Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue

Manuela Russo; Selman Repisti; Biljana Blazhevska Stoilkovska; Stefan Jerotic; Ivan Ristic; Eldina Mesevic Smajic; Fitim Uka; Aliriza Arenliu; Stojan Bajraktarov; Alma Dzubur Kulenovic; Lidija Injac Stevovic; Stefan Priebe; Nikolina Jovanovic

doi:10.3389/fpsyt.2021.785144

Structure of Negative Symptoms in Schizophrenia: An Unresolved Issue

Front Psychiatry. 2021 Dec 14:12:785144. doi: 10.3389/fpsyt.2021.785144. eCollection 2021.

Affiliations

¹ Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
² Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro.
³ University Clinic of Psychiatry, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia.
⁴ Faculty of Medicine University of Belgrade & Clinic for Psychiatry, University Clinical Centre of Serbia, Belgrade, Serbia.
⁵ Department of Psychiatry, Clinical Centre of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁶ Department of Psychology, University of Pristina, Pristina, Albania.

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 alternative model 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.

Keywords: BNSS; CAINS; confirmatory factor analysis; five-factor model; negative symptoms; schizophrenia.