Can patients at risk for persistent negative symptoms be identified during their first episode of psychosis?

J Nerv Ment Dis. 2004 Jul;192(7):455-63. doi: 10.1097/01.nmd.0000131804.34977.c1.

Abstract

Patients with schizophrenia who show persistent negative symptoms are an important subgroup, but they are difficult to identify early in the course of illness. The objective of this study was to examine characteristics that discriminate between first-episode psychosis (FEP) patients in whom primary negative symptoms did or did not persist after 1 year of treatment. Patients with a DSM-IV diagnosis of FEP whose primary negative symptoms did (N = 36) or did not (N = 35) persist at 1 year were contrasted on their baseline and 1-year characteristics. Results showed that patients with persistent primary negative symptoms (N = 36) had a significantly longer duration of untreated psychosis (p < .005), worse premorbid adjustment during early (p < .001) and late adolescence (p < .01), and a higher level of affective flattening (p < .01) at initial presentation compared with patients with transitory primary negative symptoms. The former group also showed significantly lower remission rates at 1 year (p < .001). Multiple regression analysis confirmed the independent contribution of duration of untreated psychosis, premorbid adjustment, and affective flattening at baseline to the patients' likelihood of developing persistent negative symptoms. It may therefore be possible to distinguish a subgroup of FEP patients whose primary negative symptoms are likely to persist on the basis of characteristics shown at initial presentation for treatment.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antipsychotic Agents / therapeutic use
  • Cognition Disorders / diagnosis
  • Combined Modality Therapy
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Neuropsychological Tests
  • Prognosis
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Psychotherapy
  • Regression Analysis
  • Risk Factors
  • Schizophrenia / diagnosis*
  • Schizophrenia / therapy
  • Schizophrenic Psychology*
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Antipsychotic Agents