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Progress of negative symptoms over the initial 5 years of a first episode of psychosis

Published online by Cambridge University Press:  14 March 2018

Danyael Lutgens ,
Ridha Joober ,
Srividya Iyer ,
Martin Lepage ,
Ross Norman ,
Norbert Schmitz ,
Sally Mustafa ,
Sherezad Abadi  and
Ashok Malla Open the ORCID record for Ashok Malla [Opens in a new window]
Danyael Lutgens
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, QC, Canada
Ridha Joober
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, QC, Canada
Srividya Iyer
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, QC, Canada
Martin Lepage
Affiliation:
McGill University, Douglas Hospital Research Centre, Montreal, QC, Canada
Ross Norman
Affiliation:
Department of Psychiatry, Western University; Prevention and Early Intervention Program for Psychosis (PEPP–London) London, Ontario, Canada
Norbert Schmitz
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, QC, Canada McGill University, Douglas Hospital Research Centre, Montreal, QC, Canada
Sally Mustafa
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, QC, Canada
Sherezad Abadi
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, QC, Canada
Ashok Malla*
Affiliation:
Department of Psychiatry, McGill University, Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, QC, Canada McGill University, Douglas Hospital Research Centre, Montreal, QC, Canada
*
Author for correspondence: Prof. Ashok Malla, E-mail: [email protected]
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Abstract

Background

Specialized early intervention (EI) following a first episode of psychosis (FEP) are effective at reducing negative symptoms, although its trajectory warrants systematic assessment. However, findings are equivocal as to whether extended gains are made post 2 years of EI and whether there is additional benefit of extending EI for an additional 3 years.

Methods

Data on 178 FEP patients, from a randomized controlled trial of a 3-year extension of EI service v. transfer to regular care following 2 years of EI service, were used for this report. Repeated measures analysis of variance were conducted separately for the initial 2 years of treatment in an EI service, and for the 3-year post-randomization to examine trajectories of negative symptoms over the two periods in the two arms of the study.

Results

There were significant improvements in total negative symptoms over the first 2 years of EI F(4.612, 797.905) = 25.263, p < 0.001 and in domains of ‘expressivity’ and ‘motivation’. In the following 3 years, there were further significant improvements in negative symptoms F(4.318, 759.908) = 4.182, p = 0.002 with no difference between groups F(4.318, 759.908) = 1.073, p = 0.371. Changes in negative symptoms over the extension period were driven by expressivity F(4.01, 674.73) = 7.19, p < 0.01, but not motivation F(6.58, 1112.18) = 0.95, p = 0.46.

Conclusion

Negative symptoms improve significantly over the first 2 years of EI. Subsequent amelioration was largely the result of expressivity. Motivation deficits remained stable. Extended EI offered no advantage over regular care post-randomization.

Keywords

Expressivityextended specialized early interventionfirst-episode psychosismotivationnegative symptomsspecialized early intervention
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 1 , January 2019 , pp. 66 - 74
Copyright
Copyright © Cambridge University Press 2018 

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