Timothy R. Campellone

Modeling the role of negative symptoms in determining social functioning in individuals at clinical high risk of psychosis

A priority for improving outcome in individuals at clinical high risk (CHR) is enhancing our understanding of predictors of psychosis as well as psychosocial functioning. Social functioning, in particular, is a unique indicator of risk as well as an important outcome in itself. Negative symptoms are a significant determinant of social functioning in CHR individuals; yet, it is unclear which specific negative symptoms drive functional outcome and how these symptoms function relative to other predictors, such as neurocognition and mood/anxiety symptoms. In a sample of 85 CHR individuals, we examined whether a two-factor negative symptom structure that is found in schizophrenia (experiential vs expressive symptoms) would be replicated in a CHR sample; and tested the degree to which specific negative symptoms predict social functioning, relative to neurocognition and mood/anxiety symptoms, which are known to predict functioning. The two-factor negative symptom solution was replicated in this CHR sample. Negative symptom severity was found to be uniquely predictive of social functioning, above and beyond depression/anxiety and neurocognition. Experiential symptoms were more strongly associated with social functioning, relative to expression symptoms. In addition, experiential symptoms mediated the relationship between expressive negative symptoms and social functioning. These results suggest that experiences of motivational impairment are more important in determining social functioning, relative to affective flattening and alogia, in CHR individuals, thereby informing the development of more precise therapeutic targets. Developing novel interventions that stimulate goal-directed behavior and reinforce rewarding experiences in social contexts are recommended.

The power to resist: The relationship between power, stigma, and negative symptoms in schizophrenia

Stigmatizing beliefs about mental illness can be a daily struggle for people with schizophrenia. While investigations into the impact of internalizing stigma on negative symptoms have yielded mixed results, resistance to stigmatizing beliefs has received little attention. In this study, we examined the linkage between internalized stigma, stigma resistance, negative symptoms, and social power, or perceived ability to influence others during social interactions among people with schizophrenia. Further, we sought to determine whether resistance to stigma would be bolstered by social power, with greater power in relationships with other possibly buffering against motivation/pleasure negative symptoms. Fifty-one people with schizophrenia or schizoaffective disorder completed measures of social power, internalized stigma, and stigma resistance. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS). Greater social power was associated with less internalized stigma and negative symptoms as well as more stigma resistance. Further, the relationship between social power and negative symptoms was partially mediated by stigma resistance. These findings provide evidence for the role of stigma resistance as a viable target for psychosocial interventions aimed at improving motivation and social power in people with schizophrenia.

Emotion Perception in Schizophrenia: Context Matters

Research on emotion perception in schizophrenia has focused primarily on the perception of static faces displaying different emotion signals or expressions. However, perception of emotion in daily life relies on much more than just the face. In this article, we review the role of context in emotion perception among people with and without schizophrenia. We argue that not only is context central to the perception of emotion, it in fact helps to construct the perception. Implications for future research on emotion perception are discussed.

Who do you trust? The impact of facial emotion and behaviour on decision making

During social interactions, we use available information to guide our decisions, including behaviour and emotional displays. In some situations, behaviour and emotional displays may be incongruent, complicating decision making. This study had two main aims: first, to investigate the independent contributions of behaviour and facial displays of emotion on decisions to trust, and, second, to examine what happens when the information being signalled by a facial display is incongruent with behaviour. Participants played a modified version of the Trust Game in which they learned simulated players’ behaviour with or without concurrent displays of facial emotion. Results indicated that displays of anger, but not happiness, influenced decisions to trust during initial encounters. Over the course of repeated interactions, however, emotional displays consistent with an established pattern of behaviour made independent contributions to decision making, strengthening decisions to trust. When facial display and behaviour were incongruent, participants used current behaviour to inform decision making.

Context and the perception of emotion in schizophrenia: Sex differences and relationships with functioning

People with schizophrenia have difficulty perceiving facial emotion (Kohler et al., 2010), which is associated with poor social skill (Pinkham and Penn, 2006) and functional outcome (Brekke et al., 2005). However, these studies present faces alone, ignoring the influence of context on emotion perception (Kring and Campellone, 2012). Developing tasks to assess the influence of context on emotion perception among people with schizophrenia is top priority in social cognitive research (Carter et al., 2009). Another important area research that has received little attention is sex differences. Given the numerous differences between men and women with schizophrenia (e.g. Mote and Kring, 2013), it is also important to investigate sex differences in emotion perception. In the present study, 25 peoplewith schizophrenia or schizoaffective disorder and 30 healthy controls (see Table 1) completed the Context and Perception of Emotion (CAPE) task, a computerized task of emotion perception that presents pictures of emotional faces with and without context. In the no context condition, 18 positive or negative faces selected from the Interdisciplinary Affective Science Laboratory (IASLab) Facial Stimulus Set (see www.affectivescience.org) were presented alone against a black background. In the context condition, the same faces were embedded in positive and negative scenes selected from the International Affective Picture Set (IAPS; Lang et al., 2008). In addition to the CAPE, people with schizophrenia were administered tests of

The feasibility, acceptability, and outcomes of PRIME-D: A novel mobile intervention treatment for depression

Despite decades of research and development, depression has risen from the fifth to the leading cause of disability in the United States. Barriers to progress in the field are (1) poor access to high‐quality care; (2) limited mental health workforce; and (3) few providers trained in the delivery of evidence‐based treatments (EBTs). Although mobile platforms are being developed to give consumers greater access to high‐quality care, too often these tools do not have empirical support for their effectiveness. In this study, we evaluated PRIME‐D, a mobile app intervention that uses social networking, goal setting, and a mental health coach to deliver text‐based, EBTs to treat mood symptoms and functioning in adults with depression.

Social motivation in people with recent-onset schizophrenia spectrum disorders

People with schizophrenia-spectrum disorders (SSD) often experience impairments in non-social motivation. In this study, we extended this line of investigation by examining specific components of social motivation and the extent to which these components work together in people with and without a recent-onset SSD. Sixty-four people with a recent-onset SSD and 26 controls completed a task that allowed us to examine changes in anticipated pleasure, decisions to trust, and effort expenditure over the course of repeated interactions with positive or negative outcomes. Compared to controls, we found that people in the SSD group placed less trust, tended to anticipate less pleasure, and expended less effort to increase the likelihood of future interactions with positive outcomes. Further, in the SSD group, effort expenditure was not associated with either anticipated pleasure or decisions to trust. While there were no group differences in anticipated pleasure or trust placed during interactions with negative outcomes, people in the SSD group expended less effort to decrease to the likelihood of future interactions. Taken together, our findings suggest that people with a recent-onset SSD may experience both impairment and disconnection between various components of social motivation for interactions with positive outcomes. Implications for interventions for social engagement in people with SSD are discussed.

Negative symptoms in psychometrically defined schizotypy: The role of depressive symptoms

People high in schizotypy, a risk factor for schizophrenia-spectrum disorders, can have negative symptoms, including diminished experience of motivation/pleasure (MAP) and emotional expressivity (EXP). Additionally, people high in schizotypy often report elevated depressive symptoms, which are also associated with diminished MAP and EXP. In this study, we examined whether negative symptoms were related to schizotypy above and beyond the presence of depressive symptoms. Thirty-one people high in schizotypy and 24 people low in schizotypy were administered the Clinical Assessment Interview for Negative Symptoms (CAINS), an interview-based measure of MAP and EXP negative symptoms and completed a self-report measure of cognitive and somatic-affective depressive symptoms. People high in schizotypy had more MAP negative symptoms than people low in schizotypy, but we found no group differences in EXP negative symptoms. Importantly, the relationship between MAP negative symptoms and schizotypy was fully mediated by cognitive depressive symptoms. These findings suggest that depressive symptoms, specifically cognitive depressive symptoms, may be a pathway for motivation and pleasure impairment, in people at elevated risk for developing schizophrenia-spectrum disorders.

Anticipated pleasure for positive and negative social interaction outcomes in schizophrenia

While recent research suggests that people with schizophrenia anticipate less pleasure for non-social events, considerably less is known about anticipated pleasure for social events. In this study, we investigated whether people with and without schizophrenia differ in the amount and updating of anticipated pleasure over the course of repeated interactions as well as the influence of emotional displays. Thirty-two people with schizophrenia and 29 controls rated their anticipated pleasure over the course of repeated interactions with smiling, scowling, or neutral social partners that had either positive or negative outcomes. Compared to controls, people with schizophrenia anticipated a lower amount of pleasure during interactions with smiling, but not neutral social partners that had positive outcomes. However, the groups did not differ in the amount or updating of anticipated pleasure during interactions that had negative outcomes. Both groups anticipated more pleasure over the course of repeated interactions with smiling partners and less pleasure over the course of repeated interactions with scowling partners compared to interactions with neutral partners. We discuss how less anticipated pleasure for interactions with smiling social partners may be linked to difficulties in social engagement among people with schizophrenia.

High inpatient utilization among Veterans Health Administration patients with substance-use disorders and co-occurring mental health conditions

ABSTRACT Background. Substance-use disorders (SUDs) are common and costly conditions. Understanding high inpatient utilization (HIU) among patients with SUD can inform the development of treatment approaches designed to reduce healthcare expenditures and improve service quality. Objectives. To examine the prevalence, type, and predictors of HIU among patients with SUD and co-occurring mental health conditions. Methods. Service utilization and demographic and clinical variables were extracted from a national sample of Veterans Health Administration (VA) patients with SUD-only [n = 148,960 (98.3% male)], SUD plus serious mental illness ([i.e. schizophrenia- and/or bipolar-spectrum disorders; SUD/SMI; n = 75,913 (91.6% male)], and SUD plus other mental illness [SUD/MI; n = 245,675 (94.6% male)]. Regression models were used to examine HIU during a follow-up year. Results. Prevalence of HIU among the SUD-only group was 6.2% (95% confidence interval (CI): 6.1%–6.3%) compared with 22.7% (95% CI: 22.4%–23.0%) and 9.7% (95% CI: 9.6%–9.8%) among the SUD/SMI and SUD/MI groups, respectively. Patients with SUD/MI represented nearly half of the HIU sample. Primary type of inpatient service use varied by comorbidity: SUD-only = medicine; SUD/SMI = psychiatric; SUD/MI similar use of psychiatric, SUD-related, and medicine. Predictors of HIU were generally similar across groups: older age, unmarried, homelessness, suicide risk, pain diagnosis, alcohol/opioid/sedative-use disorders, and prior-year emergency department/inpatient utilization. Conclusions. Substantial reductions in HIU among an SUD population will likely require treatment approaches that target patients with less-severe mental health conditions in addition to SMI. Cross-service collaborations (e.g., integration of medical providers in SUD care) and interventions designed to target issues and/or conditions that lead to HIU (e.g., homeless care services) may be critical to reducing HIU in this population.