Validation of the Chinese version of the Multidimensional Schizotypy Scale (MSS): Convergent evidence from exploratory and confirmatory factor analyses.

BACKGROUND: Schizotypy has been shown to be a time-stable construct that exists across the schizophrenia spectrum. The Multidimensional Schizotypy Scale (MSS) was developed to capture the three factors underlying schizotypy: positive, disorganized and negative schizotypy. However, a recent validation study reported a four-factor construct with an additional negative social anhedonia factor. The factor structure of the Chinese version of the MSS remains unknown. This study aimed to identify and validate the factor structure of the Chinese version of the MSS. METHODS: We recruited 641 Chinese speakers via on-line advertisement. We administered the Chinese version of the MSS, which was a self-report instrument. The scale consists of 77 items with true or false response options. We identified and removed 43 outliers. Finally, a total of 294 participants were randomly selected as the derivative sample for exploratory factor analysis (EFA). The remaining 304 participants were retained as the validation sample for confirmatory factor analysis (CFA). RESULTS: EFA identified four factors: the positive factor, the disorganization factor, the negative affective and motivational anhedonia factor, and the negative social anhedonia factor. The EFA-identified four-factor model was compared with the unidimensional, three-factor bifactorial and theoretical three-factor models using CFAs. The three-factor bifactorial model fitted the data better than the EFA-identified four-factor model. CONCLUSION: Our finding suggests that the Chinese version of the MSS is a valid tool for assessing schizotypy in the Chinese setting.

Effort-cost computation in a transdiagnostic psychiatric sample: Differences among patients with schizophrenia, bipolar disorder, and major depressive disorder.

Amotivational symptoms are observed in schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD). Effort-cost computation may be a potential contributor to amotivation transdiagnostically. This study examined effort-cost computation in these three diagnostic groups. This study recruited 141 outpatients (49 SCZ, 52 non-psychotic BD, and 40 non-psychotic MDD) and 57 healthy controls (HCs). We administered the Effort-Expenditure for Reward Task (EEfRT), which manipulated different levels of reward magnitude and probability relating to a high and low physical effort task. There were significant interactions between group and reward magnitude, group and reward probability, and group and expected value on the percentage of high-effort choices. SCZ, BD, and MDD patients made comparably fewer high-effort choices than HCs in the high-reward magnitude, high-reward probability, and high-expected-value conditions. Self-reported amotivation did not correlate with decision-making on the EEfRT. Our findings suggest that reduced effort expenditure for reward is a transdiagnostic phenotype in SCZ, BD, and MDD.

Prospection deficits in schizophrenia: Evidence from clinical and subclinical samples.

Previous research has revealed anticipatory pleasure deficits in people with schizophrenia and people with social anhedonia but who do not have schizophrenia. Prospection is an important component of anticipatory pleasure, but little is known about the role of prospection in social anhedonia. In 2 studies, we investigated prospection and anticipatory pleasure in people with schizophrenia and people with social anhedonia using an affective prospection task and a self-report measure, the Temporal Experience of Pleasure Scale (TEPS). In Study 1, we found that people with schizophrenia (n = 31) reported less TEPS anticipatory pleasure, generated less rich and vivid prospections, and reported less preexperiencing of future events than people without schizophrenia (n = 29). In Study 2, we found that people with social anhedonia (n = 34) reported less TEPS anticipatory pleasure, generated less rich prospections, and reported less pleasure and preexperiencing for future events than people without social anhedonia (n = 33). Taken together, prospection impairments and decreased anticipatory pleasure were observed in schizophrenia and social anhedonia. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Revisiting the persistent negative symptoms proxy score using the Clinical Assessment Interview for Negative Symptoms.

OBJECTIVE: The present study aimed to validate a severity cut-off of negative symptoms for persistent negative symptoms (PNS) identification using the Clinical Assessment Interview for Negative Symptoms (CAINS). METHOD: A total of 206 patients with schizophrenia were recruited and divided into the PNS group (n = 57) and the Non-PNS group (n = 149) using PNS criteria based on the SANS and the SAPS. To determine the appropriate cut-offs on the CAINS in identifying PNS, Receiver Operating Characteristic (ROC) curve analysis was conducted in the PNS and Non-PNS groups. RESULTS: Our results showed that the cutoffs for identifying PNS on the CAINS total score, the Motivation and Pleasure (MAP) subscale score and the Expression (EXP) subscale score were 25, 17, and 5 respectively. Area Under the Curve (AUC) analysis indicated excellent discrimination of the PNS group from the Non-PNS group using the cut-off for the CAINS total score. However, discrimination was somewhat better for the MAP subscale score than the EXP subscale score. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the MAP subscale were 81.54% and 97.16%. CONCLUSION: We found that the cut-off scores derived from the CAINS to identify PNS are comparable to existing scales. The CAINS offers an alternative means in identifying PNS patients in clinical trials that overcomes methodological and conceptual limitations of older scales.

Low-pleasure beliefs in patients with schizophrenia and individuals with social anhedonia.

Anhedonia in schizophrenia has been suggested to comprise a set of low-pleasure beliefs, defined as beliefs that certain things/activities were not pleasurable or that one does not feel pleasant generally. However, no instrument has been intentionally developed to specifically measure low-pleasure beliefs, and there is a paucity of empirical evidence for low-pleasure beliefs and their relationship with anhedonia in both patients with schizophrenia and individuals with high social anhedonia. We developed and validated the Beliefs About Pleasure Scale (BAPS) using non-clinical (Studies 1, 2 & 3), chronic schizophrenia (Study 2), and first episode schizophrenia (Study 3) samples. Across these studies, we examined psychometric properties of the BAPS, including temporal stability, internal consistency, factor structure, and convergent validity. The 22 BAPS items loaded onto 4 factors, namely the "Devaluation of Pleasure", the "Pleasurable Activity Expectancies", the "Negative Outcomes Expectancies", and the "Attention to Pleasure". The measure demonstrated good internal consistency and convergent validity in each sample. Moreover, both individual with schizophrenia and non-clinical participants with high social anhedonia scored higher on the BAPS than controls (Study 3), supporting construct validity. These findings provide preliminary evidence for the presence of low-pleasure beliefs in both clinical and subclinical groups and suggest that the BAPS has promising initial psychometric properties. The BAPS will be useful for exploring the cognitive component of anhedonia and provides a novel assessment for mechanism of change in psychosocial treatment studies.

Profiling of experiential pleasure, emotional regulation and emotion expression in patients with schizophrenia.

BACKGROUND: Emotion deficits may be the basis of negative symptoms in schizophrenia patients and they are prevalent in these patients. However, inconsistent findings about emotion deficits in schizophrenia suggest that there may be subtypes. AIM: The present study aimed to examine and profile experiential pleasure, emotional regulation and expression in patients with schizophrenia. METHODS: A set of checklists specifically capturing experiential pleasure, emotional regulation, emotion expression, depressive symptoms and anhedonia were administered to 146 in-patients with schizophrenia and 73 demographically-matched healthy controls. Psychiatric symptoms and negative symptoms were also evaluated by a trained psychiatrist for patients with schizophrenia. RESULTS: Two-stage cluster analysis and discriminant function analysis were used to analyze the profile of these measures in patients with schizophrenia. We found a three-cluster solution. Cluster 1 (n=41) was characterized by a deficit in experiential pleasure and emotional regulation, Cluster 2 (n=47) was characterized by a general deficit in experiential pleasure, emotional regulation and emotion expression, and Cluster 3 (n=57) was characterized by a deficit in emotion expression. Results of a discriminant function analysis indicated that the three groups were reasonably discrete. CONCLUSION: The present findings suggest that schizophrenia patients can be classified into three subtypes based on experiential pleasure, emotional regulation and emotion expression, which are characterized by distinct clinical representations.

Theory of mind impairment and its clinical correlates in patients with schizophrenia, major depressive disorder and bipolar disorder.

BACKGROUND: Although Theory of Mind (ToM) impairment has been observed in patients with a wide range of mental disorders, the similarity and uniqueness of these deficits across diagnostic groups has not been thoroughly investigated. METHODS: We recruited 35 participants with schizophrenia (SCZ), 35 with bipolar disorder (BD), 35 with major depressive disorder (MDD), and 35 healthy controls in this study. All participants were matched in age, gender proportion and IQ estimates. The Yoni task, capturing both the cognitive and affective components of ToM at the first- and second-order level was administered. Repeated-measure ANOVA and MANOVA were conducted to compare the group differences in ToM performance. A network was then constructed with ToM performances, psychotic and depressive symptoms, and executive function as nodes exploring the clinical correlates of ToM. RESULTS: Overall, ToM impairments were observed in all patient groups compared with healthy controls, with patients with SCZ performing worse than those with BD. In second-order conditions, patients with SCZ and MDD showed deficits in both cognitive and affective conditions, while patients with BD performed significantly poorer in cognitive conditions. Network analysis showed that second-order affective ToM performance was associated with psychotic and depressive symptoms as well as executive dysfunction, while second-order affective ToM performance and negative symptoms showed relatively high centrality in the network. CONCLUSIONS: Patients with SCZ, MDD and BD exhibited different types and severity of impairments in ToM sub-components. Impairment in higher-order affective ToM appears to be closely related to clinical symptoms in both psychotic and affective disorders.

Dissociation between affective experience and motivated behaviour in schizophrenia patients and their unaffected first-degree relatives and schizotypal individuals.

BACKGROUND: The neuropsychological origins of negative syndrome of schizophrenia remain elusive. Evidence from behavioural studies, which utilised emotion-inducing pictures to elicit motivated behaviour generally reported that that schizophrenia patients experienced similar affective experience as healthy individuals but failed to translate emotional salience to motivated behaviour, a phenomenon called emotion-behaviour decoupling. However, a few studies have examined emotion-behaviour decoupling in non-psychotic high-risk populations, who are relatively unaffected by medication effects. METHODS: In this study, we examined the nature and extent of emotion-behaviour decoupling in in three independent samples (65 schizophrenia patients v. 63 controls; 40 unaffected relatives v. 45 controls; and 32 individuals with social anhedonia v. 32 controls). We administered an experimental task to examine their affective experience and its coupling with behaviour, using emotion-inducing slides, and allowed participants to alter stimulus exposure using button-pressing to seek pleasure or avoid aversion. RESULTS: Schizophrenia patients reported similar affective experiences as their controls, while their unaffected relatives and individuals with high levels of social anhedonia exhibited attenuated affective experiences, in particular in the arousal aspect. Compared with their respective control groups, all of the three groups showed emotion-behaviour decoupling. CONCLUSIONS: Our findings support that both genetically and behaviourally high-risk groups exhibit emotion-behaviour decoupling. The familial association apparently supports its role as a putative trait marker for schizophrenia.