Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T02:23:23.337Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of primary negative symptoms on functional outcomes in schizophrenia

Published online by Cambridge University Press:  15 April 2020

G. Fervaha ,
G. Foussias ,
O. Agid  and
G. Remington
G. Fervaha*
Affiliation:
Schizophrenia Division, Centre for Addiction and Mental Health, 250, College Street, M5T 1R8Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Canada
G. Foussias
Affiliation:
Schizophrenia Division, Centre for Addiction and Mental Health, 250, College Street, M5T 1R8Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
O. Agid
Affiliation:
Schizophrenia Division, Centre for Addiction and Mental Health, 250, College Street, M5T 1R8Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
G. Remington
Affiliation:
Schizophrenia Division, Centre for Addiction and Mental Health, 250, College Street, M5T 1R8Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Canada Department of Psychiatry, University of Toronto, Toronto, Canada
*
* Corresponding author. Tel.: +416 535 8501x34818; fax: +416 979 4292. E-mail address: [email protected] (G. Fervaha).
Get access

Abstract

Objective

Negative symptoms are known to undermine functional outcomes in people with schizophrenia; however, most studies have not accounted for whether these symptoms were primary or secondary to other psychopathological factors. The present study examined the impact of primary negative symptoms on functional outcomes in patients with schizophrenia.

Method

The sample included 1427 patients with schizophrenia who completed the baseline visit in the CATIE study. Symptoms were assessed with the Positive and Negative Syndrome Scale and Calgary Depression Scale, extrapyramidal side effects with the Simpson-Angus scale, and functional status with the Heinrichs-Carpenter Quality of Life Scale.

Results

Negative symptoms were significantly and inversely related to each domain of functioning examined. These relationships remained after statistically controlling for the influence of potential sources of secondary negative symptoms. In addition, the relationships between negative symptoms and specific domains of functioning remained in patients who had mild/absent positive, depressive, anxiety and extrapyramidal symptoms. Negative symptoms were associated with functional outcomes even in antipsychotic-free patients.

Conclusions

Primary negative symptoms significantly contribute to the functional impairment seen in people with schizophrenia. A better understanding of the etiology and pathobiology of these symptoms is required to guide the search for effective therapeutics that promote functional recovery.

Keywords

SchizophreniaFunctional outcomeNegative symptomsPrimary symptomsAvolition-ApathyPsychosocial functioning
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 7 , September 2014 , pp. 449 - 455
Copyright
Copyright © 2014 Elsevier Masson SAS

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, D., Addington, J., Schissel, B.A depression rating scale for schizophrenics. Schizophr Res 1990;3:247–251.CrossRefGoogle ScholarPubMed
Addington, D., Addington, J., Maticka-Tyndale, E.Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry 1993;163:39–44.CrossRefGoogle Scholar
Addington, D., Addington, J., Maticka-Tyndale, E.Specificity of the Calgary Depression Scale for schizophrenics. Schizophr Res 1994;11:239–244.CrossRefGoogle ScholarPubMed
Andreasen, N.C., Olsen, S.Negative vs. positive schizophrenia. Definition and validation. Arch Gen Psychiatry 1982;39:789–794.CrossRefGoogle Scholar
Andreasen, N.C.Improvement of negative symptoms: concepts, definition and assessment. Int Clin Psychopharmacol 12Suppl. 21997 S7–S10.CrossRefGoogle ScholarPubMed
Artaloytia, J.F., Arango, C., Lahti, A., Sanz, J., Pascual, A., Cubero, P.et al.Negative signs and symptoms secondary to antipsychotics: a double-blind, randomized trial of a single dose of placebo, haloperidol, and risperidone in healthy volunteers. Am J Psychiatry 2006;163:488–493.CrossRefGoogle ScholarPubMed
Blanchard, J.J., Cohen, A.S.The structure of negative symptoms within schizophrenia: implications for assessment. Schizophr Bull 2006;32:238–245.CrossRefGoogle ScholarPubMed
Bobes, J., Arango, C., Garcia-Garcia, M., Rejas, J.Prevalence of negative symptoms in outpatients with schizophrenia spectrum disorders treated with antipsychotics in routine clinical practice: findings from the CLAMORS study. J Clin Psychiatry 2010;71:280–286.CrossRefGoogle ScholarPubMed
Bozikas, V.P., Kosmidis, M.H., Kafantari, A., Gamvrula, K., Vasiliadou, E., Petrikis, P.et al.Community dysfunction in schizophrenia: rate-limiting factors. Prog Neuropsychopharmacol Biol Psychiatry 2006;30:463–470.CrossRefGoogle ScholarPubMed
Buchanan, R.W., Kirkpatrick, B., Heinrichs, D.W., Carpenter, W.T. Jr.Clinical correlates of the deficit syndrome of schizophrenia. Am J Psychiatry 1990;147:290–294.Google ScholarPubMed
Carpenter, W.T. Jr., Heinrichs, D.W., Alphs, L.D.Treatment of negative symptoms. Schizophr Bull 1985;11:440–452.CrossRefGoogle ScholarPubMed
Carpenter, W.T. Jr., Heinrichs, D.W., Wagman, A.M.Deficit and non-deficit forms of schizophrenia: the concept. Am J Psychiatry 1988;145:578–583.Google Scholar
Chatterjee, A., Chakos, M., Koreen, A., Geisler, S., Sheitman, B., Woerner, M.et al.Prevalence and clinical correlates of extrapyramidal signs and spontaneous dyskinesia in never-medicated schizophrenic patients. Am J Psychiatry 1995;152:1724–1729.Google ScholarPubMed
Collins, A.A., Remington, G., Coulter, K., Birkett, K.Depression in schizophrenia: a comparison of three measures. Schizophr Res 1996;20:205–209.CrossRefGoogle ScholarPubMed
Crow, T.J.Molecular pathology of schizophrenia: more than one disease process?. Br Med J 1980;280:66–68.CrossRefGoogle ScholarPubMed
Evensen, J., Rossberg, J.I., Barder, H., Haahr, U., Hegelstad, W., Joa, I.et al.Apathy in first-episode psychosis patients: a ten year longitudinal follow-up study. Schizophr Res 2012;136:19–24.CrossRefGoogle Scholar
Faerden, A., Friis, S., Agartz, I., Barrett, E.A., Nesvag, R., Finset, A.et al.Apathy and functioning in first-episode psychosis. Psychiatr Serv 2009;60:1495–1503.CrossRefGoogle ScholarPubMed
Fenton, W.S., McGlashan, T.H.Testing systems for assessment of negative symptoms in schizophrenia. Arch Gen Psychiatry 1992;49:179–184.CrossRefGoogle Scholar
Fenton, W.S., McGlashan, T.H.Antecedents, symptom progression, and long-term outcome of the deficit syndrome in schizophrenia. Am J Psychiatry 1994;151:351–356.Google Scholar
Fervaha, G., Foussias, G., Agid, O., Remington, G.Amotivation and functional outcomes in early schizophrenia. Psychiatry Res 2013;210:665–668.CrossRefGoogle ScholarPubMed
Fervaha, G., Remington, G.Validation of an abbreviated quality of life scale for schizophrenia. Eur Neuropsychopharmacol 2013;23:1072–1077.CrossRefGoogle Scholar
First, M.B.User's guide for the structured clinical interview for DSM-IV axis I disorders SCID-I: clinician version. 1997 Amer Psychiatric Pub Inc; Washington, DC.Google Scholar
Flaum, M., Andreasen, N.The reliability of distinguishing primary versus secondary negative symptoms. Compr Psychiatry 1995;36:421–427.CrossRefGoogle ScholarPubMed
Fleischhacker, W.Negative symptoms in patients with schizophrenia with special reference to the primary versus secondary distinction. Encephale 2000;26(1):12–14.Google ScholarPubMed
Foussias, G., Mann, S., Zakzanis, K.K., van Reekum, R., Agid, O., Remington, G.Prediction of longitudinal functional outcomes in schizophrenia: the impact of baseline motivational deficits. Schizophr Res 2011;132:24–27.CrossRefGoogle ScholarPubMed
Galderisi, S., Bucci, P., Mucci, A., Kirkpatrick, B., Pini, S., Rossi, A.et al.Categorical and dimensional approaches to negative symptoms of schizophrenia: focus on long-term stability and functional outcome. Schizophr Res 2013;147:157–162.CrossRefGoogle ScholarPubMed
Gonul, A.S., Kula, M., Esel, E., Tutus, A., Sofuoglu, S.A Tc-99 m HMPAO SPECT study of regional cerebral blood flow in drug-free schizophrenic patients with deficit and non-deficit syndrome. Psychiatry Res 2003;123:199–205.CrossRefGoogle Scholar
Harvey, P.D., Sabbag, S., Prestia, D., Durand, D., Twamley, E.W., Patterson, T.L.Functional milestones and clinician ratings of everyday functioning in people with schizophrenia: overlap between milestones and specificity of ratings. J Psychiatr Res 2012;46:1546–1552.CrossRefGoogle ScholarPubMed
Heinrichs, D.W., Hanlon, T.E., Carpenter, W.T. Jr.The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984;10:388–398.CrossRefGoogle ScholarPubMed
Ho, B.C., Nopoulos, P., Flaum, M., Arndt, S., Andreasen, N.C.Two-year outcome in first-episode schizophrenia: predictive value of symptoms for quality of life. Am J Psychiatry 1998;155:1196–1201.CrossRefGoogle ScholarPubMed
Hogan, T.P., Awad, A.G., Eastwood, R.A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983;13:177–183.CrossRefGoogle ScholarPubMed
Horan, W.P., Blanchard, J.J.Neurocognitive, social, and emotional dysfunction in deficit syndrome schizophrenia. Schizophr Res 2003;65:125–137.CrossRefGoogle ScholarPubMed
Hunter, R., Barry, S.Negative symptoms and psychosocial functioning in schizophrenia: neglected but important targets for treatment. Eur Psychiatry 2012;27:432–436.CrossRefGoogle ScholarPubMed
Kay, S.R., Fiszbein, A., Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.CrossRefGoogle Scholar
Kelley, M.E., van Kammen, D.P., Allen, D.N.Empirical validation of primary negative symptoms: independence from effects of medication and psychosis. Am J Psychiatry 1999;156:406–411.Google ScholarPubMed
Kirkpatrick, B., Buchanan, R.W., McKenney, P.D., Alphs, L.D., Carpenter, W.T. Jr.The schedule for the Deficit syndrome: an instrument for research in schizophrenia. Psychiatry Res 1989;30:119–123.CrossRefGoogle Scholar
Kirkpatrick, B., Ram, R., Bromet, E.The deficit syndrome in the Suffolk County Mental Health Project. Schizophr Res 1996;22:119–126.CrossRefGoogle ScholarPubMed
Kirkpatrick, B., Fenton, W.S., Carpenter, W.T. Jr., Marder, S.R.The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 2006;32:214–219.CrossRefGoogle ScholarPubMed
Konstantakopoulos, G., Ploumpidis, D., Oulis, P., Patrikelis, P., Soumani, A., Papadimitriou, G.N.et al.Apathy, cognitive deficits and functional impairment in schizophrenia. Schizophr Res 2011;133:193–198.CrossRefGoogle Scholar
Lahti, A.C., Holcomb, H.H., Medoff, D.R., Weiler, M.A., Tamminga, C.A., Carpenter, W.T. Jr.Abnormal patterns of regional cerebral blood flow in schizophrenia with primary negative symptoms during an effortful auditory recognition task. Am J Psychiatry 2001;158:1797–1808.CrossRefGoogle ScholarPubMed
Leifker, F.R., Patterson, T.L., Heaton, R.K., Harvey, P.D.Validating measures of real-world outcome: the results of the VALERO expert survey and RAND panel. Schizophr Bull 2011;37:334–343.CrossRefGoogle ScholarPubMed
Lieberman, J.A., Stroup, T.S., McEvoy, J.P., Swartz, M.S., Rosenheck, R.A., Perkins, D.O.et al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353:1209–1223.CrossRefGoogle ScholarPubMed
Lysaker, P.H., Salyers, M.P.Anxiety symptoms in schizophrenia spectrum disorders: associations with social function, positive and negative symptoms, hope and trauma history. Acta Psychiatr Scand 2007;116:290–298.CrossRefGoogle ScholarPubMed
Marder, S.R., Davis, J.M., Chouinard, G.The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials. J Clin Psychiatry 1997;58:538–546.CrossRefGoogle ScholarPubMed
Milev, P., Ho, B.C., Arndt, S., Andreasen, N.C.Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 2005;162:495–506.CrossRefGoogle ScholarPubMed
Miller, D.D., Flaum, M., Arndt, S., Fleming, F., Andreasen, N.C.Effect of antipsychotic withdrawal on negative symptoms in schizophrenia. Neuropsychopharmacology 1994;11:11–20.CrossRefGoogle Scholar
Mohamed, S., Rosenheck, R., Swartz, M., Stroup, S., Lieberman, J.A., Keefe, R.S.Relationship of cognition and psychopathology to functional impairment in schizophrenia. Am J Psychiatry 2008;165:978–987.CrossRefGoogle Scholar
Moller, H.J., Muller, H.Statistical differentiation between direct and indirect effects of neuroleptics on negative symptoms. Eur Arch Psychiatry Clin Neurosci 1997;247:1–5.CrossRefGoogle ScholarPubMed
Murphy, B.P., Chung, Y.C., Park, T.W., McGorry, P.D.Pharmacological treatment of primary negative symptoms in schizophrenia: a systematic review. Schizophr Res 2006;88:5–25.CrossRefGoogle ScholarPubMed
Peralta, V., Cuesta, M.J., Martinez-Larrea, A., Serrano, J.F.Differentiating primary from secondary negative symptoms in schizophrenia: a study of neuroleptic-naive patients before and after treatment. Am J Psychiatry 2000;157:1461–1466.CrossRefGoogle ScholarPubMed
Peralta, V., Moreno-Izco, L., Sanchez-Torres, A., Garcia de Jalon, E., Campos, M.S., Cuesta, M.J.Characterization of the Deficit syndrome in drug-naive schizophrenia patients: the role of spontaneous movement disorders and neurological soft signs. Schizophr Bull 2014;40:214–224.CrossRefGoogle ScholarPubMed
Perlick, D.A., Rosenheck, R.A., Kaczynski, R., Bingham, S., Collins, J.Association of symptomatology and cognitive deficits to functional capacity in schizophrenia. Schizophr Res 2008;99:192–199.CrossRefGoogle Scholar
Pogue-Geile, M.F., Harrow, M.Negative symptoms in schizophrenia: their longitudinal course and prognostic importance. Schizophr Bull 1985;11:427–439.CrossRefGoogle ScholarPubMed
Rabinowitz, J., Levine, S.Z., Garibaldi, G., Bugarski-Kirola, D., Berardo, C.G., Kapur, S.Negative symptoms have greater impact on functioning than positive symptoms in schizophrenia: analysis of CATIE data. Schizophr Res 2012;137:147–150.CrossRefGoogle ScholarPubMed
Remington, G., Chong, S.A., Kapur, S.Distinguishing change in primary and secondary negative symptoms. Am J Psychiatry 1999;156:974–975.CrossRefGoogle ScholarPubMed
Rifkin, A.Akinesia: a poorly recognized drug-induced extrapyramidal behavioral disorder. Arch Gen Psychiatry 1975;32:672–674.CrossRefGoogle Scholar
Rosenheck, R., Leslie, D., Keefe, R., McEvoy, J., Swartz, M., Perkins, D.et al.Barriers to employment for people with schizophrenia. Am J Psychiatry 2006;163:411–417.CrossRefGoogle ScholarPubMed
Rowland, L.M., Spieker, E.A., Francis, A., Barker, P.B., Carpenter, W.T., Buchanan, R.W.White matter alterations in deficit schizophrenia. Neuropsychopharmacology 2009;34:1514–1522.CrossRefGoogle ScholarPubMed
Schooler, N.R.Deficit symptoms in schizophrenia: negative symptoms versus neuroleptic-induced deficits. Acta Psychiatr Scand Suppl 1994;380:21–26.CrossRefGoogle ScholarPubMed
Simpson, G.M., Angus, J.W.A rating scale for extrapyramidal side effects. Acta Psychiatr Scand 1970;212:11–19.CrossRefGoogle ScholarPubMed
Strauss, G.P., Harrow, M., Grossman, L.S., Rosen, C.Periods of recovery in deficit syndrome schizophrenia: a 20-year multi-follow-up longitudinal study. Schizophr Bull 2010;36:788–799.CrossRefGoogle ScholarPubMed
Stroup, T.S., McEvoy, J.P., Swartz, M.S., Byerly, M.J., Glick, I.D., Canive, J.M.et al.The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull 2003;29:15–31.CrossRefGoogle ScholarPubMed
Tamminga, C.A., Thaker, G.K., Buchanan, R., Kirkpatrick, B., Alphs, L.D., Chase, T.N.et al.Limbic system abnormalities identified in schizophrenia using positron emission tomography with fluorodeoxyglucose and neocortical alterations with deficit syndrome. Arch Gen Psychiatry 1992;49:522–530.CrossRefGoogle ScholarPubMed
Tracy, K., Adler, L.A., Rotrosen, J., Edson, R., Lavori, P.Interrater reliability issues in multicenter trials. Part I: theoretical concepts and operational procedures used in Department of Veterans Affairs Cooperative Study #394. Psychopharmacol Bull 1997;33:53–57.Google Scholar
Submit a response

Comments

No Comments have been published for this article.