Behavioral validation of avolition in schizophrenia

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• 作者：Fabien Tré ; meau^a ; ^b ; ^c ; ^{Ftremeau@NKI.RFMH.ORG} ; Karen A. Nolan^a ; ^b ; Dolores Malaspina^b ; Daniel C. Javitt^a ; ^d
• 关键词：Schizophrenia ; Avolition ; Time sampling ; Negative symptoms ; MASS ; SANS ; PANSS ; Direct observation
• 刊名：Schizophrenia Research
• 出版年：2012
• 期刊代码：240_09209964
• 类别：med
• 出版时间：July, 2012
• 卷：138
• 期：2-3
• 页码：255-261
• 文件大小：338 K

摘要

Background

Since Kraepelin, avolition, a core symptom of schizophrenia, has been defined as a decrease in spontaneous, self-initiated and purposeful behaviors observed in daily life activities. However, the concurrent validity of commonly-used avolition measures has not been studied, and direct observation may offer a more objective way to measure avolition.

Method

A direct observation measure of spontaneous and self-initiated behaviors that can be observed in an inpatient setting was defined with the use of time sampling method. This direct observation measure was used with fifty inpatients with schizophrenia. Additionally, patients were asked to rate their current interest in and their level of engagement in 10 active behaviors during the preceding 7 days. Clinicians rated the patients' engagement in the same activities for the preceding 7 days as well.

Results

The direct observation measure showed very good psychometric properties. Three clinical negative symptom scales showed moderate to high correlation with the direct measure. Concerning the retrospective ratings, patients' self-assessments were poorly correlated with clinicians' ratings, but showed high correlation with their subjective interests.

Conclusions

Clinical rating scales of negative symptoms show moderate to good concurrent validity as measures of avolition in schizophrenia. However, patients' self-reports do not appear to provide valid indices of avolition. Our results favor clinical negative symptoms scales that use observers' reports only, over patients' self-reports. The direct observation of patients' behavior offers a precise and objective measure of avolition that may be useful in drug challenges and clinical trials.