Seon-Kyeong Jang

A Two-Factor Model Better Explains Heterogeneity in Negative Symptoms: Evidence from the Positive and Negative Syndrome Scale.

Acknowledging separable factors underlying negative symptoms may lead to better understanding and treatment of negative symptoms in individuals with schizophrenia. The current study aimed to test whether the negative symptoms factor (NSF) of the Positive and Negative Syndrome Scale (PANSS) would be better represented by expressive and experiential deficit factors, rather than by a single factor model, using confirmatory factor analysis (CFA). Two hundred and twenty individuals with schizophrenia spectrum disorders completed the PANSS; subsamples additionally completed the Brief Negative Symptom Scale (BNSS) and the Motivation and Pleasure Scale—Self-Report (MAP-SR). CFA results indicated that the two-factor model fit the data better than the one-factor model; however, latent variables were closely correlated. The two-factor model’s fit was significantly improved by accounting for correlated residuals between N2 (emotional withdrawal) and N6 (lack of spontaneity and flow of conversation), and between N4 (passive social withdrawal) and G16 (active social avoidance), possibly reflecting common method variance. The two NSF factors exhibited differential patterns of correlation with subdomains of the BNSS and MAP-SR. These results suggest that the PANSS NSF would be better represented by a two-factor model than by a single-factor one, and support the two-factor model’s adequate criterion-related validity. Common method variance among several items may be a potential source of measurement error under a two-factor model of the PANSS NSF.

The Relationship between Childhood Trauma and Suicidal Ideation: Role of Maltreatment and Potential Mediators.

Objective Childhood trauma is recognized as an important risk factor in suicidal ideation, however it is not fully understood how the different types of childhood maltreatment influence suicidal ideation nor what variables mediate the relationship between childhood trauma and suicidal ideation. This study examined the path from childhood trauma to suicidal ideation, including potential mediators. Methods A sample of 211 healthy adults completed the Childhood Trauma Questionnaire (CTQ), Beck scale for Suicidal Ideation (BSI), Functional Social Support Questionnaire (FSSQ) and Hospital Anxiety and Depression Scale (HADS). Path analysis was used to investigate the relationship among study variables. Results Of the several types of childhood maltreatment we considered, only childhood sexual abuse directly predicted suicidal ideation (β=0.215, p=0.001). Childhood physical abuse (β=0.049, 95% confidence interval: 0.011–0.109) and childhood emotional abuse (β=0.042, 95% confidence interval: 0.001–0.107) indirectly predicted suicidal ideation through their association with anxiety. Childhood neglect indirectly predicted suicidal ideation through association with perceived social support (β=0.085, 95% confidence interval: 0.041–0.154). Conclusion Our results confirmed that childhood sexual abuse is a strong predictor of suicidal ideation. Perceived social support mediated the relationship between suicidal ideation and neglect. Anxiety fully mediated the relationship between suicidal ideation and both physical abuse and emotional abuse. Interventions to reduce suicidal ideation among survivors of childhood trauma should focus on anxiety symptoms and attempt to increase their social support.

Theory of mind in Koreans with schizophrenia: A meta-analysis

Previous meta-analytic studies conducted in Western countries have consistently revealed impairments in theory of mind (ToM) in schizophrenia. However, there is no systematic meta-analytic review of ToM deficits in individuals with schizophrenia in non-Western countries. In addition, ToM impairments in individuals with schizophrenia have not been investigated in the distinctive domains (i.e., verbal vs. visual, or affective vs. cognitive). The current meta-analytic study systematically synthesized 13 studies comparing ToM performance of adults with schizophrenia (n=377) and that of healthy controls (n=386) in Korea. The results indicate that Koreans with schizophrenia showed overall large ToM impairments (d=-1.273) but intact performance in control tasks that require a similar amount of cognitive demand as ToM tasks do. Large impairments in affective and cognitive ToM (d=-1.445 and -1.202, respectively) and verbal and visual ToM (d=-1.239 and -1.221, respectively) were found in Koreans with schizophrenia. There were no differences in magnitude between affective and cognitive ToM or between verbal and visual ToM. These results suggest that Koreans with schizophrenia experience substantial impairments in various ToM domains. Comprehensive multi-modality-based assessment targeting various ToM domains should be considered for treatment planning of individuals with schizophrenia.

Informationally Administered Reward Enhances Intrinsic Motivation in Schizophrenia

Even when individuals with schizophrenia have an intact ability to enjoy rewarding moments, the means to assist them to translate rewarding experiences into goal-directed behaviors is unclear. The present study sought to determine whether informationally administered rewards enhance intrinsic motivation to foster goal-directed behaviors in individuals with schizophrenia (SZ) and healthy controls (HCs). Eighty-four participants (SZ=43, HCs=41) were randomly assigned to conditions involving either a performance-contingent reward with an informationally administered reward or a task-contingent reward with no feedback. Participants were asked to play two cognitive games of equalized difficulty. Accuracy, self-reported intrinsic motivation, free-choice intrinsic motivation (i.e., game play during a free-choice observation period), and perceived competency were measured. Intrinsic motivation and perceived competency in the cognitive games were similar between the two participant groups. The informationally administered reward significantly enhanced self-reported intrinsic motivation and perceived competency in both the groups. The likelihood that individuals with schizophrenia would play the game during the free-choice observation period was four times greater in the informationally administered reward condition than that in the no-feedback condition. Our findings suggest that, in the context of cognitive remediation, individuals with schizophrenia would benefit from informationally administered rewards.

Attention and memory bias to facial emotions underlying negative symptoms of schizophrenia

ABSTRACT Introduction. This study assessed bias in selective attention to facial emotions in negative symptoms of schizophrenia and its influence on subsequent memory for facial emotions. Methods. Thirty people with schizophrenia who had high and low levels of negative symptoms (n = 15, respectively) and 21 healthy controls completed a visual probe detection task investigating selective attention bias (happy, sad, and angry faces randomly presented for 50, 500, or 1000 ms). A yes/no incidental facial memory task was then completed. Attention bias scores and recognition errors were calculated. Results. Those with high negative symptoms exhibited reduced attention to emotional faces relative to neutral faces; those with low negative symptoms showed the opposite pattern when faces were presented for 500 ms regardless of the valence. Compared to healthy controls, those with high negative symptoms made more errors for happy faces in the memory task. Reduced attention to emotional faces in the probe detection task was significantly associated with less pleasure and motivation and more recognition errors for happy faces in schizophrenia group only. Conclusions. Attention bias away from emotional information relatively early in the attentional process and associated diminished positive memory may relate to pathological mechanisms for negative symptoms.

T183. AUDITORY-STEADY-STATE RESPONSES AND CORTICAL VOLUME IN PATIENTS WITH SCHIZOPHRENIA

Abstract Background The 40-Hz auditory steady-state response (ASSR) probing gamma-band oscillations may reflect N-methyl-D-aspartate receptor (NMDAR) dysfunction in patients with schizophrenia (SZ). Diminished gamma oscillations are reported in SZ, although increased spontaneous gamma oscillations are also reported. We investigated the 40-Hz ASSR and its association with brain volumes and clinical symptoms of SZ. Methods The 40-Hz ASSR was measured using electroencephalography in 33 patients with SZ and 30 healthy controls (HCs). Four gamma oscillation components (evoked power, spontaneous oscillations (baseline and total power), and inter-trial phase coherence (ITC)) were assessed. Brain volumes were assessed using high-resolution magnetic resonance imaging and voxel-based morphometry. Results Patients with SZ had larger evoked and total powers and higher ITC than HCs. In HCs, evoked power showed significant positive correlations with bilateral superior temporal gyrus (STG) volume. In SZ, the effect of positive symptoms on the path from evoked power to left STG volume was significantly moderated. In SZ with elevated positive symptoms, large evoked power predicted small left STG volume, whereas large evoked power predicted large left STG volume in those with low positive symptoms. Increased baseline power was associated with a smaller left middle frontal gyrus (MFG) volume in SZ, whereas increased ITC correlated with larger MFG volume in HCs. Discussion Our results support the NMDAR hypofunction model of SZ, and suggest significant involvement of the STG and MFG in gamma oscillations.

Validation of the Korean Version of the Clinical Assessment Interview for Negative Symptoms

Objective Clinical Assessment Interview for Negative Symptoms (CAINS) has recently been developed to improve measurement of negative symptoms in schizophrenia. We performed a multi-center study to validate the Korean version of the CAINS (CAINS-K) and explore potential cultural variation. Methods One hundred eighty schizophrenia patients diverse in demographic and illness profile were recruited from four centers in Korea. Along with the CAINS-K, the Scale for the Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scale (BPRS), Calgary Depression Scale for Schizophrenia (CDSS), a self-report measure of behavioral inhibition and activation (BIS/BAS) and neurocognitive tasks were administered to verify external validities. Results The CAINS-K showed high internal-consistency (0.92) and inter-rater reliability (0.77). Exploratory Factor Analysis replicated a two-factor structure of the original scale including motivation/pleasure and expression deficits dimensions. Korean patients tended to report lower pleasure compared to American patients in the prior study. The CAINS-K showed an adequate convergent validity with the SANS, negative symptoms of the BPRS, and BAS. A divergent validity was supported as the CAINS-K showed zero or only weak correlations with other symptoms of the BPRS, depression from the CDSS, and neurocognitive tasks. Conclusion The CAINS-K demonstrated high internal consistency and adequate external validities, and is expected to promote studies on negative symptoms in Korean patients with schizophrenia.

PM525. Reliability and Validity of the Korean version of the Motivation and Pleasure Scale-Self Report (MAP-SR) in Patients with Schizophrenia

After Indonesia’s Mental Health Law, approved by parliament in 2014, then began the movement of mental health services in Indonesia. Rehabilitation is one of the mental health effort that must be done in the context of the patient’s recovery. Mahdi Marzoeki mental hospital in Bogor is the oldest psychiatric hospital in Indonesia which has a psychosocial rehabilitation program hospital-based and community-based. Some programs are done in the hospital include: psychoeducation, social skills training, cognitive remediation, vocational training, art, music, sports and spiritual. Mahdi Marzoeki mental hospitals also developed a psychosocial rehabilitation services, communitybased, namely: ACT (assertive community treatment), case management, mental health alert village, rehabilitation and community-based institutions. These programs are expected to perform continuous rehabilitation services from the hospital to the community, the revolving door phenomenon can be rapidly reduced and many patients can recover and be productive again. Psychopharmacology as one of therapy for mental disorder also has role for recovery. Combination between psychopharmacology and rehabilitation are superior to achieve recovery. The result from the survey that have been done in Psychosocial Rehabilitation Unit show that typical antipsychotic combine with psychosocial rehabilitation increase the GAF (Global Assesment and Functioning) score of the day care patients.

Measuring negative symptoms in patients with schizophrenia: reliability and validity of the Korean version of the Motivation and Pleasure Scale-Self-Report.

Background The Clinical Assessment Interview for Negative Symptoms (CAINS) is one of the validated interview measures of negative symptoms in psychotic disorders. The Motivation and Pleasure Scale-Self-Report (MPSR) is a self-report measure that assesses the motivation and pleasure domains of negative symptoms based on the CAINS. This study evaluated the reliability and validity of a Korean version of the MPSR. Methods A total of 139 patients with schizophrenia completed the MPSR, CAINS, Scale for the Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scales, Calgary Depression Scale for Schizophrenia, and other measures of trait and cognitive function. Results The 15-item MPSR showed good internal consistency. In addition, it also had a good convergent validity with the Motivation and Pleasure subscale of the CAINS and the anhedonia/avolition subscale of the SANS. The scale was not associated with psychotic symptoms, agitation/mania, and depression/anxiety, and it showed good discriminant validity. MPSR scores were significantly correlated with Behavioral Activation System total score for trait measure. Conclusion The Korean version of the MPSR is a notable self-report method for examining the severity of negative symptoms in schizophrenia.