Primary negative symptoms in first-episode psychosis: its relationship with functioning and subjective quality of life

Abstract

Background: Negative symptoms are a core feature of psychotic disorder and are associated with poor functional outcome. It is known that manifestation of negative symptoms may be secondary to psychotic symptoms, depression, and antipsychotic-induced extrapyramidal side effects. Negative symptoms of primary nature (PNS), which has been regarded idiopathic to psychotic disorder, constitute a clinically more homogeneous construct that may facilitate unraveling the pathophysiology of and developing effective treatments for negative symptoms. We have previously evaluated premorbid and cognitive predictors of PNS in a large representative cohort of first-episode psychosis (FEP) patients (Chang et al. 2016). In this study, we aimed to examine the relationship of PNS status with functioning and subjective quality of life (sQoL). Methods: Three-hundred fifty-five Chinese adult patients aged 26–55 years presenting with first-episode psychosis (FEP) to a territory-wide early intervention service in Hong Kong, namely, Jockey Club Early Psychosis (JCEP) project (Hui et al. 2014) was recruited. Assessments encompassing premorbid adjustment, symptom profiles, functioning, cognitive functions, and sQoLs were conducted. PNS status was operationalized as the presence of clinically significant negative symptoms (using SANS) excluding extrapyramidal signs (SAS), positive symptoms (PANSS positive symptom scale), and depression (CDSS). Results: Fifty-two (14.6%) of the 355 patients met the criteria for PNS. After controlling for the confounding effects of digit symbol and premorbid social functioning (predictors of PNS status), our multiple regression analyses revealed that PNS significantly predicted overall global functioning (Role Functioning Scale, RFS total score; P < .01), RFS work productivity (P < .05), RFS immediate (P < .01), and external social network (P < .001). PNS status was not significantly related to both physical and mental sQoL as measured by SF12. Conclusion: Our results indicate that PNS predicts work and social functioning in FEP patients. Further research is required to clarify the trajectory of PNS along the early course of illness as well as its longitudinal relationship with functional outcome.