12/2014; 1(4):175-179. DOI:10.1016/j.scog.2014.09.002
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    • "The commonly used negative symptom assessments, such as the Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1982) and the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1987) have been criticized for a number of reasons (Blanchard et al., 2011). One of the most relevant concerns is that both of these measures include items that measure cognitive functioning (e.g., attentional bias or abstract thinking), which have now been recognized to be conceptually distinct from negative symptoms (Harvey et al., 2006). Another conceptual issue is the overlap with measures of functional outcome (Forbes et al., 2010), in the sense that the measure rates performance deficits rather than negative symptoms as such. "
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    ABSTRACT: Validated assessment instruments could contribute to a better understanding and assessment of negative symptoms and advance treatment research. The aim of this study was to examine the psychometric properties of a German version of the Clinical Assessment Interview for Negative Symptoms (CAINS). In- and outpatients (N=53) with schizophrenia or schizoaffective disorder were assessed with standardized interviews and questionnaires on negative and positive symptoms and general psychopathology in schizophrenia, depression, the ability to experience anticipatory and consummatory pleasure, and global functioning. The results indicated good psychometric properties, high internal consistency and promising inter-rater agreement for the German version of the CAINS. The two-factor solution of the original version of the CAINS was confirmed, indicating good construct validity. Convergent validity was supported by significant correlations between the CAINS subscales with the negative symptom scale of the Positive and Negative Syndrome Scale, and with consummatory pleasure. The CAINS also exhibited discriminant validity indicated by its non-significant correlations with positive symptoms, general psychopathology and depression that are in line with the findings for the original version of the CAINS. In addition, the CAINS correlated moderately with global functioning. The German version of the CAINS appears to be a valid and suitable diagnostic tool for measuring negative symptoms in schizophrenia.
    Psychiatry Research 10/2014; 220(1-2):659-663. DOI:10.1016/j.psychres.2014.07.070 · 2.47 Impact Factor
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