Innovations In Clinical Neuroscience

NOV-DEC 2017

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

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18 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 N Negative symptoms in schizophrenia have been described since the early days of psychiatry. These symptoms reflect the absence of putatively normal processes, such as motivation, emotion, communication, and experience. Despite several scientific advances in the fields of genetics, biology, and psychopharmacology in relation to the epidemiology, diagnosis, and treatment of schizophrenia, individuals with enduring negative symptoms have significantly poor everyday functioning and overall poor quality of life. 1–4 Along with cognitive impairments and related impairments in the ability to perform everyday functional skills, negative symptoms are among the most important contributors to disability. A lack of agreement and consistency in the construct of negative symptomology has impeded research efforts in the field. Primarily, 55 years after the Brief Psychiatric Rating Scale (BPRS) 5 was developed, 33 years after the Scale for the Assessment of Negative Symptoms A B S T R A C T ABSTRACT: Background: Reduced emotional experience and expression are two domains of negative symptoms. The authors assessed these two domains of negative symptoms using previously developed Positive and Negative Syndrome Scale (PANSS) factors. Using an existing dataset, the authors predicted three different elements of everyday functioning (social, vocational, and everyday activities) with these two factors, as well as with performance on measures of functional capacity. Methods: A large (n=630) sample of people with schizophrenia was used as the data source of this study. Using regression analyses, the authors predicted the three different aspects of everyday functioning, first with just the two Positive and Negative Syndrome Scale factors and then with a global negative symptom factor. Finally, we added neurocognitive performance and functional capacity as predictors. Results: The Positive and Negative Syndrome Scale reduced emotional experience factor accounted for 21 percent of the variance in everyday social functioning, while reduced emotional expression accounted for no variance. The total Positive and Negative Syndrome Scale negative symptom factor accounted for less variance (19%) than the reduced experience factor alone. The Positive and Negative Syndrome Scale expression factor accounted for, at most, one percent of the variance in any of the functional outcomes, with or without the addition of other predictors. Implications: Reduced emotional experience measured with the Positive and Negative Syndrome Scale, often referred to as "avolition and anhedonia," specifically predicted impairments in social outcomes. Further, reduced experience predicted social impairments better than emotional expression or the total Positive and Negative Syndrome Scale negative symptom factor. In this cross-sectional study, reduced emotional experience was specifically related with social outcomes, accounting for essentially no variance in work or everyday activities, and being the sole meaningful predictor of impairment in social outcomes. KEYWORDS: Schizophrenia, negative symptoms factor analysis Using the Positive and Negative Syndrome Scale (PANSS) to Define Different Domains of Negative Symptoms: Prediction of Everyday Functioning by Impairments in Emotional Expression and Emotional Experience by PHILIP D. HARVEY, PhD; ANZALEE KHAN, PhD; and RICHARD S. E. KEEFE, PhD Dr. Harvey is Professor of Psychiatry and Behavioral Sciences at University of Miami School of Medicine in Miami, Florida. Dr. Khan is Senior Biostatistician at NeuroCog Trials and holds an appointment in the Psychopharmacology Research Program at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York. Dr. Keefe is an employee of NeuroCog Trials and Professor of Psychiatry and Behavioral Sciences at Duke University Institute for Brain Sciences in Chapel Hill, North Carolina. Innov Clin Neurosci. 2017;14(11–12):18–22 FUNDING: The collection of the data in this study was supported by NIMH grants MH63116, MH78775, and MH93432. DISCLOSURES: Dr. Harvey has served as a consultant to AbbVie, Allergan, Akili, Boehringer Ingelheim, Forum Pharmaceuticals, Genentech, Lundbeck Pharmaceuticals, Minerva Pharma, Otsuka Digital Health, Roche Pharma, Sanofi, Sunovion, and Takeda Pharmaceutical during the past three years. He has a research grant from Takeda. Dr. Khan currently or in the past three years has received funding support and honoraria from, served as consultant for, and served as speaker for the National Institute of Mental Health, Research Foundation for Mental Hygiene, Inc., the New York State Office of Mental Health, Qatar Foundation Weill Cornell Medicine and/or eResearch Technologies. She also holds positions at NeuroCog Trials, Nathan S. Kline Institute for Psychiatric Research, and Manhattan Psychiatric Center. Dr. Keefe currently or in the past three years has received investigator-initiated research funding support from the Department of Veteran's Affairs, the National Institute of Mental Health, and the Singapore National Medical Research Council. He has received honoraria and served as a consultant, speaker, or advisory board member for Abbvie, Acadia, Akebia, Akili, Alkermes, Astellas, Asubio, Avanir, AviNeuro/ChemRar, Axovant, Biogen, Boehringer-Ingelehim, Cerecor, CoMentis, FORUM, Global Medical Education (GME), GW Pharmaceuticals, Intracellular Therapeutics, Janssen Pharmaceutica, Lundbeck, MedScape, Merck, Minerva Neurosciences Inc., Mitsubishi, the Moscow Research Institute of Psychiatry, Neuralstem, Neuronix, Novartis, the New York State Office of Mental Health, Otsuka, Pfizer, Reviva, Roche, Sanofi, Sunovion, Takeda, Targacept, the University of Moscow, the University of Texas Southwest Medical Center, and WebMD. Dr. Keefe also receives royalties from the BACS testing battery, the MATRICS Battery (BACS Symbol Coding), and the Virtual Reality Functional Capacity Assessment Tool (VRFCAT), and is a shareholder in NeuroCog Trials, Inc. and Sengenix. CORRESPONDENCE: Philip D. Harvey, PhD; Email:

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