PMH56 Negative Symptoms Have Greater Impact on Functioning Than Positive Symptoms in Schizophrenia: Analysis of Catie Data
ABSTRACT Increased attention has been given to treatment of negative symptoms and its potential impact on functional outcomes, however previous inferences have been confounded by the fact that measures of functional outcomes often use items similar to those of negative symptoms. We attempted to discern the relative effects of negative symptoms on functioning, as compared to other symptoms, using data from the National Institute of Mental Health CATIE trial of chronic schizophrenia (n=1447) by examining correlations of Positive and Negative Syndrome Scale factors, Calgary Depression Rating Scale and select items from Heinrich's and Lehman's Quality of Life Scales measuring aspects of functioning that did not overlap with negative symptoms. Baseline functioning and change in functioning were more strongly related to PANSS negative factor than any of the other symptoms - though the amount of variance explained by symptom changes in general was small. The data suggests that improvement in negative symptoms may have a distinctive and independent effect on functional outcome relative to other symptoms. This should be further tested in studies where negative symptoms improve without concomitant improvement of other symptoms.
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- "A combination of illness-related variables, personal resources and context-related factors contribute to functional disability in schizophrenia (Galderisi et al., 2014). Among illness-related determinants , cognitive deficits across general neurocognition (NC), social cognition (SC) and meta-cognition (Green, 1996; Vauth et al., 2004; Couture et al., 2006; Brekke et al., 2007; Bowie et al., 2008; Lysaker et al., 2013a) and residual symptoms that include lack of insight, amotivation and other negative symptoms like apathy, alogia, and anhedonia (Milev et al., 2005; Velligan et al., 2006; Lincoln et al., 2007; Ventura et al., 2009; Rabinowitz et al., 2012) are consistently associated with poor functional outcome. "
ABSTRACT: Understanding the complex relationship among determinants of real-world functioning in schizophrenia patients in remission is important in planning recovery-oriented interventions. We explored two path-analytical models of functioning in schizophrenia. 170 Schizophrenia patients remitted from positive symptoms underwent fairly comprehensive assessments of cognition - neurocognition (NC) and social cognition (SC), residual symptoms - insight, motivation and other negative symptoms, and socio-occupational functioning. We explored (a) a cascading model, where NC predicted functional outcome through its effects on other determinants and (b) a combined model, incorporating additional direct paths from each of the determinants. The combined model, and not the cascading model demonstrated a good fit. Post-hoc trimming of the combined model by elimination of non-significant paths maintained the goodness-of-fit and was retained as the final model. In addition to the direct paths, this final model demonstrated that (a) NC influenced functioning through SC and insight and (b) SC influenced functioning through motivation and negative symptoms. This suggests that NC and SC may influence functional outcome directly, as well as indirectly, via specific impact on insight, and motivation and negative symptoms respectively. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.07/2015; 229(1-2). DOI:10.1016/j.psychres.2015.07.022
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- "Moreover, Lin et al. reported that the incidence of nonpsychotic disorders was associated with more negative symptoms at baseline in CHR non-converters, emphasizing the importance of negative symptoms in the prognosis estimation for CHR non-converters (Lin et al., 2015). Negative symptoms are also known to be more important in later functional outcome than positive symptoms in patients with schizophrenia (Rabinowitz et al., 2012). These findings may explain the phenomenon that CHR subjects who were classified as remitters showed sustained functional impairment discordant with their improvement in positive prodromal symptoms (Addington et al., 2011; Lee et al., 2014a). "
ABSTRACT: The aim of this study was to investigate whether P300 could predict the short-term prognosis of subjects at clinical high risk (CHR) for psychosis who do not convert to psychotic disorder (non-converters). CHR subjects were examined with auditory P300 at baseline, and their clinical state was regularly assessed up to 2years. 45 CHR non-converters were divided into remitter and non-remitter groups. Repeated-measures analysis of variance (ANOVA) was performed to compare baseline P300 between the two groups. Multiple regression analysis was used to identify factors predicting symptomatic or functional improvement in CHR subjects during the follow-up period. There were no group differences in P300 amplitude or latency between CHR remitters and non-remitters. In the multiple regression analysis, P300 amplitude at Pz (β=0.206, 95% confidence interval [95CI]=0.035 to 0.567, p=0.028) significantly predicted later amelioration of the Scale of Prodromal Symptoms (SOPS) negative symptoms. Improvement in SOPS general symptoms was significantly predicted by P300 amplitude at Pz (β=0.255, 95CI=0.065 to 0.455, p=0.010) and mood stabilizer use (β=0.199, 95CI=0.081 to 4.154, p=0.042). These results indicate that P300 may be a possible predictor of improvement in negative and general symptoms in CHR non-converters. Our findings support the recommendation that a broader concept of assessment guidelines is needed to forecast clinical outcome and provide appropriate interventions for CHR non-converters. Copyright © 2015 Elsevier B.V. All rights reserved.Schizophrenia Research 05/2015; 165(2-3). DOI:10.1016/j.schres.2015.04.033 · 3.92 Impact Factor
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- "However, the known heterogeneity in association between negative symptom domains and functional outcome, as well as the potential for heterogeneity in response to therapeutic interventions between domains, would suggest a domain specific definition. Since the current evidence support a greater impact of the apathy–avolition (AA) domain on function, as opposed to the deficit of expression (DE) domain (Rabinowitz et al., 2012; Strauss et al., 2013), a rating of no more than " mild " on AA scale items may currently represent the best method for evaluating remission of negative symptoms. "
ABSTRACT: Schizophrenia is a complex, heterogeneous, multidimensional disorder within which negative symptoms are a significant and disabling feature. Whilst there is no established treatment for these symptoms, some pharmacological and psychosocial interventions have shown promise and this is an active area of research. Despite the effort to identify effective interventions, as yet there is no broadly accepted definition of therapeutic success. This article reviews concepts of clinical relevance and reports on a consensus conference whose goal was to apply these concepts to the treatment of negative symptoms.Schizophrenia Research 01/2015; 162(1-3). DOI:10.1016/j.schres.2014.12.001 · 3.92 Impact Factor