Longitudinal course of schizophrenia negative symptoms revealed

By Lynda Williams, Senior medwireNews Reporter

Schizophrenia negative symptoms are relatively stable in the first year for most patients after they begin antipsychotic medication but research suggests around a quarter will experience exacerbation or relapse.

Furthermore, the initial severity of negative symptoms predicts the long-term pattern and their impact on patient functioning, say Joseph Ventura, from University of California Los Angeles in the USA, and team.

“These findings suggest that negative symptoms may be an important early course target for intervention aimed at promoting recovery”, they hypothesise.

Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS) scores were measured at 2-week intervals in 149 patients in their first outpatient year after antipsychotic medication stabilisation.

Both measures demonstrated “moderate stability” in negative symptoms, although 24% of patients experienced relapse after initial remission, or symptom exacerbation regardless of whether they achieved remission. Indeed, 5% of patients had two exacerbations in the first year.

The BPRS score for negative symptoms immediately after the first episode was found to be moderately predictive for social functioning and work or school functioning 9 to 12 months later, with a similar pattern found for baseline SANS scores.

BPRS negative symptom scores reduced significantly between baseline and when measured again after medication stabilisation and 1 year later. However, there was no significant difference in BPRS scores for negative symptoms between medication stabilisation and follow-up 8 years later, with the initial score significantly predicting 8-year levels.

After 8 years, BPRS negative symptoms also showed a moderate association with work or school functioning, as did SANS negative symptoms.

“These converging cross-sectional and longitudinal results indicate the significance of developing interventions that decrease negative symptoms to maximize long-term recovery for [first episode psychosis]”, Ventura et al write in Schizophrenia Research.

“Such interventions are needed to actively prevent negative symptoms in the first outpatient

year from persisting into the chronic period of illness”, they say, in the hope that early treatment can prevent such symptoms from disrupting long-term school and employment functioning.

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