Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue
Journal
Frontiers in Psychiatry
Date Issued
2021-12-14
Author(s)
Russo, Manuela
Repisti Selman
Jerotic, Stefan
Ristic, Ivan
Mesevic Smajic, Eldina
Uka, Fitim
Arenliu, Aliriza
Dzubur Kulenovic, Almai
Injac Stevovic, Lidija
Priebe Stefan
Jovanovic, Nikolina
DOI
doi: 10.3389/fpsyt.2021.785144
Abstract
Background: Negative symptoms are core features of schizophrenia and very
challenging to be treated. Identification of their structure is crucial to provide a better
treatment. Increasing evidence supports the superiority of a five-factor model (alogia,
blunted affect, anhedonia, avolition, and asociality as defined by the NMIH-MATRICS
Consensus); however, previous data primarily used the Brief Negative Symptoms
Scale (BNSS). This study, including a calibration and a cross-validation sample (n
= 268 and 257, respectively) of participants with schizophrenia, used the Clinical
Assessment Interview for Negative Symptoms (CAINS) to explore the latent structure
of negative symptoms and to test theoretical and data-driven (from this study) models of
negative symptoms.
Methods: Exploratory factor analysis (EFA) was carried out to investigate the structure
of negative symptoms based on the CAINS. Confirmatory factor analysis (CFA) tested in
a cross-validation sample four competing theoretical (one-factor, two-factor, five-factor,
and hierarchical factor) models and two EFA-derived models.
Result: None of the theoretical models was confirmed with the CFA. A CAINS-rated
model from EFA consisting of five factors (expression, motivation for recreational
activities, social activities, vocational, and close/intimate relationships) was an excellent
fit to the data (comparative fix index = 0.97, Tucker–Lewis index = 0.96, and root mean
square error of approximation = 0.07).
Conclusions: This study cannot support recent data on the superiority of the five-factor
model defined by the NMIH-MATRICS consensus and suggests that an alternativemodel
might be a better fit. More research to confirm the structure of negative symptoms in
schizophrenia, and careful methodological consideration, should be warranted before a
definitive model can put forward and shape diagnosis and treatment of schizophrenia.
challenging to be treated. Identification of their structure is crucial to provide a better
treatment. Increasing evidence supports the superiority of a five-factor model (alogia,
blunted affect, anhedonia, avolition, and asociality as defined by the NMIH-MATRICS
Consensus); however, previous data primarily used the Brief Negative Symptoms
Scale (BNSS). This study, including a calibration and a cross-validation sample (n
= 268 and 257, respectively) of participants with schizophrenia, used the Clinical
Assessment Interview for Negative Symptoms (CAINS) to explore the latent structure
of negative symptoms and to test theoretical and data-driven (from this study) models of
negative symptoms.
Methods: Exploratory factor analysis (EFA) was carried out to investigate the structure
of negative symptoms based on the CAINS. Confirmatory factor analysis (CFA) tested in
a cross-validation sample four competing theoretical (one-factor, two-factor, five-factor,
and hierarchical factor) models and two EFA-derived models.
Result: None of the theoretical models was confirmed with the CFA. A CAINS-rated
model from EFA consisting of five factors (expression, motivation for recreational
activities, social activities, vocational, and close/intimate relationships) was an excellent
fit to the data (comparative fix index = 0.97, Tucker–Lewis index = 0.96, and root mean
square error of approximation = 0.07).
Conclusions: This study cannot support recent data on the superiority of the five-factor
model defined by the NMIH-MATRICS consensus and suggests that an alternativemodel
might be a better fit. More research to confirm the structure of negative symptoms in
schizophrenia, and careful methodological consideration, should be warranted before a
definitive model can put forward and shape diagnosis and treatment of schizophrenia.
Subjects
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