The course of negative symptom in first episode psychosis and the relationship with social recovery
Introduction
Negative symptoms represent a significant unmet clinical need and the search for effective treatments has received renewed interest in recent years (Kirkpatrick et al., 2006). However, the mechanisms that underpin negative symptoms remain poorly understood. Negative symptoms can be subject to significant fluctuations over time, particularly in the early course of psychosis (Edwards et al., 1999, Ventura et al., 2004). Individuals vary in the stability of their negative symptoms (Kelley et al., 2008) and those with persistently elevated negative symptoms are at highest risk of poor outcome (Husted et al., 1992, Mäkinen et al., 2008). Increased understanding of variation in negative symptom course might help illuminate the mechanisms which underlie negative symptoms.
The prevalence of persistent negative symptoms in first episode psychosis (FEP) remains unclear due to the use of inconsistent criteria for persistence. Moreover, grouping individuals into those with persistent negative symptoms and those without might mask the true complexity of individual variation in negative symptom course. Chen et al. (2013) found that variation in negative symptom course in a cohort of schizophrenia patients was best modelled by four distinct trajectory classes, characterised by differing levels of negative symptoms at baseline and a distinctive pattern of longitudinal change. It is not yet known whether multiple negative symptoms trajectories are similarly evident in FEP. This study examines negative symptom trajectories in a large FEP sample using latent class growth analysis (LCGA), a data-driven approach to identifying patterns of longitudinal change within a heterogeneous population. Predictors of the identified trajectories are then investigated.
This study also explores the relationship between negative symptom course and social recovery. Although the association between negative symptoms during FEP and poor functional outcomes is well established (Evensen et al., 2012, Galderisi et al., 2013), the relationship between the trajectory of an individual's negative symptoms and concurrent change in their functioning has yet to be investigated. Understanding the relationship between negative symptom course and contemporaneous changes in functioning might inform the development of targeted interventions to improve functional outcomes following FEP.
Section snippets
Participants
The sample comprises participants in the National EDEN study: a national evaluation of the impact and cost-effectiveness of Early Intervention in Psychosis (EIP) services in the UK (Birchwood et al., 2014). All individuals accepted into EIP services in Birmingham, Bristol, Cambridge, Cornwall, Lancashire and Norfolk between August 2005 and April 2009 were invited to take part. The Policy Implementation Guide (Department of Health, 2001) provides details of the acceptance criteria for these
Exploratory structural equation modelling
A five-factor model which fit the data adequately (RMSEA = 0.054; CFI = 0.914; TLI = 0.874) resulted in a negative symptoms factor including the items ‘Blunted affect’, ‘Lack of spontaneity’, ‘Emotional withdrawal’, ‘Passive social withdrawal’, ‘Poor rapport’, ‘Motor retardation’ and ‘Active social avoidance’. The mean rating of these items was used to measure negative symptom severity. The identified factor structure was similar to that found in van der Gaag et al.'s (2006) study employing similar
General discussion
This study identified four distinct negative symptom trajectories in a large sample of individuals receiving treatment for FEP. Only a small proportion of the sample (5.4%) had persistently high levels of negative symptoms. A further 13.5% of the sample presented with consistently elevated negative symptoms of lesser severity. The mean intercept of both these trajectories was sufficiently high to indicate multiple clinically significant negative symptoms. Membership of the class with the
Role of funding source
This article presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme (RP-PG-0109-10074). Professor Max Birchwood, Chief Investigator of National EDEN and Super EDEN, is part-funded by NIHR CLAHRC West Midlands; Professor Singh is part funded by the NIHR through the Collaborations for Leadership in Applied Health Research and Care for the West Midlands; and Professor Jones is part funded by the NIHR
Contributors
BG was involved in designing the study, analysed the data and wrote the first draft of the manuscript. JH and DF were involved in designing the study and supervised the data analysis and interpretation. MB, MM, LE, HL, PJ, TA, SS, VS, NF and DF were key investigators on the National EDEN study and contributed to the analysis and interpretation of this data.
All authors contributed to and have approved the final manuscript.
Conflict of interest
The authors declare that they have no conflicts of interest concerning this article.
Acknowledgments
We thank all National EDEN participants and the EIP teams who supported this research. Helen Lester, our great friend and colleague, who was a co-CI on National EDEN sadly died during the production of this paper. We thank the UK Mental Health Research Network for their support in case finding and follow-up.
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Subtyping negative symptoms in first-episode psychosis: Contrasting persistent negative symptoms with a data-driven approach
2022, Schizophrenia ResearchCitation Excerpt :Unlike theory-driven approaches (e.g., PNS), which rely on a priori definitions of grouping variables, patient classification is informed by measures of between-subjects and within-subjects variability (van der Nest et al., 2020). Several studies (Abdin et al., 2017; Austin et al., 2015; Chan et al., 2020; Chang et al., 2019; Gee et al., 2016; Pelayo-Teran et al., 2014) have applied LGM to categorise patients based on negative symptom severity. Three such studies (Abdin et al., 2017; Austin et al., 2015; Chang et al., 2019) linked poorer functioning to latent classes with more severe negative symptoms.
Cerebellar and cortico-striatal-midbrain contributions to reward-cognition processes and apathy within the psychosis continuum
2022, Schizophrenia ResearchCitation Excerpt :Across the psychosis continuum, negative symptoms (NS) represent a core psychopathological domain that maps onto at least two dimensions: apathy and diminished expression (Kirkpatrick et al., 2006; Sauvé et al., 2019; Begue et al., 2020). Apathy, in particular, has received increasing scientific and clinical attention in recent years due to its high impact on long-term disability and poor quality of life even in subclinical and early phases of psychosis (Milev et al., 2005; Cohen and Davis, 2009; Gee et al., 2016; Rammou et al., 2019). On a neurobiological level, emergence of apathy has been predominantly examined in schizophrenia and is conceptualized as resulting from impairments in goal-directed behavior with compelling evidence pointing to abnormal reward processing (reviewed in (Strauss et al., 2014)).