In recent years there have been at least 4-factor analyses of the negative symptoms schedules or checklists. While the titles differ, the analyses yield two factors; the first labeled avolition, includes avolition, apathy, anhedonia (see below), asociality, and diminished activity. The second factor, labeled social expressiveness, has to do with the physical movements or lack thereof, involved in social communication. This factor consists of blank faces, expressive gestures, and alogia.
In factor 1, it has been shown that the anhedonia is actually an artifact. It is observed only because the individuals are not engaged in a pleasurable activity. The crucial dimension of anhedonia appears to be the expectation of a non-pleasurable experience. Actually, these individuals do experience pleasure, when exposed to pleasurable circumstances.
Putting all of this together, it seems that factor one is a conscious experience. The individual does not expect pleasure, and therefore, makes a conscious decision to withdrawal. The second factor, which we might call motor expressiveness, seems to be at a less conscious level and is a kind of a reflex action. The individual does not deliberately have a blank face or poverty of speech.
We predicted that defeatist attitudes will correlate more with factor 2 since these attitudes have to do with movement (or the lack thereof). We also predicted that factor 2 would be correlated with neurocognitive impairment. This would also fit into the depression/conservation of energy paradigm, whereby energy is not immediately accessible or can be, but salient stimuli can mobilize the energy.
Another hypothesis is that there are two separate processes involved. Factor 1 is based primarily on asocial attitudes and expectations of non-pleasure, whereas Factor 2 is based on expectations of failure and diminished access to energy. Question: Does this fit into the conservation of the energy model in depression? It is conceivable that its effects might be widespread and involve any involuntary processes. I once heard that the kneejerk reflex was absent in patients with schizophrenia (I don’t know whether this is an old wives’ tale).
-Correlation of asocial beliefs and factor 1= r=.29 (p< .05)
-Correlation of defeatist beliefs and factor 2= r=.17 (p< .05)
-Correlation of defeatist beliefs and neurocognitive impairment*= r= -.18 (p< .05)
A previous analysis (Grant & Beck 2009) showed much higher coefficients, which were re-run by Keith Bredemeier, are noted below (N=78):
-Defeatist beliefs > overall SANS score (global) = .56 (this is a little higher than was reported in the paper, possibly because there were data exclusions that I am not accounting for)
-Defeatist beliefs > alogia = .45
-Defeatist beliefs > affective flattening = .40
-Defeatist beliefs > avolition-apathy = .51
-Defeatist beliefs > anhedonia-asociality = .55
*the two-factor scores weren’t computed/included in this dataset.
It is possible to think of factor 1 as a network of functions, driving voluntary behavior. For example, suppose an individual has the belief that he has no energy to do anything, and that nothing he does will bring gratification. As a result of this belief, the individual makes a conscious decision to isolate himself and remain inactive. Suppose, however, that the individual is exposed to an engaging stimulus (such as having a birthday party, or listening to favorite music). As a result, his expectancy changes to “I might have a good time,” he makes a conscious decision to participate, and then, engages in singing and dancing with the rest of individuals on the unit.
If factor 1 is associated with motivation and voluntary action (withdrawal vs participation), then factor 2 is involved with less voluntary reactions: attenuated affect, reduced expressiveness in gestures, and alogia. Interestingly, dysfunctional attitudes, or their opposite, are associated with the second factor, even though the volition and decision making may not be conscious. In fact, other non-conscious functions may be associated with the instigation or activation of the negative dysfunctional beliefs. An example of this is the attenuation of pupillary dilation when engaged in an effortful activity. While the constriction (or dilation) of the pupil is not conscious, there still is a non-conscious pathway from defeatist attitudes to dysfunction (Granholm et al). The function of the pupil is to increase attention when the individual is exerting effort. Since the individuals’ defeatist beliefs curtail their effort, the pupillary response is very sluggish. It is also possible that certain reflexes such as the knee jerk reflex are curtailed.