Innovations In Clinical Neuroscience

NOV-DEC 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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37 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE November-December 2017 • Volume 14 • Number 11–12 O R I G I N A L R E S E A R C H emotion regulation and display. In explaining geographical differences in negative symptoms, not only are the norms for expression of emotions and flow of conversation relevant, but so are the norms for experience of behavior. Examinations of emotion intensity perception have confirmed that facial expressions with varying levels of intensity of positive and negative affect are perceived and categorized differently across cultures. 37 Intrinsic biological factors, such as genes and the central nervous system, are substantially shaped by cultural and social contexts during development. These relations between biology and context subscribe to observed behavioral patterns of individuals (e.g., PANSS raters) and cultural agreement/ disagreement in identifying expressions of affect (N1) and verbal interaction (N6). 38–40 For this study, we observed large DIF for Brazil, India, and South Africa as compared with the United States, and moderate DIF for Austria-Germany, Nordic, France, Poland, and Russia as compared with the United Staates. It has been shown that individualistic cultures (e.g., the United States, South Africa, Austria-Germany, France) tend to endorse physical display of expression and conversation, while collectivistic cultures (e.g., Brazil, India, Nordic, Poland, Russia) encourage the control of expressions of affect to maintain group harmony. 41-43 Thus, the role of display rules in regulating and interpreting affect and flow of conversation in a variety of contexts has been well-documented and varies across cultures. Although the United States is considered an individualistic culture, it also comprises a heterogeneous community of raters and subjects from other geographic locations, such that it would be difficult to assess pure cultural differences in presentation and interpretation of affect and flow of conversation. However, since it is more difficult to regulate the variability of subjects with schizophrenia, each rater should have a clear understanding of the presentation of negative symptoms within and across their specific cultural contexts. It is important to look at items N4 Passive/ Apathetic Social Withdrawal and G16 Active Social Avoidance, as these items of the PANSS experiential deficit are scored exclusively by reports from the subject's caregiver. These have previously been shown to be the two best items for predicting everyday social outcomes in people with schizophrenia. 44 Both of these items showed the fewest amount of DIF between the 15 geographic regions as compared with the United States. Moreover, only one country— Italy—showed DIF (at a moderate level) for G16 Active Social Avoidance, with no countries showing large DIF. Additionally, Brazil and India, highly heterogeneous countries with multiple subcultures and distinct languages, showed large DIF for N4 Passive/Apathetic Social Withdrawal. With the exception of Brazil TABLE 4, continued. Differential item functioning of PANSS expressive and experiential deficits with the United States as the reference geographical region GEOGRAPHICAL REGION PANSS EXPRESSIVE DEFICITS PANSS EXPERIENTIAL DEFICITS N1 BLUNTED AFFECT N3 POOR RAPPORT N6 LACK OF SPONTANEITY G7 MOTOR RETARDATION N2 EMOTIONAL WITHDRAWAL N4 PASSIVE/ APATHETIC SOCIAL WITHDRAWAL G16 ACTIVE SOCIAL AVOIDANCE Eastern Europe p 0.26 <0.001 0.02 0.01 0.64 0.86 0.11 ES 0.08 0.34 0.17 0.16 0.03 0.001 -0.09 ETS Class AA BB+ AA AA AA AA AA Russia p <0.001 <0.001 0.03 0.54 <0.001 0.01 0.06 ES 0.41 0.63 0.24 -0.05 0.27 0.23 -0.19 ETS Class BB+ CC+ AA AA AA AA AA South Africa p <0.001 <0.001 <0.001 <0.001 <0.001 < 0.001 0.16 ES 0.79 0.76 0.63 0.23 0.31 0.38 -0.07 ETS Class CC+ CC+ CC+ AA BB+ BB+ AA Spain p 0.01 <0.001 0.01 0.18 0.06 0.41 0.31 ES 0.27 0.62 0.32 0.13 0.18 0.08 -0.11 ETS Class AA CC+ CC+ AA AA AA AA Differential Item Functioning (DIF) Number of large DIF 3 7 5 1 2 2 0 Number of moderate DIF 5 6 5 5 4 5 1 Number of negligible DIF 7 2 5 9 9 8 14 PANSS=Positive and Negative Syndrome Scale; ES=effect size; ETS=Education Testing Services; AA =negligible DIF; BB+ =moderate DIF favoring the focal group; BB- =moderate DIF favoring the reference group; CC+ =large DIF favoring the focal group; CC- =large DIF favoring the reference group

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