Cited by 726Schizophrenia research and treatmentPsychological Testing and AssessmentMental Health and Psychiatry

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The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

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Kring, Ann M., Gur, Raquel E., Blanchard, Jack J., Horan, William P., Reise, Steven P.·2013·American Journal of Psychiatry

DOI 10.1176/appi.ajp.2012.12010109PMC PMC3785242

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Abstract

OBJECTIVE: A major barrier to developing treatments for negative symptoms has been measurement concerns with existing assessment tools. Fulfilling the top recommendation of the National Institute of Mental Health's Consensus Development Conference on Negative Symptoms, the Clinical Assessment Interview for Negative Symptoms (CAINS) was developed using an iterative, empirical approach, and includes items assessing motivation, pleasure, and emotion expression. The authors employed multiple analytic techniques to develop the CAINS and here provide final development and validation results. METHOD: The CAINS structure, interrater agreement, test-retest reliability, and convergent and discriminant validity were assessed in a large and diverse sample of 162 outpatients with schizophrenia or schizoaffective disorder recruited from four sites. RESULTS: Three items with poor psychometric properties were removed, resulting in a 13-item CAINS. The CAINS factor structure was replicated, demonstrating two modestly correlated scales: expression (four items) and motivation/pleasure (nine items). The scales demonstrated good internal consistency, test-retest stability, and interrater agreement. Strong convergent validity was demonstrated by linkages with other negative symptom measures, self-report scales of sociality, pleasure, and motivation, and coded facial expressions. Discriminant validity was shown by independence from depression, medication side effects, and cognition. Notably, the CAINS scales were related to real-world vocational, independent living, and social/familial functioning. CONCLUSIONS: The CAINS is an empirically developed and evaluated measure of negative symptoms. Findings indicate that the CAINS is brief yet comprehensive and employable across a wide range of research and clinical contexts.

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Method
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BackgroundInfluential
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Anhedonia in Schizophrenia: A Brief History and Overview of the Construct
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MethodInfluential
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Franza, F., Fasano, V., Guglielmo, S. D., & Solomita, B. (2015) · PubMed · Cited by 4
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“These are the Clinical Assessment Interview for Negative Symptoms (CAINS) [42,43] and the Brief Negative Symptom Scale (BNSS) [44,45].”
Method
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“We administered the Brief Psychiatric Rating Scale (BPRS, Overall and Gorham, 1962) to quantify symptom severity, the Clinical Assessment Interview for Negative Symptoms (Kring et al., 2013) to quantify negative symptoms, the Specific Levels of Function informant report (SLOF) to measure level of community function (S…”
Method
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Method
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Self-citation
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“41,42”
Self-citation
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“To examine the relationship between baseline TMS indices and clinical effect of iTBS, clinical effect was defined as reduction in the total score on The Clinical Assessment Interview for Negative Symptoms (CAINS) (Kring et al., 2013).”
Influential
Neurobiological fingerprints of negative symptoms in schizophrenia identified by connectome‐based modeling
Gao, Z., Xiao, Y., Zhu, F., Bo, T., Zhao, Q., Yu, W., Bishop, J. R., Gong, Q., & Lui, S. (2025) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13782 · Cited by 3
“The recently developed scales including the Brief Negative Symptom Scale (BNSS) 66 and Clinical Assessment Interview for Negative Symptoms (CAINS), 67 may capture more symptom variance and provide better assessment for speci ﬁ c symptom subdomains.”
Protocol for evaluation of iTEST, a novel blended intervention to enhance introspective accuracy in psychotic disorders
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“Clinician-rated negative symptoms were assessed in all patient groups by using the Clinical Assessment Interview for Negative Symptoms (CAINS) (Kring et al., 2013), which includes a Motivation and Pleasure (MAP) and Expression (EXP) subscale.”
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Neural and Behavioral Markers of Negative Symptoms and Cognitive Impairment in Patients with Psychosis
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Animal Models of Psychotic Disorders
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Historical perspectives
Goldstein, G., Allen, D. N., & DeLuca, J. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-802203-0.00001-8 · Cited by 3
Factor structure and internal consistency of the Clinical Assessment Interview for Negative Symptoms (CAINS) on a sample of persons with psychotic disorders in Bosnia and Herzegovina
Kulenović, A. D., Mešević, E. S., Ribić, E., Repišti, S., Radojičić, T., & Jovanović, N. (2021) · Journal of Neural Transmission · doi:10.1007/s00702-021-02435-8 · Cited by 3
“1 3 factors, which are consistent with the results of previously published studies (Kring et al. 2013; Engel et al. 2014; Chan et al. 2015; Valiente-Gomez et al. 2015; Jung et al. 2016; Rekhi et al. 2019).”
BackgroundMethodResultInfluential
Sex and substance use in first episode psychosis: Impact on clinical symptoms, psychosocial functioning and cognitive performance
Safont, G., Garriga, M., Amoretti, S., Cuesta, M. J., Parellada, M., González-Pinto, A. M., Bergé, D., Rodríguez–Jiménez, R., Roldán, A., Sarró, S., et al. (2022) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2022.03.002 · Cited by 3
Maintenance Therapy of Psychosis Spectrum Disorders in a Real-World Setting: Antipsychotics Prescription Patterns and Long-Term Benzodiazepine Use
Marić, N. P., Petrović, S. A., Russo, M., Jerotić, S., Ristić, I., Savić, B., Pemovska, T., Milutinović, M., Ribić, E., Markovska-Simoska, S., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.796719 · Cited by 3
“Symptom severity at the time of the evaluation was measured using the 24-item Brief Psychiatric Rating Scale (BPRS) (17) and the 13-item interview-based questionnaire Clinical Assessment Interview for Negative Symptoms (CAINS) (18).”
Method
Reorganization of the functional connectome from rest to a visual perception task in schizophrenia and bipolar disorder
Riedel, P., Lee, J., Watson, C. G., Jimenez, A. M., Reavis, E. A., & Green, M. F. (2022) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2022.111556 · Cited by 4
Validation of the Social Effort and Conscientious Scale (SEACS) in Schizophrenia
Botello, R. M., Gill, K., Mow, J. L., Leung, L., Mote, J., Mueser, K. T., Gard, D. E., & Fulford, D. (2023) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-023-10031-1 · Cited by 3
“…such as the Scale for the Assessment of Negative Symp - toms (SANS; Andreasen, 1989) or the Clinical Assessment Interview for Negative Symptoms (CAINS; Kring et al., 2013 ), conflate reduced social interest and pleasure with the behavioral outputs of such impairment (Marder & Galderisi, 2017 ).”
Background
The Self-Evaluation of Negative Symptoms in Differentiating Deficit Schizophrenia: The Comparison of Sensitivity and Specificity with Other Tools
Samochowiec, J., Jabłoński, M., Plichta, P., Piotrowski, P., Stańczykiewicz, B., Bielawski, T., & Misiak, B. (2023) · Psychopathology · doi:10.1159/000529244 · Cited by 3
“Similar findings were obtained by Dollfus et al. [12] and other studies that used different tools to record negative symptoms [31, 32].”
Result
Neurophysiological indices of face processing in people with psychosis and their siblings: An event‐related potential study
Wynn, J. K., Clayson, P. E., Green, M. F., Jimenez, A. M., Lee, J., Reavis, E. A., & Horan, W. P. (2023) · European Journal of Neuroscience · doi:10.1111/ejn.16034 · Cited by 3
“…2008) from the Brief Psychiatric Rating Scale (BPRS) (Ventura et al., 1993) and negative symptoms were assessed with the two subscales from the Clinical Assessment Interview for Negative Symptoms (CAINS) (Kring et al., 2013): motivation and pleasure (MAP) and expressive negative symptoms (EXP).”
MethodInfluentialSelf-citation
Psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression and its relationship to affective symptoms
Bengtsson, J., Rad, P., Cernvall, M., & Bodén, R. (2023) · Annals of General Psychiatry · doi:10.1186/s12991-023-00474-x · Cited by 4
“Our main result indicated that the inter-rater agreement was acceptable, which is in accordance with previous studies in schizophrenia [17].”
BackgroundMethodResultInfluential
Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders
Le, T. P., Green, M. F., Wynn, J. K., Iglesias, J., Franco, R., Kopelowicz, A. J., & Kern, R. S. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.11.003 · Cited by 3
Reward Learning as a Potential Mechanism for Improvement in Schizophrenia Spectrum Disorders Following Cognitive Remediation: Protocol for a Clinical, Nonrandomized, Pre-Post Pilot Study
Dark, F. L., Galloway, G. J., Gray, M. A., Cella, M., Monte, V. E. D., Gore‐Jones, V., & Ritchie, G. (2024) · JMIR Research Protocols · doi:10.2196/52505 · Cited by 4
“The Clinical Assessment Interview for Negative Symptoms (CAINS) is a measure of anhedonia, avolition, and emotional expression [40] with strong psychometric properties [41].”
Method
Anhedonia and Negative Symptom Schizotypy
Kwapil, T. R., Gross, G. M., Chun, C. A., Silvia, P. J., & Neus Barrantes-vidal, A. (2014) · Springer eBooks · doi:10.1007/978-94-017-8610-2_9 · Cited by 3
Assessing Psychosis in African American Clients
Culbreth, A. J., & Strauss, G. P. (2014) · Springer eBooks · doi:10.1007/978-1-4939-1004-5_16 · Cited by 3
Assessing Social Affiliative Behavior: A Comparison of in Vivo and Video Tasks
Garcia, C. P., Catalano, L. T., Dwyer, K., McCarthy, J. M., Bennett, M. E., & Blanchard, J. J. (2018) · Behavior Therapy · doi:10.1016/j.beth.2018.03.006 · Cited by 4
Self-citation
Psychometric properties and diagnostic criteria of Negative Symptoms Assessment-5 (NSA-5) in schizophrenia
Assanovich, M. V. (2020) · V M BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY · doi:10.31363/2313-7053-2020-1-83-92 · Cited by 3
“матики: NSA-4 (Методике 4-пунктовой оценки негативных симптомов), BNSS (Краткой шкале негативных симптомов) и CAINS (Интервью для клинической оценки негативных симптомов) [5, 13, 14].”
We need to make progress on blunted affect: A commentary
Cowan, T., Phalen, P. L., Brown, C. H., Blanchard, J. J., & Bennett, M. E. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.01.001 · Cited by 2
Self-citation
Emotion anticipation and processing in depression: Behavioral, neural, and physiological reactivity
Wlad, M., Struckmann, W., Persson, J., Rosén, J., Fällmar, D., Bodén, R., & Gingnell, M. (2025) · European Psychiatry · doi:10.1192/j.eurpsy.2025.10043 · Cited by 2
“Symptoms of anhedonia were assessed using the Clinical Inter-view for Assessment of Negative Symptoms (CAINS) [27], which discriminates between consummatory and anticipatory pleasures [28, 29].”
Assessment of motivation in schizophrenia: Patient- and clinician-rated outcomes
Fernández-Egea, E., Robert, G., Mané, A., Sabé, M., Kuenzi, N., Kaliuzhna, M., Carruzzo, F., Diniel, F., Riclet, A. J., Martínez-Sadurní, L., et al. (2025) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.sjpmh.2025.08.001 · Cited by 2
Why clinical neuropsychology matters in schizophrenia care
Øie, M. G., Barbosa, F., Lettner, S., Baker, G. A., Duarte, C., Hessen, E., & Ueland, T. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1713751 · Cited by 3
“…Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1987), the Scale for the Assessment of Negative Symptoms (SANS) (Andreasen, 1981), the Brief Negative Symptom Scale (BNSS) (Kirkpatrick et al., 2011), and the Clinical Assessment Interview for Negative Symptoms (CAINS) (Kring et al., 2013).”
Dysfunctional Beliefs and Their Psychological Pathways to Negative Symptoms and Functioning in Schizophrenia Spectrum Disorders
Saperia, S., Prosserman, A., Anaya, E. F., Agarwal, S. M., Hahn, M., Best, M. W., Kidd, S. A., Zakzanis, K. K., & Foussias, G. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf229 · Cited by 2
Computational phenotypes underlying effort-based decision-making and negative symptoms in a transdiagnostic severe mental illness sample
Luther, L., Cooper, J. A., Treadway, M. T., Knippenberg, A. R., Walker, E. F., Gold, J. M., Waltz, J. A., Schiffman, J. E., Ellman, L. M., Mittal, V. A., et al. (2026) · Molecular Psychiatry · doi:10.1038/s41380-026-03474-x · Cited by 3
“The ﬁ ve negative symptom domains [48] were measured either with the Brief Negative Symptom Scale (BNSS [49]), Clinical Assessment Interview for Negative Symptoms (CAINS [50]), Scale for the Assessment of Negative Symptoms (SANS [51]), or Negative Symptom Inventory-Psychosis Risk (NSI-PR [52]).”
Beyond the emotion paradox: Avenues to understanding anhedonia in schizophrenia
Pillny, M., Edwards, C. J., & Riehle, M. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2026.04.003 · Cited by 2
Association of plasma DISC1 levels with expression of negative symptoms of first-episode schizophrenia
Yang, Q. Y., Wu, H. Q., Zhu, Z. H., Yin, X. Y., Hou, W. L., Man, L. J., Bian, W., Wang, H. Y., Zhang, H., Yu, X., et al. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2026.04.021 · Cited by 2
Characterizing social motivation deficits in treatment‐resistant schizophrenia: Evidence from social incentive performance
Lui, S. S. Y., Chan, J. W. S., Chan, J. L. F., Lam, K. H. Y., Choi, L.-Y., Wong, R. W. K., Leung, P. B. M., Zhan, N., Wong, J. W. Y., Chiu, M. W. Y., et al. (2026) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.70094 · Cited by 2
“Nevertheless, the CAINS-MAP and CAIN-EXP did not appear to in ﬂ uence other SID performance variables, including anticipatory pleasure and consummatory pleasure in TRS and remitted schizophrenia patients.”
Influential
Structured Diagnostic Interview Schedules
Gerritsen, C. J. (2021) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00112-6 · Cited by 2
The Role of Disability Benefits as an Environmental Factor Contributing to Negative Symptoms
Collins, D. E., Luther, L., Raugh, I. M., Condray, R., Allen, D. N., & Strauss, G. P. (2022) · Schizophrenia Bulletin · doi:10.1093/schbul/sbac077 · Cited by 2
Negative symptoms in drug-naive patients with a first-episode psychosis (FEP)
Cuñat, O., Hoyo, B., Vila‐Badia, R., Serra‐Arumí, C., Butjosa, A., Cacho, N. D., Colomer-Salvans, A., Dolz, M., Cuevas‐Esteban, J., Iglesias-González, M., et al. (2023) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2023.103448 · Cited by 2
Transdiagnostic Predictors of Everyday Functioning: Examining the Relationships of Depression and Reinforcement Learning
Dalloul, N., Moran, E. K., Gold, J. M., Carter, C. S., MacDonald, A. W., Ragland, J. D., Silverstein, S. M., Luck, S. J., & Barch, D. M. (2023) · Schizophrenia Bulletin · doi:10.1093/schbul/sbad095 · Cited by 2
Pre-stimulus EEG phase coherence predicts visual target detection failures in schizophrenia: A pilot study
Reavis, E. A., Wynn, J. K., & Green, M. F. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2024.08.016 · Cited by 2
“…and medical history, the updated version of the Structured Clinical Interview for DSM-5 (SCID-1) (First et al., 2015), the Expanded Brief Psychiatric Rating Scale (BPRS) (Overall and Gorham, 1962), and the Clinical Assessment Interview for Negative Symptoms (CAINS) (Kring et al., 2013).”
Using pupillometry to predict outcome in cognitive behavioral therapy for negative symptoms of schizophrenia
Delay, C., Link, P. C., Holden, J. L., & Granholm, E. L. (2025) · Schizophrenia Research · doi:10.1016/j.schres.2025.01.014 · Cited by 2
French Validation of the Brief Negative Symptom Scale (BNSS)
Métivier, L., Tréhout, M., Leroux, E., Rothärmel, M., & Dollfus, S. (2025) · The Canadian Journal of Psychiatry · doi:10.1177/07067437251328350 · Cited by 2
Associations between negative symptoms and thermal pain perception in bipolar I disorder
Vrolix, L., Legarreta, J. H., van der Heijden, H. C., van Gool, R., Ray, A., Golden, E., Cay, M., Yogesh Rathi, A., Gonzalez–Heydrich, J., O’Donnell, L. J., et al. (2025) · International Journal of Bipolar Disorders · doi:10.1186/s40345-025-00403-9 · Cited by 2
Identifying the “Therapy Targets” for Treating the Negative Symptoms of Psychosis Using Cognitive Behavioral Therapy
Tomlinson, M. F., & Wright, J. D. (2018) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.32.3.203 · Cited by 2
Associations between schizophrenia polygenic risk and apathy in schizophrenia spectrum disorders and healthy controls
Lyngstad, S. H., Bettella, F., Aminoff, S. R., Athanasiu, L., Andreassen, O. A., Færden, A., & Melle, I. S. (2020) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13167 · Cited by 2
“Commonly used assessments of negative symptoms, such as the Scale for the Assessment of Negative Symptoms (18), the Clinical Assessment Interview for Negative Symptoms (19), and the Positive and Negative Syndrome Scale (20), are based on observations of behaviors, without links to biological underpinnings and thus wit…”
Method
Le déficit motivationnel dans la schizophrénie
Dollfus, S. (2018) · Bulletin de l Académie Nationale de Médecine · doi:10.1016/s0001-4079(19)30345-0 · Cited by 2
Factor structure of the Albanian version of the Clinical Assessment Interview for Negative Symptoms (CAINS): Associations with the Brief Symptoms Inventory (BSI)
Uka, F., Repišti, S., Arënliu, A., Ramadani, F., Bërxulli, D., Konjufca, J., & Jovanović, N. (2020) · GLOBAL PSYCHIATRY ARCHIVES · doi:10.2478/gp-2020-0013 · Cited by 2
“…compared with other instruments that measure the same construct, CAINS was shown to have good convergent validity: both CAINS scales were correlated with the negative symptom subscale of Brief Symptom Rating Scale (BPRS; Overall & Gorham, 1962) and with the subscales of SANS (Kring et al., 2013).”
MethodResultInfluential
Pengaruh regulasi emosi kognitif terhadap depresi pada mahasiswa tingkat akhir dimasa pandemi covid-19
Maslita, V. Q., Saraswati, P., & Hijrianti, U. R. (2021) · Cognicia · doi:10.22219/cognicia.v9i2.18023 · Cited by 10
Women with schizophrenia have worse clinical presentation compared to their men counterpart in Kosovo: a cross-sectional study
Russo, M., Jovanović, N., Uka, F., Konjufca, J., Bërxulli, D., & Arënliu, A. (2022) · GLOBAL PSYCHIATRY ARCHIVES · doi:10.52095/gp.2022.4548.1043 · Cited by 2
Decision value signals in the ventromedial prefrontal cortex and motivational and hedonic symptoms across mood and psychotic disordersPreprint
Kang, M. S., Wolf, D. H., Kazinka, R., Lee, S., Ruparel, K., Elliott, M. A., Xu, A., Cieslak, M., Prettyman, G., Satterthwaite, T. D., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.12.01.407197 · Cited by 2
Cognitive Remediation Program for Family Caregivers in Schizophrenia (CIRCUS): Study of the Effectiveness of a Guided AND WEB-BASED Compensatory Cognitive Remediation: A Randomized Pilot StudyPreprint
Garbisson, A., Laraki, Y., Dubois, T., André, M., Rainteau, N., Capdevielle, D., & Raffard, S. (2021) · Research Square · doi:10.21203/rs.3.rs-561341/v1 · Cited by 2

Authors: Kring, A. M., Gur, R. E., Blanchard, J. J., Horan, W. P., & Reise, S. P.
Affiliations: University of California, Los Angeles (US)
ORCID: Kring, Ann M.
Gur, Raquel E.
Blanchard, Jack J.
Horan, William P.
Reise, Steven P.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2013-02
Volume: 170
Issue: 2
Pages: 165-172
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.2012.12010109
PMC: PMC3785242
OpenAlex: W2131925003
Cited by: 726
References: 43
Citations by year: 2026: 55 · 2025: 55 · 2024: 51 · 2023: 62 · 2022: 62 · 2021: 48 · 2020: 70 · 2019: 51 · 2018: 61 · 2017: 46 · 2016: 52 · 2015: 51 · 2014: 37 · 2013: 24
FWCI: 38.03
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5r01mh082782-03, 5r01mh082890-03)
National Institute of Mental Health (1R01MH082890, R01-MH082890, R01-MH082782, R01MH082839, R01MH082783, 1R01MH082782)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords: negative symptoms, schizophrenia, schizoaffective disorder, motivation, pleasure, emotional expression, interview assessment, psychometric validation, factor structure, convergent validity, discriminant validity, vocational functioning, independent living, social functioning
MeSH terms: Adult, Female, Humans, Interview, Psychological, Male, Middle Aged, Motivation, Outpatients, Psychiatric Status Rating Scales, Psychological Tests, Psychotic Disorders, Schizophrenia, Schizophrenic Psychology, Social Behavior, Socioeconomic Factors, Volition, Reproducibility of Results, Expressed Emotion, Diagnostic and Statistical Manual of Mental Disorders, Pleasure, Anhedonia

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The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

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