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Negative Symptom and Cognitive Deficit Treatment Response In Negative Symptom and Cognitive Deficit Treatment Response in Schizophrenia This page intentionally left blank Negative Symptom and Cognitive Deficit Treatment Response in Schizophrenia Edited by RICHARD S. E. KEEFE, PH.D. JOSEPH P. M CEVOY, M.D. Washington, DC London, England Note: The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, how- ever, therapeutic standards may change. For this reason and because human and me- chanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. Books published by the American Psychiatric Press, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of the Press or the American Psychiatric Association. Copyright © 2001 American Psychiatric Press, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 040302014321 First Edition American Psychiatric Press, Inc. 1400 K Street, N.W., Washington, DC20005 www.appi.org Library of Congress Cataloging-in-Publication Data Negative symptom and cognitive deficit treatment response in schizophrenia / edited by Richard S. E. Keefe, Joseph P. McEvoy. — 1st ed. p. ; cm. Includes bibliographic references and index. ISBN 0-88048-785-2 (alk. paper) 1. Schizophrenia—Diagnosis. 2. Schizophrenia—Chemotherapy. 3. Cognition disorders—Chemotherapy. I. Keefe, Richard S. E. II. McEvoy, Joseph P., 1948- [DNLM: 1. Schizophrenia—drug therapy. 2. Antipsychotic Agents— therapeutic use. 3. Cognition Disorders—drug therapy. 4. Schizophrenia— diagnosis. 5. Schizophrenia Psychology. 6. Treatment Outcome. WM 203 A846 2000] RC514 .A79 2000 616.89'82—dc21 00-023099 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Contributors vii Introduction xi Richard S. E. Keefe, Ph.D., Joseph P. McEvoy, M.D. 1 Evaluating Negative Symptom Treatment Efficacy 1 Robert W. Buchanan, M.D., William T. Carpenter Jr., M.D. 2 Issues in the Assessment of Negative Symptom Treatment Response 19 Peg Nopoulos, M.D., Del D. Miller, Pharm.D., M.D., Michael Flaum, M.D., Nancy C. Andreasen, M.D., Ph.D. 3 Social Functioning and Its Relationship to Cognitive Deficits Over the Course of Schizophrenia 33 Susan L. Trumbetta, Ph.D., Kim T. Mueser, Ph.D. 4 Evaluation of Negative Symptoms in Short-Term Pharmacological Trials 69 Jean-Pierre Lindenmayer, M.D. 5 Negative Symptoms and the Assessment of Neurocognitive Treatment Response 85 Richard S. E. Keefe, Ph.D. 6 Negative Symptoms and the Experience of Emotion 111 Christie Limpert, Ph.D., Xavier F. Amador, Ph.D. 7 The Family Perspective in the Assessment of Negative Symptom Treatment Efficacy 139 Dale L. Johnson, Ph.D. 8 Regulatory Aspects of Drug Treatment for Negative Symptoms 153 Paul Bailey, M.R.C.Psych. 9 The Biology and Pathophysiology of Negative Symptoms 163 Del D. Miller, Pharm.D., M.D., Rajiv Tandon, M.D. Index 187 Contributors Xavier F. Amador, Ph.D. Director, Department of Psychology, New York State Psychiatric Institute, and Associate Professor in Psychology, College of Physicians and Surgeons and Teacher’s College, Columbia University, New York, New York Nancy C. Andreasen, M.D., Ph.D. Director, Mental Health Clinical Research Center and PET Imaging Center, The University of Iowa College of Medicine and Hospitals and Clinics, Iowa City, Iowa Paul Bailey, M.R.C.Psych. Research Psychiatrist, FORENAP (Foundation for Research in Neuroscience Applied to Psychiatry), Centre Hospitalier, Rouffach, France Robert W. Buchanan, M.D. Chief, Outpatient Research Program, Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland at Baltimore William T. Carpenter Jr., M.D. Director, Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland at Baltimore Michael Flaum, M.D. Associate Professor, Mental Health Clinical Research Center, The University of Iowa College of Medicine and Hospitals and Clinics, Iowa City, Iowa vii viii Negative Symptom and Cognitive Deficit Treatment Response Dale L. Johnson, Ph.D. Professor, Department of Psychology, University of Houston, Houston, Texas Richard S. E. Keefe, Ph.D. Associate Professor, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina Christie Limpert, Ph.D. Associate Psychologist, Bronx Children’s Psychiatric Center, Bronx, New Yo r k Jean-Pierre Lindenmayer, M.D. Director, Psychopharmacology Research Unit, Manhattan Psychiatric Center, Nathan Kline Institute for Psychiatric Research, and Clinical Professor, Department of Psychiatry, New York University School of Medicine, New Yo r k , N e w Yo r k Joseph P. McEvoy, M.D. Associate Professor, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina Del D. Miller, Pharm.D., M.D. Associate Professor of Psychiatry, Department of Psychiatry, and Director, Neuropsychiatry Unit, Mental Health Clinical Research Center, The University of Iowa Hospitals and Clinics, Iowa City, Iowa Kim T. Mueser, Ph.D. Professor, Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire Peg Nopoulos, M.D. Clinical Director, Mental Health Clinical Research Center, The University of Iowa College of Medicine and Hospitals and Clinics, Iowa City, Iowa Contributors ix Rajiv Tandon, M.D. Professor of Psychiatry, Department of Psychiatry; Director, Hospital Services Division; and Director, Schizophrenia Program, University of Michigan Medical Center, Ann Arbor, Michigan Susan L. Trumbetta, Ph.D. Assistant Professor, Department of Psychology, Vassar College, Poughkeepsie, New York This page intentionally left blank Introduction Richard S. E. Keefe, Ph.D. Joseph P. McEvoy, M.D. Negative symptoms have become increasingly impor- tant in the diagnosis and treatment of schizophrenia. Not only were negative symptoms included for the first time as a criterion for the diagnosis of schizo- phrenia in DSM-IV (American Psychiatric Association 1994), but atypical antipsychotic medications for schizophrenia, such as clozapine, risperidone, and olanzapine, are purported to have specific effects on negative symptoms and cognitive dysfunction. However, many controversies relating to the assess- ment of these symptoms have prevented researchers from drawing clear conclusions about the efficacy of these treatments, and these areas of conflict often prevent clinicians from making clear determinations about the treatment response of individual patients. This book describes the latest research on the assessment of negative symptoms and cognitive dysfunction for the purposes of evaluating treatment efficacy in research studies and determining individual treatment response in clinical practice. A variety of different approaches to defining—and assessing the effects of treatment on—schizophrenia symptoms have been developed in recent years. The understanding of treatment response in different symptom domains in schizophrenia has been advanced by these conceptualizations and the assess- ment instruments that have sprung from them. However, as is clear from the varying methodologies used and the contradictory results reported by studies of negative symptom response to typical and atypical antipsychotics (reviewed by Lindenmayer in Chapter 4), no consensus has been reached regarding the best methods for assessing negative symptom treatment response—or even for the definition of adequate response. In addition, as discussed by Bailey in Chapter 8, no drug has been licensed specifically for the indication of negative symptom treatment, and the criteria for this indication have not been estab- xi xii Negative Symptom and Cognitive Deficit Treatment Response lished. The negative symptoms that have been assessed and the instruments that have been used to measure negative symptom treatment response have varied considerably from study to study. Furthermore, the relationship between extrapyramidal side effects and negative symptom variation as a result of pharmacological treatment has only recently begun to be explored—yet elucidation of this relationship is sorely needed. These issues are complex and are addressed fully in this volume. One of the primary difficulties faced in evaluating negative symptom treatment response is that whereas many of the instruments currently in use for assessing treatment outcome have significant strengths, none stands out as clearly better than any other. Thus, the decision to use a particular scale in a particular trial is either arbitrary or the result of a compromise between competing needs. As a consequence, results from different research centers addressing the same question are not comparable. In his comparison of seven negative symptom rating scales, Lindenmayer (Chapter 4) notes that although the reliability of all of these scales is fair to good, the temporal stability of negative symptoms varies tremendously depending on which scale is used. He also points out that current conceptions of and assessment methods for negative symptoms vary tremendously, with often very little overlap. Instru- ments differ substantially regarding the symptoms assessed, the scaling of the items in terms of frequency
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