Skip to main content Accessibility help

Positive and Negative Symptom Course in Chronic Community-Based Patients: A Two-Year Prospective Study

  • Donald M. Quinlan (a1), David Schuldberg (a1), Hal Morgenstern (a2) and William Glazer (a3)



The long-term symptom profile of chronic out-patients was studied.

Method. 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over out-patient maintenance treatment.


Overall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P< 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change.


Support is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of ‘progressive downward course’ in schizophrenia.


Corresponding author

Donald M. Quinlan, Room 10-635, Yale-New Haven Hospital, 20 York Street, New Haven, CT 06504, USA


Hide All
Andreasen, N. C., & Olsen, S. (1982) Negative vs positive schizophrenia: definition and validation. Archives of General Psychiatry, 39, 789794.
Arndt, S., Alliger, R. J. & Andreasen, N. C. (1991) The distinction of positive and negative symptoms: the failure of the two-dimensional model. British Journal of Psychiatry, 158, 317322.
Cohen, J. (1988) Statistical Power Analysis for the Behavioral Sciences (2nd edn). Hillside, NJ: Erlbaum.
Crow, T. J. (1980) Molecular pathology of schizophrenia: more than one disease process? British Medical Journal, 280, 19.
Fenton, W. S., & McGlashan, T. H. (1991) Natural history of schizophrenic subtypes: II. Positive and negative symptoms and long-term course. Archives of General Psychiatry, 48, 978986.
Glazer, W., Morgenstern, H., Niedzwiecki, D., et al (1988) Heterogeneity of tardive dyskinesia. A multivariate analysis. British Journal of Psychiatry, 152, 253259.
Goldberg, S. C. (1985) Negative and deficit symptoms in schizophrenia do respond to neuroleptics. Schizophrenia Bulletin, 11, 453456.
Johnstone, E. C., Owens, D. G. C., Frith, C. D., et al (1986) The relative stability of positive and negative features in chronic schizophrenia. British Journal of Psychiatry, 150, 6064.
Kay, S. R., & Lindenmayer, J. P. (1987) Outcome predictors in acute schizophrenia: prospective significance of background and clinical dimensions. Journal of Nervous and Mental Disease, 175, 152160.
Knight, R. A., Roff, J. D., Barrnett, J., et al (1979) Concurrent and predictive validity of thought disorder and affectivity: a 22-year follow-up of acute schizophrenics. Journal of Abnormal Psychology, 88, 112.
Lewine, P. (1990) A discriminant validity study of negative symptoms with special focus on depression and anti-psychotic medication. American Journal of Psychiatry, 147, 14331466.
Pfohl, B., & Winokur, G. (1982) The evolution of symptoms in institutionalized hebephrenic/catatonic schizophrenics. British Journal of Psychiatry, 141, 567572.
Pogue-Geile, M. F. (1989) The prognostic significance of negative symptoms in schizophrenia. In Symposium on Negative Symptoms in Schizophrenia, London, 1987. British Journal of Psychiatry, 155 (Suppl. 7), 123127.
Pogue-Geile, M. F. & Harrow, M. (1984) Negative and positive symptoms in schizophrenia and depression: A follow-up. Schizophrenia Bulletin, 10, 371387.
Psychopharmacology Review Branch (1975) Abnormal Involuntary Movements Scale. In Early Clinical Drug Evaluation Unit Intercom. Bethesda, MD: National Institute for Mental Health.
Ragin, A. B., Pogue-Geile, M. F., & Oltmans, T. F. (1989) Poverty of speech in schizophrenia and depression during in-patient and post-hospital periods. British Journal of Psychiatry, 154, 5257.
Schuldberg, D., Quinlan, D. M., Morgenstern, H., et al (1990) Positive and negative symptoms in chronic psychiatric outpatients: reliability, stability, and factor structure. Psychological Assessment, 2, 262268.
Spitzer, R. L., & Endicott, J. (1977) Schedule for Affective Disorders and Schizophrenia – lifetime version New York: Psychiatric Institute.
Strauss, J. S., Carpenter, W. T., & Bartko, J. J. (1974) The diagnosis and understanding of schizophrenia. III. Speculations on the processes that underlie schizophrenic symptoms and signs. Schizophrenia Bulletin, 11, 6169.
Walker, E. F., Harvey, P. D., & Perlman, D. (1988) The positive/negative symptom distinction in psychoses: a replication and extension of previous findings. Journal of Nervous and Mental Disease, 176, 359363.
World Health Organization (WHO) (1979) Schizophrenia: An International Follow-up Study. New York: Wiley.

Positive and Negative Symptom Course in Chronic Community-Based Patients: A Two-Year Prospective Study

  • Donald M. Quinlan (a1), David Schuldberg (a1), Hal Morgenstern (a2) and William Glazer (a3)


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

Positive and Negative Symptom Course in Chronic Community-Based Patients: A Two-Year Prospective Study

  • Donald M. Quinlan (a1), David Schuldberg (a1), Hal Morgenstern (a2) and William Glazer (a3)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *