Negative symptoms in first episode non-affective psychosis

OBJECTIVE: To determine the prevalence of negative symptoms and to examine secondary sources of influence on negative symptoms and the role of specific negative symptoms in delay associated with seeking treatment in first episode non-affective psychosis. METHOD: One hundred and ten patients who met Diagnostic Statistical Manual-IV (DSM-IV) criteria for a first episode of schizophrenia spectrum psychoses were rated for assessment of negative, positive, depressive and extrapyramidal symptoms, the premorbid adjustment scale and assessment of demographic and clinical characteristics including duration of untreated psychosis (DUP). RESULTS: Alogia/flat affect and avolition/anhedonia were strongly influenced by parkinsonian and depressive symptoms, respectively. A substantial proportion (26.8%) of patients showed at a least moderate level of negative symptoms not confounded by depression and Parkinsonism. DUP was related only to avolition/anhedonia while flat affect/alogia was related to male gender, diagnosis of schizophrenia, age of onset and the length of the prodrome. CONCLUSION: Negative symptoms that are independent of the influence of positive symptoms, depression and extra pyramidal symptoms (EPS) are present in a substantial proportion of first episode psychosis patients and delay in seeking treatment is associated mainly with avolition and anhedonia.     

Early identification of non‐remission in first‐episode psychosis in a two‐year outcome study

Simonsen E, Friis S, Opjordsmoen S, Mortensen EL, Haahr U, Melle I, Joa I, Johannessen JO, Larsen TK, Røssberg JI, Rund BR, Vaglum P, McGlashan TH. Early identification of non‐remission in first‐episode psychosis in a two‐year outcome study. Objective: To identify predictors of non‐remission in first‐episode, non‐affective psychosis. Method: During 4 years, we recruited 301 patients consecutively. Information about first remission at 3 months was available for 299 and at 2 years for 293 cases. Symptomatic and social outcomes were assessed at 3 months, 1 and 2 years. Results: One hundred and twenty‐nine patients (43%) remained psychotic at 3 months and 48 patients (16.4%) remained psychotic over 2 years. When we compared premorbid and baseline data for the three groups, the non‐remitted (n = 48), remitted for <6 months (n = 38) and for more than 6 months (n = 207), duration of untreated psychosis (DUP) was the only variable that significantly differentiated the groups (median DUP: 25.5, 14.4 and 6.0 weeks, respectively). Three months univariate predictors of non‐remission were being single, longer DUP, core schizophrenia, and less excitative and more negative symptoms at baseline. Two‐year predictors were younger age, being single and male, deteriorating premorbid social functioning, longer DUP and core schizophrenia. In multivariate analyses DUP, negative and excitative symptoms predicted non‐remission at 3 months, but only DUP predicted at 2 years. Conclusion: Long DUP predicted both 3 month and 2‐year non‐remission rates in first‐episode psychosis.     

分裂样精神病与精神分裂症阴性、阳性症状比较

目的：探讨分裂样精神病与精神分裂症阴性和阳性症状的特点。方法：对49例分裂样精神病与70例精神分裂症患者的阴性和阳性症状作对照研究。结果：两组患者阳性和阴性症状的发生率差异无显著性（P〉0.05）;分裂样精神病组中有妄想症状者明显多于精神分裂症组;而精神分裂症组中情感平淡、思维贫乏等阴性症状者明显多于分裂样精神病（P〈0.01）。结论：分裂样精神病与精神分裂症在阴性、阳性症状方面存在差异。     

Subjective distress in first‐episode psychosis: role of symptoms and self‐esteem

Background: Patients with psychotic disorders are assumed to experience significant distress, especially during their first episode. It is unclear whether such distress is associated with the level of psychotic or other symptoms and/or to other characteristics such as level of self‐esteem. Methods: One hundred and five patients who presented with first episode psychosis (FEP) (54% male; mean age 22.74 years; 79.4% schizophrenia; 20.6% affective psychosis) were administered the Symptom Checklist 90‐Revised (SCL‐90‐R) at first presentation for treatment. Four indices derived from the SCL‐90‐R were used as measures of distress. Psychopathology was assessed with the Calgary Depression Scale, the Hamilton Anxiety Scale, the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms and self‐esteem with the Self‐esteem Rating Scale.Spearman's Correlation coefficients were calculated, followed by a regression analysis. Results: Measures of distress were highly correlated with depression (rho = 0.44–0.56), and anxiety (rho = 0.38–0.48), modestly with lack of judgement and insight (rho = ?0.28 to ?0.37) and not with positive or negative symptoms of psychosis. In a smaller sample (n = 68) distress measures were also highly correlated with self‐esteem (rho = ?0.55 to ?0.73). Logistic regression confirmed that self‐esteem explained 53% of the total variance explained (57%) by any combination of the independent variables. Conclusion: Distress experienced by individuals suffering from FEP is associated with levels of self‐esteem, depression and anxiety and not with the level of psychotic or negative symptoms. Self‐esteem may play a significant role in the magnitude of distress experienced by patients presenting with a FEP.