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. 2023 Jun 16:14:1136097.
doi: 10.3389/fpsyt.2023.1136097. eCollection 2023.

A transdiagnostic approach to negative symptoms: exploring factor structure and negative symptoms in bipolar disorders

Henrik Myhre Ihler  1 , Siv Hege Lyngstad  2 , Lynn Egeland Mørch-Johnsen  1   3 , Trine Vik Lagerberg  1 , Ingrid Melle  1 , Kristin Lie Romm  4
Affiliations

A transdiagnostic approach to negative symptoms: exploring factor structure and negative symptoms in bipolar disorders

Henrik Myhre Ihler et al. Front Psychiatry. .

Abstract

Background: Negative symptoms are increasingly recognized as transdiagnostic phenomena, linked to reduced quality of life and functioning, and often caused or worsened by amendable external factors such as depression, social deprivation, side-effects of antipsychotics or substance use. The structure of negative symptoms fits into two dimensions: diminished expression and apathy. These may differ in association with external factors that influence their severity and may thus require different treatment approaches. The dimensions are comprehensively established in non-affective psychotic disorders but are understudied in bipolar disorders.

Methods: We conducted exploratory and confirmatory factor analyses in a sample of 584 individuals with bipolar disorder to assess the latent factor structure of negative symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), and performed correlational analyses and multiple hierarchical regression analyses to investigate links between the two dimensions of negative symptoms and clinical and sociodemographic correlates.

Results: The latent factor structure of negative symptoms fits into two dimensions, i.e., diminished expression and apathy. A diagnosis of bipolar type I or a history of psychotic episodes predicted more severe levels of diminished expression. Depressive symptoms were associated with more severe negative symptoms across dimensions, yet 26.3% of euthymic individuals still displayed at least one mild or more severe negative symptom (PANSS score ≥ 3).

Discussion: The two-dimensional structure of negative symptoms seen in non-affective psychotic disorders reproduces in bipolar disorders indicating similarities in their phenomenology. Diminished expression was associated with a history of psychotic episodes and a diagnosis of BD-I, which may infer closer connections to psychosis liability. We found significantly less severe negative symptoms in euthymic than depressed participants. Nevertheless, more than a quarter of the euthymic individuals had at least one mild negative symptom, demonstrating some degree of persistence beyond depressed states.

Keywords: apathy; bipolar disorder; cannabis use; diminished expression; negative symptoms.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Number of participants with negative symptom scores equal to or above 3.
Figure 2
Figure 2
Percentage of participants with symptoms present within diminished expression and apathy.
See this image and copyright information in PMC

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