Cross-site reliability in the ratings of the SOPS, was conducted on a yearly basis using a new videotape each year. Ratings from all raters at all sites were compared to “gold standard” ratings on the SOPS. Intra class correlations, over three years, for the total SOPS scores ranged from 0.82 to 0.93 and for the attenuated positive symptom score from the SOPS ranged from 0.92–0.96. There were minimal differences across the individual sites. All interclass correlations were in the excellent range. Those at CHR had to be between 12 and 35 years old and meet diagnostic criteria for a prodromal syndrome as per the COPS criteria or if under 19 meet criteria for schizotypal personality disorder . Participants were excluded if they met criteria for current or lifetime Axis I psychotic disorder, including affective psychoses, IQ > 70, or had a past history of a central nervous system disorder, or substance dependence in the past 6 months or the diagnostic prodromal symptoms were clearly caused by an Axis 1 disorder. Other non-psychotic DSM-IV disorders were not exclusionary , as long as the disorder did not account for the individual’s prodromal symptoms. Use of antipsychotics was not an exclusion provided there was clear evidence that prodromal but not psychotic symptoms were present when the medication was started. Control subjects could not meet criteria for any prodromal syndrome, any current or past psychotic disorder or a Cluster A personality disorder diagnosis, not have a family history of any psychotic disorder or any other disorder involving psychotic symptoms. They could not be currently using psychotropic medication.One concern with large multisite,outdoor vertical farming longitudinal studies including many assessments is data integrity. Data are managed at the Calgary site through a centralized Oracle database. Sites can remotely manage both the input of participant study data and also track participant protocol adherence and staff task management. Data input is strictly controlled with data validation prior to saving and a two-step forced resolution of required data.
No data can be submitted until missing data fields are flagged with either reasons for absence or with a predetermined code. Prior to forcing a second blind double entry of all the data, all missing data reasons must be validated and signed off with an acceptance code by a data manager from the site. This rigorous feedback loop ensures better data collection, near perfect data entry and much better data quality assurance. These codes can then be reported and reviewed by the appropriate Task Force to determine further action. The system produces numerous reports. These are used to track recruitment, dropout rates, data collection and consequent data entry completion levels. Furthermore, it can measure the utility and validity of measures and the protocol. This allows the data cleanup process to be continuous. There is an overall data manager at the Calgary site with each site having their own data manager to work with both within and across site data. NAPLS-2 will be the one of the largest cohort studies of young people at clinical high risk for psychosis to be followed longitudinally. It will be the first to study all of these clinical and biological factors prospectively and simultaneously in a large and well-characterized sample. This paper has described the aims and methods of the project and reported on recruitment and preliminary descriptive data from the first half of the sample. The recruitment practices are similar across most of the sites. There are very few significant site differences in samples and no-one site differs on more than one variable. Yet one of the advantages of having multiple sites is that they are diverse with respect to the regions and ethnicities represented. Our multi-site approach affords the opportunity to examine regional and ethnic differences in the ascertainment of CHR individuals, as well as the nature and course of prodromal syndromes. Further, by having multiple sites, we are able to validate our measures across a range of clinical research facilities, and this has important benefits with respect to establishing the generalizability of NAPLS findings, especially those that bear on prediction algorithms Future reports will focus on baseline clinical and biological characteristics, longitudinal changes and eventually predictors of conversion.
Recent evidence indicates that people with schizophrenia or schizoaffective disorder experience deficits in anticipatory pleasure, or pleasure related to future activities, but not in consummatory pleasure, or pleasure experienced in-the-moment . The Temporal Experience of Pleasure Scale is a self-report measure of the general propensity to experience anticipatory and consummatory pleasure . Studies in the U.S., China, Switzerland, and France have found that people with schizophrenia or schizoaffective disorder reported lower anticipatory pleasure but comparable consummatory pleasure on the TEPS compared to healthy controls . Prior studies have also found that TEPS anticipatory and consummatory pleasure scores are positively correlated with functional outcome and negatively correlated with negative symptoms . TEPS anticipatory, but not consummatory, pleasure is negatively correlated with sub-clinical negative symptoms and is lower in people who score higher on social anhedonia measures compared to those who do not . Studies that utilize the TEPS have thus far almost exclusively included chronically ill people with schizophrenia. However, studies using other self-report measures of anhedonia, such as the Chapman scales of physical and social anhedonia, have found that people early in the course of schizophrenia report more physical anhedonia than the controls and people experiencing their first lifetime episode of psychosis report more social anhedonia compared to the controls . To date, two studies have administered the TEPS to people early in the course of a schizophrenia spectrum disorder . Cassidy et al. found no differences in TEPS anticipatory pleasure between people with and without a psychotic disorder. However, most participants in the study had used cannabis throughout the lifetime, thus making conclusions about the contributions of psychosis versus cannabis use on TEPS scores difficult to disentangle. Schlosser et al. found that people with recent-onset schizophrenia reported less anticipatory than consummatory pleasure on the TEPS but did not differ on either scale compared to a younger, healthy control group. However, people at clinical high risk for schizophrenia reported less anticipatory pleasure than a demographically matched healthy control group. In the current study, we examined people with a recent-onset SSD to determine if and when deficits in reported anticipatory pleasure emerge in the course of the illness. We defined “recent-onset” in our study as experiencing a first episode of psychosis within one year of study participation. Based on previous studies with more chronically ill samples, we hypothesized that people with an SSD would show deficits in anticipatory pleasure but not in consummatory pleasure compared to people without an SSD.
We also included measures of symptom severity, occupational functioning, and social functioning in order to examine the correlates of anticipatory pleasure.In the current study, we assessed whether deficits in the propensity to experience anticipatory pleasure are evident early in the course of schizophrenia spectrum disorders. We found that people in the early course of an SSD reported lower dispositional anticipatory pleasure but did not differ in reported dispositional consummatory pleasure compared to healthy controls.However, our findings differ from two recent studies with people early in the course of an SSD . Identifying reasons why some studies find deficits in anticipatory pleasure and others do not is an important direction for future research. Likely explanations include the characteristics of the clinical and control groups. With respect to clinical characteristics, our sample did not include any participants with current substance use disorder, whereas most participants in the Cassidy et al. study did . Another explanation may be related to how anticipatory deficits are described. We considered “deficits” in anticipatory pleasure as a significantly lower score on the TEPS anticipatory pleasure measure in people with an SSD compared to the controls. However, this assumes that the control group is homogeneous in a variety of factors that may influence self-reported anticipatory pleasure. There are likely unstudied individual differences that influence TEPS scores within different groups that may partially account for why some studies fail to find anticipatory pleasure deficits in people with schizophrenia. For example, in Strauss et al. , the control group had a consummatory pleasure score of 4.96,vertical farming benefits while the control group in our study had a score of 4.39, a seemingly significant difference between the two groups. This may partially account for why Strauss et al. did not find the same pattern of differences in anticipatory and consummatory pleasure scores on the TEPS in people with and without schizophrenia as our study did. While Schlosser et al. did not find that people with recent onset schizophrenia differed from younger healthy controls in anticipatory pleasure, they found that people with recent onset schizophrenia reported significantly lower TEPS anticipatory pleasure than consummatory pleasure. Future studies may wish to adopt both within and between-group comparisons in defining “deficits” in self-reported pleasure. Furthermore, as studies continue to include the TEPS, meta analysis will prove useful in better understanding differences between people with and without schizophrenia on this measure. We found that both anticipatory and consummatory pleasure scores were related to negative symptoms, consistent with prior studies including more chronic samples . These results suggest that even in the early stages of the illness, people with an SSD who report lower dispositional anticipatory pleasure are also likely to exhibit negative symptoms. Deficits in the propensity to experience anticipatory pleasure may be an indicator of early negative symptoms that may not be otherwise detectable. On the other hand, greater dispositional consummatory pleasure was related to lower negative symptom scores and depression, suggesting that while diminished experience of consummatory pleasure may also be an indicator of negative symptoms, it may additionally be more sensitive to state-dependent factors .
It will be informative to assess the linkage between dispositional anticipatory and consummatory pleasure and symptom-level anticipatory and consummatory pleasure in future studies using measures that distinguish these types of pleasure, such as the Clinical Assessment Interview for Negative Symptoms . Contrary to our findings, studies of chronically ill people with schizophrenia have found that social functioning is related to TEPS anticipatory and consummatory pleasure . It is possible that people in our SSD group had other resources or support that help guide their functioning that chronically ill people with schizophrenia do not have, thus deficits in anticipatory pleasure may not be as tightly linked with their functioning. Another possibility is that the strength of the relationship between anticipatory pleasure deficits and functional outcome increases over time, even if both constructs remain independently stable. Herbener et al. found that over a 20-year period, neither physical anhedonia nor functional outcome became significantly more severe in a sample of people with schizophrenia; however, over time the strength of the correlation between physical anhedonia and functional outcome increased. They suggested that physical anhedonia may be one factor that contributes to the heterogeneity in functional outcome scores in schizophrenia samples and that the co-occurrence of both may reflect a common underlying deficit. The relationship between anticipatory pleasure and functional outcome may follow a similar trajectory over time, and future studies that examine the longitudinal nature of anticipatory pleasure and functioning in schizophrenia can help answer this open question. Although we administered the TEPS to a group of people who had experienced a psychotic episode, future studies should continue to examine other populations, including clinical high risk samples, to further pinpoint when anticipatory pleasure deficits may emerge during the development of an SSD. Schlosser et al. found that CHR individuals reported less TEPS consummatory and anticipatory pleasure compared to demographically matched healthy controls, suggesting that such deficits may reflect a vulnerability towards a future psychotic episode. Future studies should continue to administer the TEPS during multiple time points as the illness progresses, both in between and within-group designs, to help understand the longitudinal course of anticipatory pleasure in schizophrenia. One limitation of our study is that our SSD group differed from our control group on demographic factors, including sex and ethnicity. While there were no significant sex differences in reports of either TEPS anticipatory or consummatory pleasure within our two groups, future studies will want to include more women with an SSD in their samples to replicate this finding and address the under-representation of women with schizophrenia in research more generally .