Advancing the Measurement of Social Functioning in Schizophrenia: Applications of Egocentric Social Network Analysis.

People with schizophrenia face challenges with forming and maintaining social relationships, often resulting in poor social functioning. Commonly used measures of social functioning provide broad information relating to social relationships, but they do not adequately capture information regarding network structure and characteristics of network members. One method that can assess these more detailed aspects of social networks and provide a more comprehensive understanding of social functioning deficits is egocentric social network analysis (SNA). SNA is a scientific discipline that uses principles of network science and graph theory to analyze social relations quantitatively. Even though some types of SNA have been applied in prior schizophrenia studies, its application as a framework to measure social functioning has been extremely limited. Therefore, this article aims to formally introduce SNA and select quantitative SNA metrics, including measures of network composition, structure, homophily, and centrality, to schizophrenia researchers as novel ways of measuring components of social functioning. To demonstrate the application of SNA, we provide illustrative examples of the SNA metrics and graphical diagrams of social networks for two individuals with schizophrenia.

Peak alpha frequency in schizophrenia, bipolar disorder, and healthy volunteers: Associations with visual information processing and cognition.

BACKGROUND: Schizophrenia (SCZ) and bipolar disorder (BD) are associated with information processing abnormalities, including visual perceptual and cognitive impairments, that impact daily functioning. Recent work in healthy samples suggests that peak alpha frequency (PAF) is an electrophysiological index of visual information processing speed that is also correlated with cognitive ability. There is evidence that PAF is slowed in SCZ, but it remains unclear whether PAF is reduced in BD, or if slower PAF is associated with impaired visual perception and cognition in these clinical disorders. METHODS: The current study recorded resting-state brain activity (both eyes open and closed) with electroencephalography (EEG) in 90 SCZ participants, 62 BD participants, and 69 healthy controls. Most participants also performed a visual perception task (backward masking) and cognitive testing (MATRICS Consensus Cognitive Battery). RESULTS: We replicated previous findings of reduced PAF in SCZ compared with healthy controls. In contrast, PAF in BD did not significantly differ from healthy controls. Further, PAF was significantly correlated with performance on the perceptual and cognitive measures in SCZ, but not BD. PAF was also correlated with visual perception in the healthy control group, and showed a trend-level correlation with cognition. CONCLUSIONS: Together, these results suggest that PAF deficits characterize SCZ, but not BD, and that individual differences in PAF relate to abnormalities in visual information processing and cognition in SCZ.

An ERP Study of Face Processing in Schizophrenia, Bipolar Disorder, and Socially Isolated Individuals from the Community.

People with schizophrenia (SCZ) and bipolar disorder (BD) have impairments in processing social information, including faces. The neural correlates of face processing are widely studied with the N170 ERP component. However, it is unclear whether N170 deficits reflect neural abnormalities associated with these clinical conditions or differences in social environments. The goal of this study was to determine whether N170 deficits would still be present in SCZ and BD when compared with socially isolated community members. Participants included 66 people with SCZ, 37 with BD, and 125 community members (76 "Community-Isolated"; 49 "Community-Connected"). Electroencephalography was recorded during a face processing task in which participants identified the gender of a face, the emotion of a face (angry, happy, neutral), or the number of stories in a building. We examined group differences in the N170 face effect (greater amplitudes for faces vs buildings) and the N170 emotion effect (greater amplitudes for emotional vs neutral expressions). Groups significantly differed in levels of social isolation (Community-Isolated > SCZ > BD = Community-Connected). SCZ participants had significantly reduced N170 amplitudes to faces compared with both community groups, which did not differ from each other. The BD group was intermediate and did not differ from any group. There were no significant group differences in the processing of specific emotional facial expressions. The N170 is abnormal in SCZ even when compared to socially isolated community members. Hence, the N170 seems to reflect a social processing impairment in SCZ that is separate from level of social isolation.

Approaches to Studying and Improving Social Motivation in Schizophrenia.

Social motivation impairments, or "asociality," have long been considered a core clinical feature of schizophrenia. Although the prevalence and pervasive negative impact of poor social motivation is well-documented, our understanding is limited regarding causal mechanisms. Advances in definition, conceptualization, and characterization are needed to inform research aimed at understanding these mechanisms and developing effective interventions. This theme issue is intended to accelerate efforts to study and treat social motivation in schizophrenia by synthesizing the current knowledge and providing new frameworks to guide future research in this area.

Social Motivation in Schizophrenia: What's Effort Got to Do With It?

BACKGROUND AND HYPOTHESIS: Social motivation, defined as the fundamental human desire to seek out, engage in, and maintain interpersonal bonds, has become a growing area of research in schizophrenia. The major focus has been on understanding the impact of social reward-related processes. An obvious but rarely acknowledged fact is that social interactions, much like other goal-directed acts, require the exertion of effort. In this Review Article, we argue that social motivation in schizophrenia can be conceptualized through the lens of an established framework: effort-based decision-making (EBDM). STUDY DESIGN: We conducted a literature review on social reward processing in schizophrenia, then extended these findings by applying concepts and insights from the literature on EBDM to the study of social motivation. STUDY RESULTS: Within the EBDM framework, decisions about whether or not to pursue social interactions are bound by cost/benefit calculations. That is, people do not pursue social behaviors when the estimated "cost" of the required effort outweighs the anticipated "benefit" or reward. We propose that people with schizophrenia are less likely to engage in social interaction compared with healthy samples because they: (1) underestimate the benefits of relationships (based on expectations of reward/punishment), (2) overestimate the effort costs associated with social interaction, and/or (3) fail to integrate cost-benefit information in an optimal manner. CONCLUSIONS: EBDM is an especially promising framework of social motivation that goes beyond the current focus on social reward processing to include a focus on effort.

An Update on Treatment of Cognitive Impairment Associated with Schizophrenia.

Cognitive impairment associated with schizophrenia (CIAS) is widely regarded as a critically important treatment target for schizophrenia. Despite major efforts and a number of promising findings, we do not yet have an approved drug for CIAS. Similarly, promising cognitive remediation approaches are limited in their ability to help patients achieve real-world functional gains on a wide scale. This article provides an update and critical evaluation of recent treatment development activities for CIAS. First, we provide update on pharmacological approaches, which include a glutamatergic drug that is currently in Phase III trials for CIAS, and discuss factors that may have impacted past efforts to identify efficacious drugs. Second, we review positive findings, limitations, and current trends involving cognitive remediation approaches. Third, we consider newer transdiagnostic approaches aimed at looking beyond, or identifying more homogenous subgroups within, the diagnostic category schizophrenia to advance treatment development. Despite its many challenges, treatment development for CIAS remains a major public health issue and research continues to push forward on several encouraging fronts.

Reduced neural activity when anticipating social versus nonsocial rewards in schizophrenia: Preliminary evidence from an ERP study.

Diminished social motivation is a core feature of schizophrenia that might reflect disturbances in social reward processing. It is not known whether these disturbances reflect anticipatory ("wanting") and/or consummatory ("liking") pleasure deficits. The primary aim of this study was to examine social versus nonsocial reward processing during these temporally distinct substages using event-related potential (ERP) components. Twenty-three schizophrenia participants and 20 healthy participants completed an incentive delay task with social (i.e., smiling expressions) and nonsocial (i.e., money) rewards. We measured two anticipatory ERPs (i.e., "wanting") (target anticipation: Contingent Negative Variation [CNV]; feedback anticipation: Stimulus Preceding Negativity [SPN]) and one consummatory ERP (i.e., "liking") (feedback receipt: P300). As a secondary aim, we examined correlations between the ERPs and interview-rated motivational negative symptoms and social functioning. Schizophrenia participants showed overall less target anticipation (blunted CNV) across all trials (social and nonsocial) than healthy participants. Importantly, schizophrenia participants exhibited less anticipation of social rewards relative to nonsocial rewards (SPN), whereas healthy participants showed similar anticipation for both reward types. Both groups showed similar responses to social and nonsocial reward receipt (P300). Furthermore, social reward anticipation during the incentive delay task was associated with more social approach behaviors in the real-world. Together, these findings provide preliminary evidence for intact social reward "liking" and impaired "wanting" in schizophrenia.

A comparison of stages of attention for social and nonsocial stimuli in schizophrenia: An ERP study.

Social motivation disturbances have been long observed in people with schizophrenia, yet the underlying components that drive these impairments remain unclear. Social attention is one component of social motivation and involves stages of attentional orienting, alerting/sustained attention, and executive control. It is not known at which stage the breakdown in social attention occurs in schizophrenia. The present study examined the allocation of social versus nonsocial attention at multiple stages of processing using event related potential (ERP) components. Electroencephalography from 36 outpatients with schizophrenia and 20 healthy participants was recorded during a dot probe task while viewing social/nonsocial stimuli that assessed: (1) orienting (indexed by the N1pc), (2) sustained attention (Contingent Negative Variation, [CNV]), and (3) executive control of attention during target evaluation (P300). Additionally, we analyzed correlations between the ERPs and participants' reaction times (RT) to the targets. Schizophrenia participants oriented their attention equally to social and nonsocial stimuli (N1pc), showed greater sustained attention to social than nonsocial stimuli (i.e., larger CNV), and exerted greater executive control on social trials (i.e., larger P300) than nonsocial trials, similarly to healthy participants. However, schizophrenia participants showed diminished overall sustained attention (blunted CNV) during the task, compared with healthy participants. Furthermore, greater sustained attention (larger CNV) and greater executive control (larger P300) were associated with improved behavioral performance (faster RTs) for healthy participants, but not schizophrenia participants. Together, these findings suggest there is impaired sustained attention for both social and nonsocial stimuli in schizophrenia, and their attention may not correspond with their behavior.

Support for the social-cognitive model of internalized stigma in serious mental illness.

One prominent social-cognitive model of internalized stigma by Corrigan and his colleagues (2012; 2002) proposes that individuals are exposed to societal stereotypes about mental illness, at least tacitly agree with them, and may apply them to oneself, engendering harmful self-beliefs. There is limited empirical support for this model in serious mental illness. Moreover, it is not clearly established how internalized stigma and its associated factors impact recovery in this population. The current study uses structural equation modeling (SEM) to assess the social-cognitive model's goodness of fit in a sample of Veterans with serious mental illness (Veteran sample, n = 248), and then validates the model in a second and independent sample of individuals receiving community-based psychiatric rehabilitation services (community sample, n = 267). Participants completed the Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006) and measures of self-esteem, self-efficacy, and recovery attitudes. Consistent with Corrigan and colleagues' formulation of internalized stigma, SEM analyses showed a significant indirect pathway from stereotype awareness, to stereotype agreement, to application to self, to self-esteem decrement, to poorer recovery attitudes. Additionally, there was a significant direct effect from stereotype awareness to self-esteem. This study shows that individuals with serious mental illness experience psychological harm from stigma in two ways: (1) through perceived public prejudice and bias, and (2) through internalizing these negative messages. In particular, stigma harms individuals' self-esteem, which then reduces their recovery attitudes.

Self-stigma in psychotic disorders: Clinical, cognitive, and functional correlates in a diverse sample.

Self-stigma in mental illness is linked to negative clinical and functional outcomes, but little is known about its correlates specifically in psychotic disorders. Here we investigated the role of clinical symptoms, cognition, and vocational status as correlates of self-stigma in 98 individuals with psychotic disorders (36 Black American, 32 White Hispanic, 11 White Non-Hispanic, 11 Asian American). A principal component analysis of the Internalized Stigma of Mental Illness scale yielded three components: Experiential Stigma, Stereotype Endorsement, and Stigma Resistance. Higher Experiential Stigma was associated with greater severity of affective symptoms and lower vocational status. Higher Stigma Resistance was associated with higher social and non-social cognition, and higher vocational status. Stereotype Endorsement did not significantly correlate with any predictor variable. Linear regression models showed that 13% of the variance in Experiential Stigma was explained by affective symptoms and vocational status, and 20% of the variance in Stigma Resistance was explained by non-social cognition and vocational status. These findings provide new information about the correlates of self-stigma in an ethnically and racially diverse psychotic disorder sample. Such information may lead to a better understanding of self-stigma mechanisms in this population.

People with schizophrenia do not show the normal benefits of social versus nonsocial attentional cues.

OBJECTIVE: Schizophrenia is associated with impairments in social motivation. Social attention has been proposed as an underlying mechanism for social motivation. However, studies in schizophrenia have rarely examined social attention, and none of these studies examined the effects with rapidly presented stimuli. METHOD: The current study examined whether individuals with schizophrenia have reduced social attention and whether reduced social attention was related to social motivation deficits (measured with the Clinical Assessment Interview for Negative Symptoms) and decreased social functioning (Role Functioning Scale). Thirty-seven outpatients with schizophrenia and 29 healthy participants completed a gaze cueing task with directional social cues (eye gaze) and nonsocial cues (arrows) at varying stimulus onset asynchronies. RESULTS: As predicted, schizophrenia participants had reduced social attention relative to nonsocial attention, compared with healthy participants. Healthy participants were quicker to respond to social cues than nonsocial cues, but schizophrenia participants did not exhibit this same pattern. Schizophrenia participants showed higher accuracy when targets appeared in the same location as a directional cue (i.e., congruency) for nonsocial, but not social, cues. Contrary to expectations, reduced social attention was not significantly correlated with clinically rated social motivation deficits or decreased social functioning in the schizophrenia group. CONCLUSION: These findings provide evidence for social attention deficits in schizophrenia, but without a clear mapping of its influence on social motivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Assessing Social Affiliative Behavior: A Comparison of in Vivo and Video Tasks.

Social affiliation, or engagement in positive social interactions, is often profoundly impaired in individuals with schizophrenia. Valid measures of social affiliation are needed to understand these impairments and their symptom and functional correlates; however, such measures are limited and have not been validated. This pilot study evaluated one such measure-the video-based Social Affiliation Interaction Task (SAIT)-and a novel in vivo behavioral measure, the Affiliative Conversation Task (ACT). Twenty participants with schizophrenia or schizoaffective disorder (SZ) and 35 nonpsychiatric controls (CT) completed both tasks and measures of negative symptoms and functioning. We explored group differences in social affiliation skills; convergent validity between social affiliation skill ratings from the two tasks; and concurrent validity with social affiliation skill ratings, negative symptoms, and functioning. SZ evidenced lower affiliation skill ratings than CT on the video SAIT, but not on the ACT, and the tasks displayed moderate convergent validity for affiliation skill ratings. Less affiliation skill in the SAIT was correlated with more negative symptoms and less functioning in the SZ group with medium effects, though the results were not significant. Findings suggest that the SAIT may be more sensitive to individual differences in skill level. Future research should continue to examine the SAIT for use in measuring affiliation skills.

The valuation of social rewards in schizophrenia.

Social impairment in schizophrenia is often thought to reflect poor social cognition. Here we examine responses to social rewards, an aspect of social functioning that is not featured prominently in the literature. The goal of this experiment was to explore whether people with schizophrenia (a) undervalue social rewards, and (b) whether the undervaluation of social rewards was related to motivation and pleasure deficits in schizophrenia and decreased social functioning. People with schizophrenia and healthy participants completed a game (Shore & Heerey, 2011) to explore preferences for different types of social (polite and genuine smiles) and nonsocial (monetary) rewards from computerized opponents. Preferences for reward types were quantified for each participant based on choice behavior during the game. Participants also completed a smile discrimination task to assess their ability to discriminate these types of smiles. Analyses revealed that people with schizophrenia (N = 41) treated genuine smiles as significantly less rewarding than did healthy participants (N = 29), despite showing a similar preference for monetary rewards. The undervaluation of social rewards was not related to the ability to discriminate between the smiles. The current findings provide preliminary evidence of reduced social reward valuation among individuals with schizophrenia, which may have implications for behavior in face-to-face social interactions. (PsycINFO Database Record

Negative symptoms and the formation of social affiliative bonds in schizophrenia.

Negative symptoms in schizophrenia are characterized by deficits in normative experiences and expression of emotion, and they are associated with poor social functioning. Negative symptoms relating to deficits in motivation and pleasure may hinder the development of affiliative bonds. The current study used a novel procedure to examine the relation between negative symptoms and the development of social affiliation within a laboratory setting. Fifty-five men (35 controls; 20 with a schizophrenia spectrum disorder) completed three Social Affiliation Enhancement Tasks with an experimenter partner. Self-reported affiliation and affect ratings were assessed before and after the affiliative interaction. Across groups, social affiliation and positive affect increased following the interactive tasks. However, the schizophrenia group reported less positive and more negative affect than controls. Within individuals with schizophrenia, negative symptoms reflecting motivation and pleasure deficits and self-reported social anhedonia were associated with less affiliative feelings of interpersonal closeness and less willingness to interact. Additionally, these self-reported reactions to the interaction partner were significantly related to social functioning in the community. These findings indicate that though individuals with schizophrenia can form affiliative bonds, the extent to which this is possible may be limited by negative symptoms relating to motivation and pleasure. Additional research will be necessary to examine just how these negative symptoms interfere with social affiliation.

Treatment of substance use disorders in schizophrenia.

BACKGROUND: Substance use disorders (SUDs) represent a great barrier to functional recovery for individuals with schizophrenia. It is important to use research on treatment of SUDs in schizophrenia to guide treatment recommendations and program planning. OBJECTIVES: We review studies of pharmacological and psychosocial interventions to treat SUDs in individuals with schizophrenia. METHODS: The criteria used to select studies for inclusion are (1) the percentage of the sample with a schizophrenia spectrum diagnosis is at least 25%; (2) participants have a comorbid SUD or problem use of substances; (3) an intervention for SUD is provided; (4) a substance use-related outcome is measured; and (5) the study design enabled examination of pre-post outcome measures including open label trials, nonrandomized evaluations (quasi-experimental designs, nonrandom assignment to groups), or randomized controlled trials. RESULTS: There are few psychopharmacology outcomes studies. Most have examined use of antipsychotic medications to treat SUDs in schizophrenia. Several trials have yielded positive findings for naltrexone in reducing drinking compared to placebo in this population. Motivational and cognitive-behavioral interventions are associated with decreased substance use in several trials. CONCLUSION: Treatment for SUDs is feasible within a range of settings and acceptable to many individuals with schizophrenia. All individuals with schizophrenia should be offered brief or more extended psychosocial interventions that incorporate discussion of personal reasons to change and training in cognitive-behavioral strategies to reduce use, cope with cravings and stress, and avoid relapse. Future research must include larger samples, longitudinal designs, and similar outcome measures across studies.

Social affiliation and negative symptoms in schizophrenia: Examining the role of behavioral skills and subjective responding.

Schizophrenia is characterized by profound impairment in the motivation for social affiliation. Negative symptoms are associated with such impairment but the contribution of behavioral skill deficits is unclear. In this study we utilized a novel video paradigm to assess performance-based affiliative behavioral skills in individuals with schizophrenia (N=48) and community controls (N=29). Individuals with schizophrenia displayed significant impairment in behavioral affiliative skills compared to controls; however, in response to the affiliative interaction the groups did not differ on self-reported affective responding, appraisal of the interaction partner, or desire to interact with the partner in the future. Importantly, within the patient group more severe negative symptoms (particularly those related to motivation and pleasure) were associated with poorer affiliative social skills and this relationship was independent of instrumental (non-social) skills, depression or positive symptoms. More severe negative symptoms were also associated with less positive affect in response to the interaction and less positive appraisals of the interaction partner. Self-reported social anhedonia was related to patients' diminished willingness to interact with the partner in the future. These results demonstrate that negative symptoms in schizophrenia are related to both affiliative skill deficits and less affiliative subjective responses to interaction partners.

Emotion regulation abnormalities in schizophrenia: Directed attention strategies fail to decrease the neurophysiological response to unpleasant stimuli.

Previous research provides evidence that individuals with schizophrenia (SZ) have emotion regulation abnormalities, particularly when attempting to use reappraisal to decrease negative emotion. The current study extended this literature by examining the effectiveness of a different form of emotion regulation, directed attention, which has been shown to be effective at reducing negative emotion in healthy individuals. Participants included outpatients with SZ (n = 28) and healthy controls (CN: n = 25), who viewed unpleasant and neutral images during separate event-related potential and eye-movement tasks. Trials included both passive viewing and directed attention segments. During directed attention, gaze was directed toward highly arousing aspects of an unpleasant image, less arousing aspects of an unpleasant image, or a nonarousing aspect of a neutral image. The late positive potential (LPP) event-related potential component indexed emotion regulation success. Directing attention to nonarousing aspects of unpleasant images decreased the LPP in CN; however, SZ showed similar LPP amplitude when attention was directed toward more or less arousing aspects of unpleasant scenes. Eye tracking indicated that SZ were more likely than CN to attend to arousing portions of unpleasant scenes when attention was directed toward less arousing scene regions. Furthermore, pupilary data suggested that SZ patients failed to engage effortful cognitive processes needed to inhibit the prepotent response of attending to arousing aspects of unpleasant scenes when attention was directed toward nonarousing scene regions. Findings add to the growing literature indicating that individuals with SZ display emotion regulation abnormalities and provide novel evidence that dysfunctional emotion-attention interactions and generalized cognitive control deficits are associated with ineffective use of directed attention strategies to regulate negative emotion. (PsycINFO Database Record

The processing of emotional stimuli during periods of limited attentional resources in schizophrenia.

When participants are asked to attend to two target stimuli in a rapid serial visual presentation sequence, the successful identification of the 1st target (T1) leads to transient impairment in reporting the 2nd target (T2)--this effect is known as the attentional blink (AB). In healthy individuals, this AB effect is either diminished or accentuated when emotional stimuli are presented in the T2 or T1 positions, respectively, suggesting that affective content influences bottom-up (i.e., exogenous) attention. In the current study, we conducted two separate experiments using the Emotional Attentional Blink paradigm where emotional words were presented in the T2 or T1 position to determine whether schizophrenia patients with high and low negative symptoms differ from controls in the extent to which emotional stimuli influence bottom-up attentional processes. Participants included 33 schizophrenia patients and 28 controls in Experiment 1 (T2 Task), and 30 schizophrenia patients and 24 controls in Experiment 2 (T1 Task). In both experiments, patients were divided into high (HI-NEG) and low (LOW-NEG) negative symptom subgroups using the Scale for the Assessment of Negative Symptoms. Results of Experiment 1 indicated that controls and LOW-NEG patients displayed the typical pattern of AB sparing at early lags for emotional relative to neutral words; however, HI-NEG patients showed no difference in T2 accuracy between emotional and neutral stimuli. Results of Experiment 2 indicated that controls and LOW-NEG patients displayed reduced T2 accuracy following unpleasant T1 stimuli, while HI-NEG patients showed no decrement in T2 accuracy after emotional T1s. Across both experiments, findings suggest that emotional stimuli have a bottom-up competitive advantage in LOW-NEG patients and controls; however, this bottom-up advantage is absent in HI-NEG patients.

Emotion regulation abnormalities in schizophrenia: cognitive change strategies fail to decrease the neural response to unpleasant stimuli.

Contrary to early conceptualizations of emotional experience in schizophrenia (SZ), recent research indicates that patients do not self-report less in-the-moment pleasure than controls (CN). Rather, patients report experiencing elevated levels of negative emotionality in response to a range of evocative stimuli. In this study, we examined the possibility that elevations in negative emotionality in SZ may reflect an underlying emotion regulation abnormality. Event-related potentials (ERPs) were recorded from outpatients with SZ (n = 25) and demographically matched healthy controls (n = 21) during passive viewing of unpleasant and neutral photographs. Unpleasant images were preceded by an audio description that described the image as being either negative or neutral. Neutral images were preceded by neutral audio descriptions. The late positive potential (LPP), an ERP component sensitive to cognitive change strategies, was examined as an index of emotion regulation. Both CN and SZ showed an increased LPP to negatively described unpleasant images compared with neutral images. In addition, CN showed evidence of emotion regulation, as reflected by a smaller LPP for unpleasant images preceded by a neutral descriptor, relative to a negative descriptor. In contrast, SZ patients showed an inability to downregulate emotional response, as evidenced by no difference in the amplitude of the LPP for unpleasant images preceded by negative or neutral descriptors. Findings provide neurophysiological evidence for an emotion regulation abnormality in SZ and suggest that failures in cognitive change may underlie increased negative emotionality in SZ.

Next-generation negative symptom assessment for clinical trials: validation of the Brief Negative Symptom Scale.

The current study examined the psychometric properties of the Brief Negative Symptom Scale (BNSS), a next-generation rating instrument developed in response to the NIMH sponsored consensus development conference on negative symptoms. Participants included 100 individuals with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder who completed a clinical interview designed to assess negative, positive, disorganized, and general psychiatric symptoms, as well as functional outcome. A battery of anhedonia questionnaires and neuropsychological tests were also administered. Results indicated that the BNSS has excellent internal consistency and temporal stability, as well as good convergent and discriminant validity in its relationships with other symptom rating scales, functional outcome, self-reported anhedonia, and neuropsychological test scores. Given its brevity (13-items, 15-minute interview) and good psychometric characteristics, the BNSS can be considered a promising new instrument for use in clinical trials.