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Theories and models of negative symptoms in schizophrenia and clinical implications

Nature Reviews Psychology volume 1, pages 454–467 (2022)Cite this article

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Abstract

Negative symptoms in schizophrenia include avolition, anhedonia, asociality, alogia and affective blunting. These symptoms correlate strongly with clinical and functional outcomes, but respond poorly to conventional treatments. Research on the origins and mechanisms of negative symptoms can potentially advance the development of interventions. In this Review, we outline important points of convergence for phenomenological and neurobiological evidence. First, we summarize how negative symptoms are conceptualized and how these psychopathologies manifest in clinical and subclinical populations. Next, we critically review theoretical and empirical models of negative symptoms. We propose that the ‘trait with state-elevation’ properties of negative symptoms make them particularly useful for identifying individuals who may be at risk of developing psychosis and for predicting the onset of psychosis. Finally, we suggest that future research should use sophisticated technology and longitudinal designs to capture both inter-individual and intra-individual variability in negative symptoms and to improve diagnosis and treatments.

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Fig. 1: An integrated perspective on theoretical frameworks for negative symptoms.
Fig. 2: Roadmap and future research on negative symptoms.

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References

  1. Galderisi, S. et al. EPA guidance on treatment of negative symptoms in schizophrenia. Eur. Psychiat. 64, e21 (2021).

    Article  Google Scholar 

  2. Galderisi, S. et al. EPA guidance on assessment of negative symptoms in schizophrenia. Eur. Psychiat. 64, e23 (2021).

    Article  Google Scholar 

  3. Marder, S. R. & Galderisi, S. The current conceptualization of negative symptoms in schizophrenia. World Psychiat. 16, 14–24 (2017).

    Article  Google Scholar 

  4. Kirkpatrick, B., Fenton, W. S., Carpenter, W. T. & Marder, S. R. The NIMH-MATRICS consensus statement on negative symptoms. Schizophr. Bull. 32, 214–219 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sicras-Mainar, A., Maurino, J., Ruiz-Beato, E. & Navarro-Artieda, R. Impact of negative symptoms on healthcare resource utilization and associated costs in adult outpatients with schizophrenia: a population-based study. BMC Psychiat. 14, 225 (2014).

    Article  Google Scholar 

  6. Bobes, J., Arango, C., Garcia-Garcia, M., Rejas, J. & the CLAMORS Study Collaborative Group. Prevalence of negative symptoms in outpatients with schizophrenia spectrum disorders treated with antipsychotics in routine clinical practice: findings from the CLAMORS study. J. Clin. Psychiat. 71, 280–286 (2010).

    Article  Google Scholar 

  7. Husain, M. & Roiser, J. P. Neuroscience of apathy and anhedonia: a transdiagnostic approach. Nat. Rev. Neurosci. 19, 470–484 (2018).

    Article  PubMed  Google Scholar 

  8. Strauss, G. P. & Cohen, A. S. A transdiagnostic review of negative symptom phenomenology and etiology. Schizophr. Bull. 43, 712–719 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Strauss, G. P. & Gold, J. M. A new perspective on anhedonia in schizophrenia. AJP 169, 364–373 (2012).

    Article  Google Scholar 

  10. Kring, A. M. & Barch, D. M. The motivation and pleasure dimension of negative symptoms: neural substrates and behavioral outputs. Eur. Neuropsychopharmacol. 24, 725–736 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jeganathan, J. & Breakspear, M. An active inference perspective on the negative symptoms of schizophrenia. Lancet Psychiat. 8, 732–738 (2021).

    Article  Google Scholar 

  12. Hamaker, E. L., Nesselroade, J. R. & Molenaar, P. C. M. The integrated trait–state model. J. Res. Personal. 41, 295–315 (2007).

    Article  Google Scholar 

  13. Chang, W. C. et al. Early-stage negative symptom trajectories and relationships with 13-year outcomes in first-episode nonaffective psychosis. Schizophr. Bull. 45, 610–619 (2019).

    Article  PubMed  Google Scholar 

  14. Rössler, W., Hengartner, M. P., Ajdacic-Gross, V., Haker, H. & Angst, J. Deconstructing sub-clinical psychosis into latent-state and trait variables over a 30-year time span. Schizophr. Res. 150, 197–204 (2013).

    Article  PubMed  Google Scholar 

  15. Buchanan, R. W. Persistent negative symptoms in schizophrenia: an overview. Schizophr. Bull. 33, 1013–1022 (2007).

    Article  PubMed  Google Scholar 

  16. Austin, S. F. et al. Long-term trajectories of positive and negative symptoms in first episode psychosis: a 10 year follow-up study in the OPUS cohort. Schizophr. Res. 168, 84–91 (2015).

    Article  PubMed  Google Scholar 

  17. Gee, B. et al. The course of negative symptom in first episode psychosis and the relationship with social recovery. Schizophr. Res. 174, 165–171 (2016).

    Article  PubMed  Google Scholar 

  18. Jaspers, K. General Psychopathology Vol. 2 (JHU Press, 1997).

  19. Guloksuz, S. & van Os, J. The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychol. Med. 48, 229–244 (2018).

    Article  PubMed  Google Scholar 

  20. Hanssen, M., Bak, M., Bijl, R., Vollebergh, W. & Van Os, J. The incidence and outcome of subclinical psychotic experiences in the general population. Br. J. Clin. Psychol. 44, 181–191 (2005).

    Article  PubMed  Google Scholar 

  21. Johns, L. C. & van Os, J. The continuity of psychotic experiences in the general population. Clin. Psychol. Rev. 21, 1125–1141 (2001).

    Article  PubMed  Google Scholar 

  22. Murphy, J., Shevlin, M., Houston, J. & Adamson, G. A population based analysis of subclinical psychosis and help-seeking behavior. Schizophr. Bull. 38, 360–367 (2012).

    Article  PubMed  Google Scholar 

  23. Chang, W. C. et al. The latent structure of negative symptoms in individuals with attenuated psychosis syndrome and early psychosis: support for the 5 consensus domains. Schizophr. Bull. 47, 386–394 (2021).

    Article  PubMed  Google Scholar 

  24. Gur, R. E. et al. Negative symptoms in youths with psychosis spectrum features: complementary scales in relation to neurocognitive performance and function. Schizophr. Res. 166, 322–327 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pelletier-Baldelli, A., Strauss, G. P., Visser, K. H. & Mittal, V. A. Initial development and preliminary psychometric properties of the Prodromal Inventory of Negative Symptoms (PINS). Schizophr. Res. 189, 43–49 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Strauss, G. P. & Chapman, H. C. Preliminary psychometric properties of the brief negative symptom scale in youth at clinical high-risk for psychosis. Schizophr. Res. 193, 435–437 (2018).

    Article  PubMed  Google Scholar 

  27. Fonseca-Pedrero, E. et al. The structure of schizotypal personality traits: a cross-national study. Psychol. Med. 48, 451–462 (2018).

    Article  PubMed  Google Scholar 

  28. Kwapil, T. R., Gross, G. M., Silvia, P. J., Raulin, M. L. & Barrantes-Vidal, N. Development and psychometric properties of the Multidimensional Schizotypy Scale: a new measure for assessing positive, negative, and disorganized schizotypy. Schizophr. Res. 193, 209–217 (2018).

    Article  PubMed  Google Scholar 

  29. Mason, O., Claridge, G. & Jackson, M. New scales for the assessment of schizotypy. Personal. Individ. Diff. 18, 7–13 (1995).

    Article  Google Scholar 

  30. Cicero, D. C., Jonas, K. G., Li, K., Perlman, G. & Kotov, R. Common taxonomy of traits and symptoms: linking schizophrenia symptoms, schizotypy, and normal personality. Schizophr. Bull. 45, 1336–1348 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Piskulic, D. et al. Negative symptoms in individuals at clinical high risk of psychosis. Psychiat. Res. 196, 220–224 (2012).

    Article  Google Scholar 

  32. Pelizza, L. et al. Anhedonia in adolescents at ultra-high risk (UHR) of psychosis: findings from a 1-year longitudinal study. Eur. Arch. Psychiat. Clin. Neurosci. 270, 337–350 (2020).

    Article  Google Scholar 

  33. Demjaha, A., Valmaggia, L., Stahl, D., Byrne, M. & McGuire, P. Disorganization/cognitive and negative symptom dimensions in the at-risk mental state predict subsequent transition to psychosis. Schizophr. Bull. 38, 351–359 (2012).

    Article  PubMed  Google Scholar 

  34. Mason, O. et al. Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’. Schizophr. Res. 71, 227–237 (2004).

    Article  PubMed  Google Scholar 

  35. Klippel, A. et al. Modeling the interplay between psychological processes and adverse, stressful contexts and experiences in pathways to psychosis: an experience sampling study. Schizophr. Bull. 43, 302–315 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lyne, J. et al. Do psychosis prodrome onset negative symptoms predict first presentation negative symptoms? Eur. Psychiat. 29, 153–159 (2014).

    Article  Google Scholar 

  37. Johnstone, E. C., Ebmeier, K. P., Miller, P., Owens, D. G. C. & Lawrie, S. M. Predicting schizophrenia: findings from the Edinburgh High-Risk Study. Br. J. Psychiat. 186, 18–25 (2005).

    Article  Google Scholar 

  38. Yung, A. R. et al. Prediction of psychosis: a step towards indicated prevention of schizophrenia. Br. J. Psychiat. 172, 14–20 (1998).

    Article  Google Scholar 

  39. Yung, A. R. et al. Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr. Res. 60, 21–32 (2003).

    Article  PubMed  Google Scholar 

  40. American Psychiatric Association Diagnostic And Statistical Manual Of Mental Disorders: DSM-5 Vol. 5 (American Psychiatric Association, 2013).

  41. Nieman, D. H. & McGorry, P. D. Detection and treatment of at-risk mental state for developing a first psychosis: making up the balance. Lancet Psychiat. 2, 825–834 (2015).

    Article  Google Scholar 

  42. Azis, M. et al. Factor analysis of negative symptom items in the structured interview for prodromal syndromes. Schizophr. Bull. 45, 1042–1050 (2019).

    Article  PubMed  Google Scholar 

  43. Kirkpatrick, B., Mucci, A. & Galderisi, S. Primary, enduring negative symptoms: an update on research. Schizophr. Bull. 43, 730–736 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lincoln, T. M., Dollfus, S. & Lyne, J. Current developments and challenges in the assessment of negative symptoms. Schizophr. Res. 186, 8–18 (2017).

    Article  PubMed  Google Scholar 

  45. Rabinowitz, J. et al. Negative symptoms in schizophrenia — the remarkable impact of inclusion definitions in clinical trials and their consequences. Schizophr. Res. 150, 334–338 (2013).

    Article  PubMed  Google Scholar 

  46. Carpenter, W. T., Heinrichs, D. W. & Wagman, A. M. Deficit and nondeficit forms of schizophrenia: the concept. Am. J. Psychiat. 145, 578–583 (1988).

    Article  PubMed  Google Scholar 

  47. Kirkpatrick, B. & Galderisi, S. Deficit schizophrenia: an update. World Psychiat. 7, 143 (2008).

    Article  Google Scholar 

  48. Crow, T. J. The two-syndrome concept: origins and current status. Schizophr. Bull. 11, 471–486 (1985).

    Article  PubMed  Google Scholar 

  49. Putnam, K. M. et al. Symptom stability in geriatric chronic schizophrenic inpatients: a one-year follow-up study. Biol. Psychiat. 39, 92–99 (1996).

    Article  PubMed  Google Scholar 

  50. Bucci, P. et al. Persistent negative symptoms in recent-onset psychosis: relationship to treatment response and psychosocial functioning. Eur. Neuropsychopharmacol. 34, 76–86 (2020).

    Article  PubMed  Google Scholar 

  51. Correll, C. U. & Schooler, N. R. Negative symptoms in schizophrenia: a review and clinical guide for recognition, assessment, and treatment. Neuropsychiatr. Dis. Treat. 16, 519–534 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Downs, J. et al. Negative symptoms in early-onset psychosis and their association with antipsychotic treatment failure. Schizophr. Bull. 45, 69–79 (2019).

    Article  PubMed  Google Scholar 

  53. Mucci, A. et al. Factors associated with real-life functioning in persons with schizophrenia in a 4-year follow-up study of the Italian network for research on psychoses. JAMA Psychiat. 78, 550 (2021).

    Article  Google Scholar 

  54. Harvey, P. D., Strassnig, M. T. & Silberstein, J. Prediction of disability in schizophrenia: symptoms, cognition, and self-assessment. J. Exp. Psychopathol. 10, 2043808719865693 (2019).

    Article  Google Scholar 

  55. Glenthøj, L. B. et al. Negative symptoms mediate the relationship between neurocognition and function in individuals at ultrahigh risk for psychosis. Acta Psychiatr. Scand. 135, 250–258 (2017).

    Article  PubMed  Google Scholar 

  56. Lee, E. H. M. et al. The role of symptoms and insight in mediating cognition and functioning in first episode psychosis. Schizophr. Res. 206, 251–256 (2019).

    Article  PubMed  Google Scholar 

  57. Glenthøj, L. B., Kristensen, T. D., Wenneberg, C., Hjorthøj, C. & Nordentoft, M. Experiential negative symptoms are more predictive of real-life functional outcome than expressive negative symptoms in clinical high-risk states. Schizophr. Res. 218, 151–156 (2020).

    Article  PubMed  Google Scholar 

  58. Rabinowitz, J. et al. Negative symptoms have greater impact on functioning than positive symptoms in schizophrenia: analysis of CATIE data. Schizophr. Res. 137, 147–150 (2012).

    Article  PubMed  Google Scholar 

  59. Strassnig, M. T. et al. Determinants of different aspects of everyday outcome in schizophrenia: the roles of negative symptoms, cognition, and functional capacity. Schizophr. Res. 165, 76–82 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  60. Galderisi, S. et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiat. 13, 275–287 (2014).

    Article  Google Scholar 

  61. Kirkpatrick, B. et al. The brief negative symptom scale: psychometric properties. Schizophr. Bull. 37, 300–305 (2011).

    Article  PubMed  Google Scholar 

  62. Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P. & Reise, S. P. The Clinical Assessment Interview for Negative Symptoms (CAINS): final development and validation. Am. J. Psychiat. 170, 165–172 (2013).

    Article  PubMed  Google Scholar 

  63. Horan, W. P., Kring, A. M., Gur, R. E., Reise, S. P. & Blanchard, J. J. Development and psychometric validation of the Clinical Assessment Interview for Negative Symptoms (CAINS). Schizophr. Res. 132, 140–145 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  64. Cohen, A. S. & Minor, K. S. Emotional experience in patients with schizophrenia revisited: meta-analysis of laboratory studies. Schizophr. Bull. 36, 143–150 (2010).

    Article  PubMed  Google Scholar 

  65. Kring, A. M. & Moran, E. K. Emotional response deficits in schizophrenia: insights from affective science. Schizophr. Bull. 34, 819–834 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  66. Robinson, M. D. & Clore, G. L. Belief and feeling: evidence for an accessibility model of emotional self-report. Psychol. Bull. 128, 934 (2002).

    Article  PubMed  Google Scholar 

  67. Sharot, T. The optimism bias. Curr. Biol. 21, R941–R945 (2011).

    Article  PubMed  Google Scholar 

  68. Yang, Y. et al. Low-pleasure beliefs in patients with schizophrenia and individuals with social anhedonia. Schizophr. Res. 201, 137–144 (2018).

    Article  PubMed  Google Scholar 

  69. Berridge, K. C. Motivation concepts in behavioral neuroscience. Physiol. Behav. 81, 179–209 (2004).

    Article  PubMed  Google Scholar 

  70. Barch, D. M. & Dowd, E. C. Goal representations and motivational drive in schizophrenia: the role of prefrontal-striatal interactions. Schizophr. Bull. 36, 919–934 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  71. Burgdorf, J. & Panksepp, J. The neurobiology of positive emotions. Neurosci. Biobehav. Rev. 30, 173–187 (2006).

    Article  PubMed  Google Scholar 

  72. Pecina, S., Smith, K. S. & Berridge, K. C. Hedonic hot spots in the brain. Neuroscientist 12, 500–511 (2006).

    Article  PubMed  Google Scholar 

  73. Smith, K. S. & Berridge, K. C. Opioid limbic circuit for reward: interaction between hedonic hotspots of nucleus accumbens and ventral pallidum. J. Neurosci. 27, 1594–1605 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  74. Frank, M. J. & Claus, E. D. Anatomy of a decision: striato-orbitofrontal interactions in reinforcement learning, decision making, and reversal. Psychol. Rev. 113, 300–326 (2006).

    Article  PubMed  Google Scholar 

  75. Gold, J. M., Waltz, J. A., Prentice, K. J., Morris, S. E. & Heerey, E. A. Reward processing in schizophrenia: a deficit in the representation of value. Schizophr. Bull. 34, 835–847 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  76. Roesch, M. R. & Olson, C. R. Neuronal activity in primate orbitofrontal cortex reflects the value of time. J. Neurophysiol. 94, 2457–2471 (2005).

    Article  PubMed  Google Scholar 

  77. Rolls, E. T., Sienkiewicz, Z. J. & Yaxley, S. Hunger modulates the responses to gustatory stimuli of single neurons in the caudolateral orbitofrontal cortex of the macaque monkey. Eur. J. Neurosci. 1, 53–60 (1989).

    Article  PubMed  Google Scholar 

  78. Rudebeck, P. H., Walton, M. E., Smyth, A. N., Bannerman, D. M. & Rushworth, M. F. S. Separate neural pathways process different decision costs. Nat. Neurosci. 9, 1161–1168 (2006).

    Article  PubMed  Google Scholar 

  79. Croxson, P. L., Walton, M. E., O’Reilly, J. X., Behrens, T. E. J. & Rushworth, M. F. S. Effort-based cost–benefit valuation and the human brain. J. Neurosci. 29, 4531–4541 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  80. Salamone, J. D., Correa, M., Farrar, A. & Mingote, S. M. Effort-related functions of nucleus accumbens dopamine and associated forebrain circuits. Psychopharmacology 191, 461–482 (2007).

    Article  PubMed  Google Scholar 

  81. Wallis, J. D. Orbitofrontal cortex and its contribution to decision-making. Annu. Rev. Neurosci. 30, 31–56 (2007).

    Article  PubMed  Google Scholar 

  82. Miller, E. K. & Cohen, J. D. An integrative theory of prefrontal cortex function. Annu. Rev. Neurosci. 24, 167–202 (2001).

    Article  PubMed  Google Scholar 

  83. Friston, K. The free-energy principle: a rough guide to the brain? Trends Cogn. Sci. 13, 293–301 (2009).

    Article  PubMed  Google Scholar 

  84. Friston, K. & Kiebel, S. Predictive coding under the free-energy principle. Phil. Trans. R. Soc. Lond. B 364, 1211–1221 (2009).

    Article  Google Scholar 

  85. Sterzer, P. et al. The predictive coding account of psychosis. Biol. Psychiat. 84, 634–643 (2018).

    Article  PubMed  Google Scholar 

  86. Adams, R. A., Stephan, K. E., Brown, H. R., Frith, C. D. & Friston, K. J. The computational anatomy of psychosis. Front. Psychiat. 4, 47 (2013).

    Article  Google Scholar 

  87. Edwards, C. J., Cella, M., Tarrier, N. & Wykes, T. Investigating the empirical support for therapeutic targets proposed by the temporal experience of pleasure model in schizophrenia: a systematic review. Schizophr. Res. 168, 120–144 (2015).

    Article  PubMed  Google Scholar 

  88. Pillny, M., Krkovic, K., Buck, L. & Lincoln, T. M. From memories of past experiences to present motivation? A meta-analysis on the association between episodic memory and negative symptoms in people with psychosis. Schizophr. Bull. 48, 307–324 (2022).

    Article  PubMed  Google Scholar 

  89. Bègue, I., Kaiser, S. & Kirschner, M. Pathophysiology of negative symptom dimensions of schizophrenia —current developments and implications for treatment. Neurosci. Biobehav. Rev. 116, 74–88 (2020).

    Article  PubMed  Google Scholar 

  90. Galderisi, S., Mucci, A., Buchanan, R. W. & Arango, C. Negative symptoms of schizophrenia: new developments and unanswered research questions. Lancet Psychiat. 5, 664–677 (2018).

    Article  Google Scholar 

  91. Moutsiana, C., Charpentier, C. J., Garrett, N., Cohen, M. X. & Sharot, T. Human frontal-subcortical circuit and asymmetric belief updating. J. Neurosci. 35, 14077–14085 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Sharot, T. & Garrett, N. Forming beliefs: why valence matters. Trends Cogn. Sci. 20, 25–33 (2016).

    Article  PubMed  Google Scholar 

  93. Haguiara, B. et al. What is the best latent structure of negative symptoms in schizophrenia? A systematic review. Schizophr. Bull. Open 2, sgab013 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  94. Brown, T. A. Confirmatory Factor Analysis for Applied Research (Guilford, 2015).

  95. Aleman, A. et al. Treatment of negative symptoms: where do we stand, and where do we go? Schizophr. Res. 186, 55–62 (2017).

    Article  PubMed  Google Scholar 

  96. Fusar-Poli, P. et al. Treatments of negative symptoms in schizophrenia: meta-analysis of 168 randomized placebo-controlled trials. Schizophr. Bull. 41, 892–899 (2015).

    Article  PubMed  Google Scholar 

  97. Foussias, G., Siddiqui, I., Fervaha, G., Agid, O. & Remington, G. Dissecting negative symptoms in schizophrenia: opportunities for translation into new treatments. J. Psychopharmacol. 29, 116–126 (2015).

    Article  PubMed  Google Scholar 

  98. Kaiser, S. et al. Individual negative symptoms and domains — relevance for assessment, pathomechanisms and treatment. Schizophr. Res. 186, 39–45 (2017).

    Article  PubMed  Google Scholar 

  99. Andreasen, N. C. The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. Br. J. Psychiat. Suppl. 155, 49–58 (1989).

    Article  Google Scholar 

  100. Ahmed, A. O. et al. Cross-cultural validation of the 5-factor structure of negative symptoms in schizophrenia. Schizophr. Bull. 45, 305–314 (2019).

    Article  PubMed  Google Scholar 

  101. Chan, R. C. K. et al. Validation of the Chinese version of the Clinical Assessment Interview for Negative Symptoms (CAINS): a preliminary report. Front. Psychol. 6, 7 (2015).

  102. de Medeiros, H. L. V. et al. The Brief Negative Symptom Scale: validation in a multicenter Brazilian study. Compr. Psychiat. 85, 42–47 (2018).

    Article  PubMed  Google Scholar 

  103. Engel, M., Fritzsche, A. & Lincoln, T. M. Validation of the German version of the Clinical Assessment Interview for Negative Symptoms (CAINS). Psychiat. Res. 220, 659–663 (2014).

    Article  Google Scholar 

  104. Mucci, A. et al. The Brief Negative Symptom Scale (BNSS): independent validation in a large sample of Italian patients with schizophrenia. Eur. Psychiat. 30, 641–647 (2015).

    Article  Google Scholar 

  105. Polat Nazlı, I. et al. Validation of Turkish version of Brief Negative Symptom Scale. Int. J. Psychiat. Clin. Pract. 20, 265–271 (2016).

    Article  Google Scholar 

  106. Rekhi, G., Ang, M. S., Yuen, C. K. Y., Ng, W. Y. & Lee, J. Assessing negative symptoms in schizophrenia: validity of the clinical assessment interview for negative symptoms in Singapore. Schizophr. Res. 206, 177–182 (2019).

    Article  PubMed  Google Scholar 

  107. Strauss, G. P. et al. Factor structure of the Brief Negative Symptom Scale. Schizophr. Res. 142, 96–98 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  108. Sun, J. et al. Validation of the traditional script Chinese version of the Brief Negative Symptom Scale. Asian J. Psychiat. 55, 102522 (2021).

    Article  Google Scholar 

  109. Valiente-Gómez, A. et al. Validation of the Spanish version of the Clinical Assessment for Negative Symptoms (CAINS). Schizophr. Res. 166, 104–109 (2015).

    Article  PubMed  Google Scholar 

  110. Ang, M. S., Rekhi, G. & Lee, J. Validation of the Brief Negative Symptom Scale and its association with functioning. Schizophr. Res. 208, 97–104 (2019).

    Article  PubMed  Google Scholar 

  111. Jeakal, E., Park, K., Lee, E., Strauss, G. P. & Choi, K.-H. Validation of the Brief Negative Symptom Scale in Korean patients with schizophrenia. Asia Pacif. Psychiat. 12, e12382 (2020).

    Google Scholar 

  112. Jung, S. I., Woo, J., Kim, Y.-T. & Kwak, S. G. Validation of the Korean version of the Clinical Assessment Interview for Negative Symptoms of schizophrenia (CAINS). J. Korean Med. Sci. 31, 1114–1120 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  113. Mucci, A. et al. A large European, multicenter, multinational validation study of the Brief Negative Symptom Scale. Eur. Neuropsychopharmacol. 29, 947–959 (2019).

    Article  PubMed  Google Scholar 

  114. Richter, J. et al. Evidence for two distinct domains of negative symptoms: confirming the factorial structure of the CAINS. Psychiat. Res. 271, 693–701 (2019).

    Article  Google Scholar 

  115. Strauss, G. P. et al. The latent structure of negative symptoms in schizophrenia. JAMA Psychiat. 75, 1271 (2018).

    Article  Google Scholar 

  116. Xie, D. et al. Cross cultural validation and extension of the Clinical Assessment Interview for Negative Symptoms (CAINS) in the Chinese context: evidence from a spectrum perspective. Schizophr. Bull. 44, S547–S555 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  117. Ahmed, A. O. et al. Two factors, five factors, or both? External validation studies of negative symptom dimensions in schizophrenia. Schizophr. Bull. 48, 620–630 (2022).

    Article  PubMed  Google Scholar 

  118. Strauss, G. P. et al. Network analysis reveals the latent structure of negative symptoms in schizophrenia. Schizophr. Bull. 45, 1033–1041 (2019).

    Article  PubMed  Google Scholar 

  119. Miyake, A. et al. The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn. Psychol. 41, 49–100 (2000).

    Article  PubMed  Google Scholar 

  120. Ritsner, M. The Handbook Of Neuropsychiatric Biomarkers, Endophenotypes And Genes. Neuropsychological Endophenotypes And Biomarkers Vol. I (Springer Science & Business Media, 2009).

  121. Buss, A. H. Personality as traits. Am. Psychol. 44, 1378 (1989).

    Article  Google Scholar 

  122. Smith, B. D. Personality: Multivariate Systems Theory And Research. Handbook Of Multivariate Experimental Psychology Vol. 2 (Springer, 1988).

  123. Cannon, T. D. Psychosis, schizophrenia, and states vs. traits. Schizophr. Res. 242, 12–14 (2021).

    Article  PubMed  Google Scholar 

  124. Krzyzanowski, D. J. et al. Trait anhedonia in schizophrenia: a systematic review and comparative meta-analysis. Schizophr. Bull. 48, 335–346 (2021).

    Article  Google Scholar 

  125. Chan, R. C. K. et al. The Chapman psychosis-proneness scales: consistency across culture and time. Psychiat. Res. 228, 143–149 (2015).

    Article  Google Scholar 

  126. Michel, C. et al. The trait–state distinction between schizotypy and clinical high risk: results from a one-year follow-up. World Psychiat. 18, 108–109 (2019).

    Article  Google Scholar 

  127. Wang, Y. et al. Trajectories of schizotypy and their emotional and social functioning: an 18-month follow-up study. Schizophr. Res. 193, 384–390 (2018).

    Article  PubMed  Google Scholar 

  128. Wang, L. et al. Altered cortico-striatal functional connectivity in people with high levels of schizotypy: a longitudinal resting-state study. Asian J. Psychiat. 58, 102621 (2021).

    Article  Google Scholar 

  129. Farreny, A., Savill, M. & Priebe, S. Correspondence between negative symptoms and potential sources of secondary negative symptoms over time. Eur. Arch. Psychiat. Clin. Neurosci. 268, 603–609 (2018).

    Article  Google Scholar 

  130. Hultsch, D. F. & MacDonald, S. W. in Intraindividual Variability In Performance As A Theoretical Window Onto Cognitive Aging. New Frontiers In Cognitive Aging 65–88 (Oxford Scholarship Online, 2004).

  131. Ram, N. & Gerstorf, D. Time-structured and net intraindividual variability: tools for examining the development of dynamic characteristics and processes. Psychol. Aging 24, 778–791 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  132. Wallace, S., Morton, S. E. & Linscott, R. J. Relationships between intra-individual variability and subclinical psychosis. Psychiat. Res. 281, 112592 (2019).

    Article  Google Scholar 

  133. Zald, D. H. & Treadway, M. T. Reward processing, neuroeconomics, and psychopathology. Annu. Rev. Clin. Psychol. 13, 471–495 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  134. Polanía, R., Woodford, M. & Ruff, C. C. Efficient coding of subjective value. Nat. Neurosci. 22, 134–142 (2019).

    Article  PubMed  Google Scholar 

  135. Zimmermann, J., Glimcher, P. W. & Louie, K. Multiple timescales of normalized value coding underlie adaptive choice behavior. Nat. Commun. 9, 3206 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  136. MacDonald, S. W., Li, S.-C. & Bäckman, L. Neural underpinnings of within-person variability in cognitive functioning. Psychol. Aging 24, 792 (2009).

    Article  PubMed  Google Scholar 

  137. Kane, M. J. et al. Individual differences in the executive control of attention, memory, and thought, and their associations with schizotypy. J. Exp. Psychol. Gen. 145, 1017–1048 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  138. Schmidt-Hansen, M. & Honey, R. C. Working memory and multidimensional schizotypy: dissociable influences of the different dimensions. Cogn. Neuropsychol. 26, 655–670 (2009).

    Article  PubMed  Google Scholar 

  139. McNally, R. J. et al. Mental disorders as causal systems: a network approach to posttraumatic stress disorder. Clin. Psychol. Sci. 3, 836–849 (2015).

    Article  Google Scholar 

  140. Molenaar, P. C. M. & Campbell, C. G. The new person-specific paradigm in psychology. Curr. Dir. Psychol. Sci. 18, 112–117 (2009).

    Article  Google Scholar 

  141. Koppe, G., Guloksuz, S., Reininghaus, U. & Durstewitz, D. Recurrent neural networks in mobile sampling and intervention. Schizophr. Bull. 45, 272–276 (2019).

    Article  PubMed  Google Scholar 

  142. Parrish, E. M. et al. Emotional determinants of life-space through GPS and ecological momentary assessment in schizophrenia: what gets people out of the house? Schizophr. Res. 224, 67–73 (2020).

    Article  PubMed  Google Scholar 

  143. Kuppens, P., Tuerlinckx, F., Russell, J. A. & Barrett, L. F. The relation between valence and arousal in subjective experience. Psychol. Bull. 139, 917 (2013).

    Article  PubMed  Google Scholar 

  144. Llerena, K., Strauss, G. P. & Cohen, A. S. Looking at the other side of the coin: a meta-analysis of self-reported emotional arousal in people with schizophrenia. Schizophr. Res. 142, 65–70 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  145. Yan, C. et al. Trait and state positive emotional experience in schizophrenia: a meta-analysis. PLoS ONE 7, e40672 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  146. Fusar-Poli, P. The Clinical High-Risk state for Psychosis (CHR-P), version II. Schizophr. Bull. 43, 44–47 (2017).

    Article  PubMed  Google Scholar 

  147. Fusar-Poli, P. & Borgwardt, S. Integrating the negative psychotic symptoms in the high risk criteria for the prediction of psychosis. Med. Hypotheses 69, 959–960 (2007).

    Article  PubMed  Google Scholar 

  148. Blanchard, J. J., Collins, L. M., Aghevli, M., Leung, W. W. & Cohen, A. S. Social anhedonia and schizotypy in a community sample: the Maryland longitudinal study of schizotypy. Schizophr. Bull. 37, 587–602 (2011).

    Article  PubMed  Google Scholar 

  149. Lenzenweger, M. F. Schizotaxia, schizotypy, and schizophrenia: Paul E. Meehl’s blueprint for the experimental psychopathology and genetics of schizophrenia. J. Abnorm. Psychol. 115, 195 (2006).

    Article  PubMed  Google Scholar 

  150. Miller, T. J. et al. Symptom assessment in schizophrenic prodromal states. Psychiat. Q. 70, 273–287 (1999).

    Article  PubMed  Google Scholar 

  151. Yung, A. R. et al. Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aus. N. Z. J. Psychiat. 39, 964–971 (2005).

    Article  Google Scholar 

  152. Vollmer-Larsen, A., Handest, P. & Parnas, J. Reliability of measuring anomalous experience: the bonn scale for the assessment of basic symptoms. Psychopathology 40, 345–348 (2007).

    Article  PubMed  Google Scholar 

  153. Fornito, A. et al. Functional dysconnectivity of corticostriatal circuitry as a risk phenotype for psychosis. JAMA Psychiat. 70, 1143 (2013).

    Article  Google Scholar 

  154. Wang, Y. et al. Altered corticostriatal functional connectivity in individuals with high social anhedonia. Psychol. Med. 46, 125–135 (2016).

    Article  PubMed  Google Scholar 

  155. Bradley, E. R. & Woolley, J. D. Oxytocin effects in schizophrenia: reconciling mixed findings and moving forward. Neurosci. Biobehav. Rev. 80, 36–56 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  156. Siskind, D., McCartney, L., Goldschlager, R. & Kisely, S. Clozapine v. first-and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis. Br. J. Psychiat. 209, 385–392 (2016).

    Article  Google Scholar 

  157. Dougall, N., Maayan, N., Soares-Weiser, K., McDermott, L. M. & McIntosh, A. Transcranial magnetic stimulation for schizophrenia. Schizophr. Bull. 41, 1220–1222 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  158. Valiengo, L. et al. Efficacy and safety of transcranial direct current stimulation for treating negative symptoms in schizophrenia: a randomized clinical trial. JAMA Psychiat. 77, 121–129 (2020).

    Article  Google Scholar 

  159. Cella, M., Preti, A., Edwards, C., Dow, T. & Wykes, T. Cognitive remediation for negative symptoms of schizophrenia: a network meta-analysis. Clin. Psychol. Rev. 52, 43–51 (2017).

    Article  PubMed  Google Scholar 

  160. Velthorst, E. et al. Adapted cognitive–behavioural therapy required for targeting negative symptoms in schizophrenia: meta-analysis and meta-regression. Psychol. Med. 45, 453–465 (2015).

    Article  PubMed  Google Scholar 

  161. Korn, C. W., Sharot, T., Walter, H., Heekeren, H. R. & Dolan, R. J. Depression is related to an absence of optimistically biased belief updating about future life events. Psychol. Med. 44, 579–592 (2014).

    Article  PubMed  Google Scholar 

  162. Hu, H. et al. Negative belief-updating bias for positive daily life events in individuals with schizophrenia and social anhedonia. Cogn. Neuropsychiat. https://doi.org/10.1080/13546805.2021.2014309 (2021).

  163. Frost, K. H. & Strauss, G. P. A review of anticipatory pleasure in schizophrenia. Curr. Behav. Neurosci. Rep. 3, 232–247 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  164. FitzGerald, T. H. B., Dolan, R. J. & Friston, K. Dopamine, reward learning, and active inference. Front. Comput. Neurosci. 9, 136 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  165. Wang, L. et al. Range-adaptive value representation in different stages of schizophrenia: a proof of concept study. Schizophr. Bull. 47, 1524–1533 (2021).

    Article  PubMed  Google Scholar 

  166. Smith, R., Badcock, P. & Friston, K. J. Recent advances in the application of predictive coding and active inference models within clinical neuroscience. Psychiat. Clin. Neurosci. 75, 3–13 (2021).

    Article  Google Scholar 

  167. Lui, S. S. Y. et al. The nature of anhedonia and avolition in patients with first-episode schizophrenia. Psychol. Med. 46, 437–447 (2016).

    Article  PubMed  Google Scholar 

  168. Forbes, N. F., Carrick, L. A., McIntosh, A. M. & Lawrie, S. M. Working memory in schizophrenia: a meta-analysis. Psychol. Med. 39, 889–905 (2009).

    Article  PubMed  Google Scholar 

  169. González-Ortega, I. et al. Working memory as a predictor of negative symptoms and functional outcome in first episode psychosis. Psychiat. Res. 206, 8–16 (2013).

    Article  Google Scholar 

  170. Hager, O. M. et al. Reward-dependent modulation of working memory is associated with negative symptoms in schizophrenia. Schizophr. Res. 168, 238–244 (2015).

    Article  PubMed  Google Scholar 

  171. Cella, M. et al. Effects of cognitive remediation on negative symptoms dimensions: exploring the role of working memory. Psychol. Med. 47, 2593–2601 (2017).

    Article  PubMed Central  Google Scholar 

  172. Li, X. et al. The neural transfer effect of working memory training to enhance hedonic processing in individuals with social anhedonia. Sci. Rep. 6, 35481 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  173. Li, X. et al. The effects of working memory training on enhancing hedonic processing to affective rewards in individuals with high social anhedonia. Psychiat. Res. 245, 482–490 (2016).

    Article  Google Scholar 

  174. Gilbert, D. T. & Wilson, T. D. Prospection: experiencing the future. Science 317, 1351–1354 (2007).

    Article  PubMed  Google Scholar 

  175. Zhang, R. et al. Affective forecasting in individuals with social anhedonia: the role of social components in anticipated emotion, prospection and neural activation. Schizophr. Res. 215, 322–329 (2020).

    Article  PubMed  Google Scholar 

  176. Kirschner, M. et al. Deficits in context-dependent adaptive coding of reward in schizophrenia. npj Schizophr. 2, 16020 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  177. Gard, D. E., Gard, M. G., Kring, A. M. & John, O. P. Anticipatory and consummatory components of the experience of pleasure: a scale development study. J. Res. Personality 40, 1086–1102 (2006).

    Article  Google Scholar 

  178. Chapman, L. J. & Chapman, J. P. The Revised Physical Anhedonia Scale (Univ. Wisconsin, 1978).

  179. Mishlove, M. & Chapman, L. J. Social anhedonia in the prediction of psychosis proneness. J. Abnorm. Psychol. 94, 384–396 (1985).

    Article  PubMed  Google Scholar 

  180. Chapman, L. J., Chapman, J. P. & Raulin, M. L. Scales for physical and social anhedonia. J. Abnorm. Psychol. 85, 374 (1976).

    Article  PubMed  Google Scholar 

  181. Kaliuzhna, M. et al. How far to go in deconstructing negative symptoms? Behavioural and neural level evidence for the amotivation domain. Schizophr. Res. 236, 41–47 (2021).

    Article  PubMed  Google Scholar 

  182. Wang, L.-L., Lui, S. S. & Chan, R. C. The past and future of mapping the biomarkers of psychosis. Curr. Opin. Behav. Sci. 43, 1–5 (2022).

    Article  Google Scholar 

  183. Myin-Germeys, I. et al. Experience sampling methodology in mental health research: new insights and technical developments. World Psychiat. 17, 123–132 (2018).

    Article  Google Scholar 

  184. Hermans, K. S. F. M. et al. Elucidating negative symptoms in the daily life of individuals in the early stages of psychosis. Psychol. Med. 51, 2599–2609 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  185. Oorschot, M. et al. Emotional experience in negative symptoms of schizophrenia — no evidence for a generalized hedonic deficit. Schizophr. Bull. 39, 217–225 (2013).

    Article  PubMed  Google Scholar 

  186. Kasanova, Z. et al. Intact striatal dopaminergic modulation of reward learning and daily-life reward-oriented behavior in first-degree relatives of individuals with psychotic disorder. Psychol. Med. 48, 1909–1914 (2018).

    Article  PubMed  Google Scholar 

  187. Moran, E. K., Culbreth, A. J. & Barch, D. M. Ecological momentary assessment of negative symptoms in schizophrenia: relationships to effort-based decision making and reinforcement learning. J. Abnorm. Psychol. 126, 96–105 (2017).

    Article  PubMed  Google Scholar 

  188. Cai, X.-L. et al. Neurological soft signs are associated with altered cerebellar-cerebral functional connectivity in schizophrenia. Schizophr. Bull. 47, 1452–1462 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  189. Brady, R. O. et al. Cerebellar-prefrontal network connectivity and negative symptoms in schizophrenia. Am. J. Psychiat. 176, 512–520 (2019).

    Article  PubMed  Google Scholar 

  190. Li, Z. et al. Improving motivation through real-time fMRI-based self-regulation of the nucleus accumbens. Neuropsychology 32, 764–776 (2018).

    Article  PubMed  Google Scholar 

  191. Boto, E. et al. Moving magnetoencephalography towards real-world applications with a wearable system. Nature 555, 657–661 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  192. Hill, R. M. et al. A tool for functional brain imaging with lifespan compliance. Nat. Commun. 10, 1–11 (2019).

    Google Scholar 

  193. Cohen, A. S. et al. Digital phenotyping of negative symptoms: the relationship to clinician ratings. Schizophr. Bull. 47, 44–53 (2020).

    Article  PubMed Central  Google Scholar 

  194. Raugh, I. M. et al. Geolocation as a digital phenotyping measure of negative symptoms and functional outcome. Schizophr. Bull. 46, 1596–1607 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  195. Narkhede, S. M. et al. Machine learning identifies digital phenotyping measures most relevant to negative symptoms in psychotic disorders: implications for clinical trials. Schizophr. Bull. 48, 425–436 (2021).

    Article  Google Scholar 

  196. Garrett, N. & Sharot, T. Optimistic update bias holds firm: three tests of robustness following Shah et al. Conscious. Cogn. 50, 12–22 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  197. Gooding, D. C. & Pflum, M. J. Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS) (Univ. Wisconsin, 2011).

  198. Heerey, E. A. & Gold, J. M. Patients with schizophrenia demonstrate dissociation between affective experience and motivated behavior. J. Abnorm. Psychol. 116, 268–278 (2007).

    Article  PubMed  Google Scholar 

  199. Wang, L.-L. et al. Revisiting anticipatory hedonic processing in patients with schizophrenia: an examination between representation activation and maintenance. Schizophr Res 216, 138–146 (2019).

    Article  PubMed  Google Scholar 

  200. Huang, J. et al. Neural substrates of the impaired effort expenditure decision making in schizophrenia. Neuropsychology 30, 685–696 (2016).

    Article  PubMed  Google Scholar 

  201. Reddy, L. F. et al. Effort-based decision-making paradigms for clinical trials in schizophrenia. Part 1 — Psychometric characteristics of 5 paradigms. Schizophr. Bull. 41, 1045–1054 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  202. Kinard, J. L. et al. Neural mechanisms of social and nonsocial reward prediction errors in adolescents with autism spectrum disorder. Autism Res. 13, 715–728 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  203. Balsters, J. H. et al. Disrupted prediction errors index social deficits in autism spectrum disorder. Brain 140, 235–246 (2017).

    Article  PubMed  Google Scholar 

  204. Overall, J. E. & Gorham, D. R. The brief psychiatric rating scale. Psychol. Rep. 10, 799–812 (1962).

    Article  Google Scholar 

  205. Blanchard, J. J., Kring, A. M., Horan, W. P. & Gur, R. Toward the next generation of negative symptom assessments: the collaboration to advance negative symptom assessment in schizophrenia. Schizophr. Bull. 37, 291–299 (2011).

    Article  PubMed  Google Scholar 

  206. Llerena, K. et al. The Motivation and Pleasure scale-Self Report (MAP-SR): reliability and validity of a self-report measure of negative symptoms. Compr. Psychiat. 54, 568–574 (2013).

    Article  PubMed  Google Scholar 

  207. Wang, L. et al. Validation and extension of the Motivation And Pleasure scale-Self Report (MAP-SR) across the schizophrenia spectrum in the Chinese context. Asian J. Psychiat. 49, 101971 (2020).

    Article  Google Scholar 

  208. Tam, M. H. W. et al. Latent structure of self-report negative symptoms in patients with schizophrenia: a preliminary study. Asian J. Psychiat. 61, 102680 (2021).

    Article  Google Scholar 

  209. Dollfus, S., Mach, C. & Morello, R. Self-evaluation of negative symptoms: a novel tool to assess negative symptoms. Schizophr. Bull. 42, 571–578 (2016).

    Article  PubMed  Google Scholar 

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Acknowledgements

The preparation of this paper was supported by the CAS Key Laboratory of Mental Health, Institute of Psychology and Philip K. H. Wong Foundation (to R.C.K.C.).

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Authors and Affiliations

  1. Neuropsychology and Applied Cognitive Neuroscience Laboratory; CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China

    Raymond C. K. Chan & Ling-ling Wang

  2. Department of Psychology, University of Chinese Academy of Sciences, Beijing, China

    Raymond C. K. Chan & Ling-ling Wang

  3. Department of Psychiatry, The University of Hong Kong, Hong Kong, Special Administrative Region, China

    Simon S. Y. Lui

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Contributions

R.C.K.C. conceived the general framework for the review. R.C.K.C., L.l.W. and S.S.Y.L. researched data for the article. R.C.K.C. and S.S.Y.L. wrote the first draft of this article. All authors contributed substantially to discussion of content and reviewed and/or edited the manuscript before submission.

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Nature Reviews Psychology thanks Jimmy Lee, who co-reviewed with Mei San Ang, Erin Moran and the other, anonymous, reviewers for their contribution to the peer review of this work.

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Glossary

At-risk mental state

The clinical presentation of those considered at risk of developing psychosis or schizophrenia but who do not currently meet diagnostic criteria.

Ultra-high-risk cases

Individuals at high and imminent risk of developing a first episode of psychosis.

Attenuated psychosis syndrome

A subthreshold psychosis-like psychiatric condition characterized by mild hallucinations, delusions or disorganized speech with relatively intact reality testing.

Antipsychotic-induced Parkinsonism

The effects of dopamine-blocking agents (commonly antipsychotic medications) on mesolimbic and mesocortical brain pathways, resulting in movement-disorder-like symptoms.

Endophenotype

A type of biological marker that is simpler to detect than genetic sequences and that may be useful in researching vulnerability to a wide range of psychological, psychiatric and neurological disorders.

Transcranial direct-current stimulation

(tDCS). A non-invasive brain stimulation technique that applies direct low-dose electrical currents via scalp electrodes to modulate neuronal activities of cortical areas of the brain.

Transcranial magnetic stimulation

(TMS). A non-invasive brain stimulation technique in which regional magnetic pulses are applied close to the scalp surface to modulate cortical excitability.

Neurofeedback

A type of biofeedback in which real-time feedback from brain activation is provided to participants.

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Chan, R.C.K., Wang, Ll. & Lui, S.S.Y. Theories and models of negative symptoms in schizophrenia and clinical implications. Nat Rev Psychol 1, 454–467 (2022). https://doi.org/10.1038/s44159-022-00065-9

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