title: Modeling the role of negative symptoms in determining social functioning in individuals at clinical high risk of psychosis.
abstract: 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.
authors.affiliation: University of California at San Francisco, United States. Electronic address: Danielle.schlosser@ucsf.edu.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Schlosser
authors.affiliation: University of California at San Francisco, United States; University of California at Berkeley, United States.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Campellone
authors.affiliation: University of California at San Francisco, United States.
authors.forename: Bruno
authors.initials: B
authors.lastname: Biagianti
authors.affiliation: University of California at San Francisco, United States.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
authors.affiliation: San Francisco State University, United States.
authors.forename: David E
authors.initials: DE
authors.lastname: Gard
authors.affiliation: Boston University, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fulford
authors.affiliation: University of California at San Francisco, United States.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Stuart
authors.affiliation: University of California at San Francisco, United States; San Francisco Veterans Affairs Medical Center, United States.
authors.forename: Melissa
authors.initials: M
authors.lastname: Fisher
authors.affiliation: University of California at San Francisco, United States.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Loewy
authors.affiliation: University of California at San Francisco, United States; San Francisco Veterans Affairs Medical Center, United States.
authors.forename: Sophia
authors.initials: S
authors.lastname: Vinogradov
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000503:physiopathology* / Q000523:psychology*; D012307:Risk Factors; D012917:Social Adjustment; D012920:Social Behavior Disorders / Q000175:diagnosis*; D013223:Statistics as Topic; D055815:Young Adult
keywords: Experiential negative symptoms; Expressive negative symptoms; Motivation; Prodromal; Psychosis; Social functioning