Negative and positive schizophrenic syndromes after the acute phase: A prospective follow-up

doi:10.1016/0010-440X(86)90003-9

Comprehensive Psychiatry

Volume 27, Issue 4, July–August 1986, Pages 276-286

https://doi.org/10.1016/0010-440X(86)90003-9 Get rights and content

Abstract

To study the stability and predictive significance of positive and negative syndromes, we assessed a group of young acute schizophrenics at index admission (N = 37) and upon 2-year follow-up (N = 19). We found these syndromes longitudinally unstable, though equally prevalent in both phases. The baseline negative score was predictive of favorable outcome. The prognostic value of negative symptoms was independent of premorbid ratings, and, in combination these predictors, correlated strongly with follow-up level of functioning. The relationship between negative syndrome and outcome was partly explained by depression, which correlated significantly with baseline negative score. Theoretical and clinical implications of this overlay of a negative syndrome with depression in young acute schizophrenics are presented.

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In this study, we used the IDF criteria, widely used and justified (Alberti et al., 2006; Zhou et al., 2021b). Furthermore, in this study the symptom severity of patients were assessed using PANSS, which is the most widely used measure of psychotic symptoms in patients with schizophrenia (Suzuki, 2011; Van den Oord et al., 2006), with excellent internal reliability, construct validity and sensitivity (Kay et al., 1988; Lindenmayer et al., 1986; Peralta and Cuesta, 1994). There were some limitations in this study.
Although metabolic abnormalities and metabolic syndrome (MetS) often occur in schizophrenia, few studies have investigated them in early-onset schizophrenia (EOS) patients. To our knowledge, this was the first to compare clinical correlates of metabolic abnormalities between first-episode drug-naïve (FEDN) EOS and adult-onset schizophrenia (AOS) patients. A total of 489 Chinese FEDN schizophrenia patients (116 EOS and 373 AOS) and 451 healthy controls were recruited in this cross-sectional study. Blood pressure, waist circumference (WC), Body mass index (BMI), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), glucose, hemoglobin A1c (HbA1c), insulin and insulin resistance were measured. The Positive and Negative Syndrome Scale (PANSS) was applied to evaluate the clinical symptoms of schizophrenia patients, and higher scores on PANSS indicate increased severity. EOS patients had lower rates of: MetS, elevated WC, hypertriglyceridemia, hypercholesterolemia, and hyper-LDLC than EOS patients (all p < 0.05). In EOS patients, WC was positively associated with PANSS general psychopathology score (p = 0.04). In AOS patients, WC (p = 0.01; p = 0.02) and glucose (p < 0.001; p < 0.001) were positively associated with PANSS general psychopathology and total score. HOMA-IR was positively associated with PANSS total score (p = 0.04). Systolic BP, triglycerides and HDLC were main contributors to MetS in AOS (all p < 0.05), but not in EOS. BMI was a risk factor of MetS in EOS, while BMI and HOMA-IR were risk factors of MetS in AOS (all p < 0.05). Our results indicate differences in metabolic abnormalities patterns, risk factors and their association with clinical characteristics between Chinese EOS and AOS patients.
The datasets that support the findings of this study are not publically available due to ongoing analyses for further publications, but are available from the corresponding author X.Z. upon reasonable request.
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The ‘pyramid’ is made by poles corresponding to the negative, positive, and depressive symptomatology which create a triangular base, while excitement symptoms constitute a separate vertical axis (Fig. 1) (Kay and Sevy, 1990). The PANSS and the model are extensively used in psychiatry research to assess diagnostic and treatment efficacy (Bunk et al., 1999; Citrome et al., 2011; Emsley et al., 2003, 2007; Lindenmayer et al., 1986; Lykouras et al., 2000; Llorca et al., 2012; Marder et al., 1997; Monteiro et al., 2008; Stochl et al., 2014; Wallwork et al., 2012; Wu et al., 2015). Difficulties arise, however, when an attempt is made to evaluate the pattern and the quality of the symptomatology with the PANSS.
Staging in schizophrenia might be an important approach for the better treatment and rehabilitation of patients. The purpose of this study was to empirically devise a staging approach in a sample of stabilized patients with schizophrenia. One hundred and seventy patients aged ≥18 years (mean = 40.7, SD = 11.6) diagnosed by DSM-5 criteria were evaluated with the Positive and Negative Syndrome Scale (PANSS). Principal components analysis (PCA) with varimax rotation was used. The model was examined in the total sample and separately across a hypothesized stage of illness based on three age groups and between the two sexes. The PCA revealed a six factor structure for the total sample: 1) Negative, 2) Positive, 3) Depression and anxiety, 4) Excitement and Hostility, 5) Neurocognition and 6) Disorganization. The separate PCAs by stage of illness and sex revealed different patterns and quality of symptomatology. The Negative and Positive factors were stable across all examined groups. The models corresponding to different stages differed mainly in terms of neurocognition and disorganization and their interplay. Catatonic features appear more prominent in males while in females neurocognition takes two forms; one with disorganization and one with stereotype thinking with delusions. This study suggests that the three arbitrary defined stages of illness (on the basis of age) seem to reflect a progress from a preserved insight and more coherent mental functioning to disorganization and eventually neurocognitive impairment. Sexes differ in terms of the relationship of psychotic features with neurocognition. These results might have significant research and clinical implications.
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This is a clinician-rated 30-item scale designed to quantify the severity of positive (seven items), negative (seven items), and general psychopathology (16 items). The scale has been shown to have good internal reliability (Peralta and Cuesta, 1994), construct validity (Kay et al., 1988) and sensitivity to change (Lindenmayer et al., 1986). Interviews were conducted according to the PANSS Manual (Kay et al., 1992) by trained psychiatrists.
Ramadan fasting is believed to be beneficial. We assessed a random sample of 100 Egyptian male schizophrenia outpatients using the Positive and Negative Syndrome Scale (PANSS) and dietary, anthropometric, clinical, and laboratory measures at baseline (T1) before Ramadan of 2014 and during the fourth week of Ramadan (T2). The metabolic syndrome was identified in 31 patients and these showed a reduction of high-density lipoprotein cholesterol (HDLc) and brain-derived neurotrophic factor (BDNF) concentrations and increase in the levels of dietary intakes, body mass index (BMI), waste circumference, systolic and diastolic blood pressure, all PANSS subscales, glucose, insulin, HOMA-IR, total cholesterol, triglycerides, low-density lipoprotein-cholesterol (LDL-c), white blood cells, granulocytes, lymphocytes, monocytes, fibrinogen and high-sensitivity C-reactive protein (hs-CRP). In a multiple regression analysis, total energy intake and body mass index (BMI) emerged as the main independent predictors of deterioration in most inflammatory and psychopathology parameters. These findings did not support our hypothesis but suggested that Ramadan fasting has a negative impact on schizophrenia patients, especially those with metabolic syndrome. This could draw attention to the need in the psycho-education management of such patients to focus more on nutrition education for safe fasting.
The evolution of illness phases in schizophrenia: A non-parametric item response analysis of the Positive and Negative Syndrome Scale
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They are found to be present in many patients when other symptoms are in relative remission (particularly in cases of the deficit syndrome). Negative symptoms are also present at the time of the first episode (Lindenmayer et al., 1986; Milev et al., 2005) and have been reported to be moderate or greater in severity in a substantial proportion of community dwelling patients (Kurtz, 2005). Studies of older patients have reported even higher levels of negative symptoms (Harris, 1991; Roseman et al., 2008), although the longitudinal detection of change over the lifespan is challenging.
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Findings confirm differences in symptom presentation and predominance of particular domains in subpopulations of schizophrenia. Identifying symptom domains characteristic of subpopulations may be more useful in assessing efficacy endpoints than total or subscale scores.
Symptom patterns and subgrouping of schizophrenic patients: Significance of negative symptoms assessed on admission
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This study subgroups schizophrenic patients based on symptoms assessed on admission and examines the validity of the subgrouping using follow-up data and other clinical outcome variables. Schizophrenic patients (n=163) from consecutive admission received ratings on the positive and negative syndrome scale (PANSS) on admission and during a 1-year follow-up course. An exploratory graphic analysis on the admission PANSS derived four symptom dimensions: negative symptoms, disorganized thought, hostility/excitement and delusions/hallucinations. This yielded two subgroups of patients on admission, a group with marked negative (GWNEG) and a group without marked negative (GONEG) symptoms. Compared with the GONEG, the GWNEG had a poorer recovery rate, more impairment in attention, a slower response of the delusion/hallucination symptoms to neuroleptic treatment and a longer duration of index hospitalization. At a one-year follow-up, the GWNEG assessed on admission had persistently higher scores on the negative symptom and disorganized thought syndromes, less relapse rate, a shorter duration on job, as well as worse social functioning than the GONEG. Thus, the GONEG might comprise patients having a pure paranoid syndrome with quick and better treatment response, while the GWNEG comprises patients with the blunt-disorganization syndrome having a poorer outcome.
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Negative and positive schizophrenic syndromes after the acute phase: A prospective follow-up

Abstract

Speculations on the processes that underlie schizophrenic symptoms and signs

Schizophr Bull

Clinical concepts of schizophrenia

Molecular pathology of schizophrenia: More than on disease process?

Br Med J

Negative vs positive schizophrenia: Definition and validation

Arch Gen Psychiatry

Positive and negative syndromes in chronic schizophrenic inpatients

J Nerv Ment Dis

Positive and negative subtypes in schizophrenia

Compr Psych

Differential effects of amphetamine and neuroleptics on negative vs positive symptoms in schizophrenia

Psychopharmacology (Berlin)

The dementia of dementia praecox

Acta Psychiatr Scand

Ventricular enlargement in schizophrenia: Relationships to positive and negative schizophrenia

Am J Psychiatry

Neuropathological Studies of Schizophrenia: A selective review

Schizophr Bull

Negative and positive symptoms in schizophrenia and depression: A follow-up

Schizophr Bull