Baseline clinical and functional correlates of first-episode psychosis patients presenting with Predominantly Negative Symptoms to the JCEP Project

Abstract

OBJECTIVES: Negative symptoms are considered as the core feature of psychotic disorders. Prior research have found associations between negative symptoms and poorer functional outcomes. Relatively few studies have focused on the implications of negative symptoms on the early course of psychotic illnesses. This study aimed to examine first-episode patients in this respect. METHODS: A total of 360 patients aged 26 to 55 years presenting with first-episode psychosis (DSM-IV schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, brief psychotic disorder, psychosis not-otherwise-specified, or manic episodes with psychotic features) to the Jockey Club Early Psychosis (JCEP) project in Hong Kong were recruited. Patients were classified as either having or not having predominantly negative symptoms (PNS), which were defined as the presence of clinically significant negative symptoms (i.e. one or more global scores on the subscales of SANS on affect, alogia, apathy, or anhedonia-asociality were >2) with an exclusion of depression, extra-pyramidal signs, and clinically significant positive symptoms. Data on premorbid functioning and baseline clinical and cognitive profiles were obtained. RESULTS: Overall, 39 (10.8%) patients had PNS at study entry. The difference in overall premorbid functioning was insignificant. However, patients with PNS exhibited significantly poorer premorbid adjustment in the social domain (Premorbid Adjustment Scale social domain: t = 1.992, p < 0.05). These patients also showed significantly poorer insight (PANSS: χ²(1, N=360) = 11.513, p = 0.001) and global functioning (SOFAS rating: t = –2.057, p < 0.05; Role Functioning Scale: t = –3.209, p < 0.05). There was no significant difference between patients with and without PNS in demographics, duration of untreated psychosis, and cognitive performance. CONCLUSION: First-episode patients with PNS exhibited specific characteristics with respect to global functioning, insight and premorbid adjustment in the social domain. Follow-up studies should examine the predictive capacity of PNS on the development of persistent negative symptoms and the longitudinal relationships between negative symptoms and other social and cognitive correlates.