Skip to main content Accessibility help
×
Home

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

  • Danyael Lutgens (a1), Ridha Joober (a1), Srividya Iyer (a1), Martin Lepage (a2), Ross Norman (a3), Norbert Schmitz (a1) (a2), Sally Mustafa (a1), Sherezad Abadi (a1) and Ashok Malla (a1) (a2)...
  • Please note a correction has been issued for this article.

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.

Copyright

Corresponding author

Author for correspondence: Prof. Ashok Malla, E-mail: ashok.malla@mcgill.ca

References

Hide All
Albert, N, Melau, M, Jensen, H, Emborg, C, Jepsen, JRM, Fagerlund, B et al. (2017) Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II). British Medical Journal 356, i6681.
Andreasen, NC (1982) Negative symptoms in schizophrenia: definition and reliability. Archives of General Psychiatry 39(7), 784788.
Andreasen, NC, Carpenter, WT Jr., Kane, JM, Lasser, RA, Marder, SR and Weinberger, DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162(3), 441449.
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlæger, J, le Quach, P et al. (2008) Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65(7), 762771.
Birchwood, M, Todd, P and Jackson, C (1998) Early intervention in psychosis: the critical-period hypothesis. International Clinical Psychopharmacology 13, S31S40.
Bird, V, Premkumar, P, Kendall, T, Whittington, C, Mitchell, J and Kuipers, E (2010) Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. The British Journal of Psychiatry 197(5), 350356.
Blanchard, JJ, Kring, AM, Horan, WP and Gur, R (2010) Toward the next generation of negative symptom assessments: the collaboration to advance negative symptom assessment in schizophrenia. Schizophrenia Bulletin 37(2), 291299.
Buchanan, RW (2007) Persistent negative symptoms in schizophrenia: an overview. Schizophrenia Bulletin 33(4), 10131022.
Callicott, JH, Bertolino, A, Mattay, VS, Langheim, FJ, Duyn, J, Coppola, R et al. (2000) Physiological dysfunction of the dorsolateral prefrontal cortex in schizophrenia revisited. Cerebral Cortex 10(11), 10781092.
Cassidy, CM, Lepage, M, Harvey, P-O and Malla, A (2012) Cannabis use and anticipatory pleasure as reported by subjects with early psychosis and community controls. Schizophrenia Research 137(1), 3944.
Chang, WC, Chan, GHK, Jim, OTT, Lau, ESK, Hui, CLM, Chan, SKW et al. (2015) Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. The British Journal of Psychiatry 206(6), 492500.
Chang, WC, Kwong, VWY, Lau, ESK, So, HC, Wong, CSM, Chan, GHK et al. (2017). Sustainability of treatment effect of a 3-year early intervention programme for first-episode psychosis. The British Journal of Psychiatry 211(1), 3744.
Fusar-Poli, P, Papanastasiou, E, Stahl, D, Rocchetti, M, Carpenter, W, Shergill, S et al. (2015) Treatments of negative symptoms in schizophrenia: meta-analysis of 168 randomized placebo-controlled trials. Schizophrenia Bulletin 41(4), 892899.
Grant, PM and Beck, AT (2009) Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin 35(4), 798806.
Green, MF, Hellemann, G, Horan, WP, Lee, J and Wynn, JK (2012) From perception to functional outcome in schizophrenia: modeling the role of ability and motivation. Archives of General Psychiatry 69(12), 12161224.
Hamer, RM, and Simpson, PM (2009) Last observation carried forward versus mixed models in the analysis of psychiatric clinical trials. The American Journal of Psychiatry 166(6), 639641.
Harrison, G, Hopper, K, Craig, T, Laska, E, Siegel, C, Wanderling, J et al. (2001) Recovery from psychotic illness: a 15-and 25-year international follow-up study. The British Journal of Psychiatry 178(6), 506517.
Harvey, P-O, Lepage, M and Malla, A (2007) Benefits of enriched intervention compared with standard care for patients with recent-onset psychosis: a metaanalytic approach. The Canadian Journal of Psychiatry 52(7), 464472.
Hovington, CL, Bodnar, M, Joober, R, Malla, AK and Lepage, M (2012) Identifying persistent negative symptoms in first episode psychosis. BMC Psychiatry 12(1), 224.
Iyer, S, Boekestyn, L, Cassidy, C, King, S, Joober, R and Malla, A (2008) Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories. Psychological Medicine 38(8), 11471156.
Iyer, S, Jordan, G, MacDonald, K, Joober, R and Malla, A (2015) Early intervention for psychosis: a Canadian perspective. The Journal of Nervous and Mental Disease 203(5), 356364.
Katschnig, H (2000) Schizophrenia and quality of life. Acta Psychiatrica Scandinavica 102(s407), 3337.
Leucht, S and Lasser, R (2006) The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry 39(5), 161170.
Liemburg, E, Castelein, S, Stewart, R, van der Gaag, M, Aleman, A, Knegtering, H et al. (2013) Two subdomains of negative symptoms in psychotic disorders: established and confirmed in two large cohorts. Journal of Psychiatric Research 47(6), 718725.
Lutgens, D, Gariepy, G and Malla, A (2017) Psychological and psychosocial interventions for negative symptoms in psychosis: systematic review and meta-analysis. The British Journal of Psychiatry 210(5), 324332.
Lutgens, D, Iyer, S, Joober, R, Brown, TG, Norman, R, Latimer, E et al. (2015) A five-year randomized parallel and blinded clinical trial of an extended specialized early intervention vs. regular care in the early phase of psychotic disorders: study protocol. BMC Psychiatry 15(1), 22.
Malla, A, Joober, R, Iyer, S, Norman, R, Schimiz, N, Brown, T et al. (2017) Comparing three years extension of early intervention service (EIS) to regular care (RC) following two years of EIS For first episode psychosis (FEP): a randomized single blinded clinical trial. World Psychiatry 16(3), 278286.
Malla, A, Norman, R, Manchanda, R and Townsend, L (2002a) Symptoms, cognition, treatment adherence and functional outcome in first-episode psychosis. Psychological Medicine 32(6), 11091119.
Malla, A, Norman, R, McLean, T, Scholten, D and Townsend, L (2003) A Canadian programme for early intervention in non-affective psychotic disorders. Australian and New Zealand Journal of Psychiatry 37(4), 407413.
Malla, A, Norman, R, Schmitz, N, Manchanda, R, Béchard-Evans, L, Takhar, J et al. (2006) Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study. Psychological Medicine 36(5), 649658.
Malla, AK, Takhar, JJ, Norman, RM, Manchanda, R, Cortese, L, Haricharan, R et al. (2002b) Negative symptoms in first episode non-affective psychosis. Acta Psychiatrica Scandinavica 105(6), 431439.
Marshall, M and Rathbone, J (2011) Early intervention for psychosis. Schizophrenia Bulletin 37(6), 11111114.
Messinger, JW, Trémeau, F, Antonius, D, Mendelsohn, E, Prudent, V, Stanford, AD et al. (2011) Avolition and expressive deficits capture negative symptom phenomenology: implications for DSM-5 and schizophrenia research. Clinical Psychology Review 31(1), 161168.
Milev, P, Ho, B-C, Arndt, S and Andreasen, NC (2005) Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. American Journal of Psychiatry 162(3), 495506.
Mote, J, Minzenberg, MJ, Carter, CS and Kring, AM (2014) Deficits in anticipatory but not consummatory pleasure in people with recent-onset schizophrenia spectrum disorders. Schizophrenia Research 159(1), 7679.
Norman, RM, Manchanda, R, Malla, AK, Windell, D, Harricharan, R and Northcott, S (2011) Symptom and functional outcomes for a 5 year early intervention program for psychoses. Schizophrenia Research 129(2), 111115.
Pelayo-Teran, J, Diaz, FJ, Perez-Iglesias, R, Suarez-Pinilla, P, Tabares-Seisdedos, R, de Leon, J et al. (2014) Trajectories of symptom dimensions in short-term response to antipsychotic treatment in patients with a first episode of non-affective psychosis. Psychological Medicine 44(1), 3750.
Petersen, L, Jeppesen, P, Thorup, A, Abel, M-B, Øhlenschlæger, J, Christensen, et al. (2005) A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331(7517), 602.
Strauss, GP, Horan, WP, Kirkpatrick, B, Fischer, BA, Keller, WR, Miski, P et al. (2013) Deconstructing negative symptoms of schizophrenia: avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome. Journal of Psychiatric Research 47(6), 783790.

Keywords

Type Description Title
WORD
Supplementary materials

Lutgens et al. supplementary material
Lutgens et al. supplementary material 1

 Word (72 KB)
72 KB
WORD
Supplementary materials

Lutgens et al. supplementary material
Lutgens et al. supplementary material 2

 Word (41 KB)
41 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A correction has been issued for this article: