Schlosser Danielle A, Campellone Timothy R, Biagianti Bruno, Delucchi Kevin L, Gard David E, Fulford Daniel, Stuart Barbara K, Fisher Melissa, Loewy Rachel L, Vinogradov Sophia
University of California at San Francisco, United States.
University of California at San Francisco, United States; University of California at Berkeley, United States.
Schizophr Res. 2015 Dec;169(1-3):204-208. doi: 10.1016/j.schres.2015.10.036. Epub 2015 Oct 31.
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.
改善临床高危（CHR）个体预后的一个优先事项是增进我们对精神病预测因素以及心理社会功能的理解。特别是社会功能，它既是风险的独特指标，其本身也是一个重要的预后指标。阴性症状是CHR个体社会功能的重要决定因素；然而，尚不清楚哪些特定的阴性症状驱动功能预后，以及这些症状相对于其他预测因素（如神经认知和情绪/焦虑症状）如何发挥作用。在一个由85名CHR个体组成的样本中，我们研究了在精神分裂症中发现的双因素阴性症状结构（体验性症状与表达性症状）是否会在CHR样本中得到复制；并测试了特定阴性症状相对于已知可预测功能的神经认知和情绪/焦虑症状对社会功能的预测程度。双因素阴性症状解决方案在这个CHR样本中得到了复制。发现阴性症状严重程度在抑郁/焦虑和神经认知之外对社会功能具有独特的预测作用。相对于表达性症状，体验性症状与社会功能的关联更强。此外，体验性症状介导了表达性阴性症状与社会功能之间的关系。这些结果表明，在CHR个体中，相对于情感平淡和言语贫乏，动机损害体验在决定社会功能方面更为重要，从而为制定更精确的治疗靶点提供了依据。建议开发新的干预措施，以刺激目标导向行为并加强社交情境中的奖励体验。
