Predicting negative symptoms: a novel scale for assessing anticipatory cognitive mechanisms in psychosis

Negative symptoms are a central feature of the schizophrenia spectrum and also appear subclinically in healthy individuals, being associated with poor functional outcomes. Although clinician-rated measures remain the gold standard, self-report tools offer efficiency and a direct insight into subjective experiences.

This study presents the development and validation of the Negative Symptoms Anticipation Scale (NSAS), a novel self-report instrument designed to assess anticipatory cognitions related to negative symptoms.

In a pilot study, an initial 28-item version was refined to a final 16-item version organized into three factors: [Kirkpatrick B, Fenton WS, Carpenter WT, Marder SR 1;32(2):214-9:2006] Anticipation of Social Difficulties [Sicras-Mainar A, Maurino J, Ruiz-Beato E, Navarro-Artieda R 14(1):225:2014], Anticipation of Relationship Difficulties, and [Stahl SM, Buckley PF 115(1):4-11:2007] Anticipation of Low Energy in Daily Activities.

In a community sample (N = 3,237), the NSAS demonstrated excellent internal consistency (α = 0.927; ω = 0.926; α ordinal = 0.949) and test-retest reliability, as well as a robust factor structure confirmed via confirmatory exploratory analysis (CFI ≥ 0.997; RMSEA ≤ 0.025). Factorial invariance was established across gender and age, and ROC curve analysis indicated outstanding predictive ability for identifying individuals at risk for transitioning to psychosis (AUC = 0.905). Convergent validity was supported by moderate to high correlations with established measures of negative symptoms and negative schizotypy. Hierarchical linear regression showed that, when controlling for social anhedonia and depression, the anticipatory component contributed approximately 7-25% of the variance in negative symptoms.

These findings support the validity of the NSAS and suggest that its application could facilitate early detection and intervention in psychosis.