Recruitment completed May 2021 until July 2025.
CHANSS - Characterising Negative Symptoms of Schizophrenia
Motivational deficits in schizophrenia can be conceptualised as a syndrome with multiple components, causal factors, and confounders. Despite diverse underlying mechanisms, these deficits converge on a common observable endpoint: impaired goal-directed behaviour. Deconstructing the motivation into cognitive components and associated factors can help delineate the deficits, potentially guiding targeted interventions.
Co-directed with Noham Wolpe, the CHANSS project aims to investigate three cognitive stages: neuro-cognition, motivational cognition and meta-cognition, while controlling for secondary factors affecting motivation. It is a large, multi-site, multicultural, and heterogeneous sample of individuals diagnosed with schizophrenia at different stages. The study employs an extensive battery of psychometric and cognitive assessments alongside computer-based tasks designed to measure executive, motivational, and meta-cognitive aspects of goal-directed behaviour
-
Group differences will emerge across all tasks, with patients performing less optimally on tasks related to the three cognitive components (neuro, motivational, and meta-cognition).
Some of these differences might be due to potentially treatable secondary causes of poor motivation (eg depression or sedation).
Patients can be grouped into clusters exhibiting fundamental neuro, motivational, or meta-cognitive deficits. As many of these processes are interrelated, specific subtypes of behaviour will emerge.
A hierarchical effect will be observed, whereby dysfunction in an early cognitive phase (e.g., neuro) disrupts subsequent processes. In other words, those with neurocognitive profile will also have more motivational and metacognitive deficits, whereas those with a predominant meta-cognitive dysfunction will not necessarily have neurocognitive deficits.
Secondary factors, such as depression and sedation, will selectively impair specific stages within the motivational syndrome.
-
The CHANSS study is conducted across multiple international research centres, including academic institutions and mental health centres in the United Kingdom (Cambridge, London, Humber, Doncaster), Spain (Barcelona, Bilbao, Oviedo and Santander) and China (Shangai).The Cambridge team is lead by Fernandez-Egea and Co-CI Wolpe. Local PI is Nuria Segarra with the help and support of Renata Zirilli and Sophie Shatford. Jones is the mentor for this study.
In the UK, the study benefits from the support of the National Institute for Health and Care Research Clinical Research Network (NIHR-CRN), which facilitates participant recruitment, site coordination, and data management.
-
Age between 18 and 65 years.
Diagnosis of schizophrenia according to the International Classification of Diseases, 10th Revision (ICD-10) criteria, with more than one year of diagnosis.
Stable antipsychotic medication regimen for at least six weeks prior to study enrolment.
Capacity to provide informed consent.
Exclusion Criteria:
- Presence of neurological disorders or significant medical conditions that may affect cognitive functioning.
- History of traumatic brain injury with loss of consciousness exceeding five minutes.
- Current substance use disorder (excluding nicotine) within the past six months.
- Intellectual disability (IQ < 70).
- Use of anticholinergic medication, except for hyoscine in cases of clozapine-induced sialorrhea. -
The study protocol has been reviewed and approved by the relevant Institutional Review Boards (IRBs) and Ethics Committees at each participating site. In the UK, the protocol received ethical approval from the Health Research Authority (HRA; IRAS:295622; 21/WA/0056) and was registered with the NIHR Clinical Research Network Portfolio. This protocol included the other sites, but each sites obtained their local ethical approval. The study complies with the principles outlined in the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Written informed consent is obtained from all participants prior to any study-related procedures. Data confidentiality and participant privacy are maintained throughout the study in accordance with the General Data Protection Regulation (GDPR).
-