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The longitudinal interplay between negative and positive symptom trajectories in patients under antipsychotic treatment: a post hoc analysis of data from a randomized, 1-year pragmatic trial

Title: The longitudinal interplay between negative and positive symptom trajectories in patients under antipsychotic treatment: a post hoc analysis of data from a randomized, 1-year pragmatic trial
Author(s): Chen, L
Johnston, JA
Kinon, BJ
Stauffer, V
Succop, P
Marques, TR
Ascher-Svanum, H
Item Type: Journal Article
Abstract: BACKGROUND: Schizophrenia is a highly heterogeneous disorder with positive and negative symptoms being characteristic manifestations of the disease. While these two symptom domains are usually construed as distinct and orthogonal, little is known about the longitudinal pattern of negative symptoms and their linkage with the positive symptoms. This study assessed the temporal interplay between these two symptom domains and evaluated whether the improvements in these symptoms were inversely correlated or independent with each other. METHODS: This post hoc analysis used data from a multicenter, randomized, open-label, 1-year pragmatic trial of patients with schizophrenia spectrum disorder who were treated with first- and second-generation antipsychotics in the usual clinical settings. Data from all treatment groups were pooled resulting in 399 patients with complete data on both the negative and positive subscale scores from the Positive and Negative Syndrome Scale (PANSS). Individual-based growth mixture modeling combined with interplay matrix was used to identify the latent trajectory patterns in terms of both the negative and positive symptoms. Pearson correlation coefficients were calculated to examine the relationship between the changes of these two symptom domains within each combined trajectory pattern. RESULTS: We identified four distinct negative symptom trajectories and three positive symptom trajectories. The trajectory matrix formed 11 combined trajectory patterns, which evidenced that negative and positive symptom trajectories moved generally in parallel. Correlation coefficients for changes in negative and positive symptom subscale scores were positive and statistically significant (P < 0.05). Overall, the combined trajectories indicated three major distinct patterns: (1) dramatic and sustained early improvement in both negative and positive symptoms (n = 70, 18%), (2) mild and sustained improvement in negative and positive symptoms (n = 237, 59%), and (3) no improvement in either negative or positive symptoms (n = 82, 21%). CONCLUSIONS: This study of symptom trajectories over 1 year shows that changes in negative and positive symptoms were neither inversely nor independently related with each other. The positive association between these two symptom domains supports the notion that different symptom domains in schizophrenia may depend on each other through a unified upstream pathological disease process.
Publication Date: 28-Nov-2013
Date of Acceptance: 19-Nov-2013
URI: http://hdl.handle.net/10044/1/40546
DOI: http://dx.doi.org/10.1186/1471-244X-13-320
ISSN: 1471-244X
Publisher: BioMed Central
Start Page: 320
End Page: 320
Journal / Book Title: BMC Psychiatry
Volume: 13
Copyright Statement: This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Adult
Antipsychotic Agents
Female
Humans
Longitudinal Studies
Male
Middle Aged
Schizophrenia
Schizophrenic Psychology
Symptom Assessment
Time Factors
Treatment Outcome
Humans
Antipsychotic Agents
Treatment Outcome
Longitudinal Studies
Schizophrenia
Schizophrenic Psychology
Time Factors
Adult
Middle Aged
Female
Male
Symptom Assessment
Psychiatry
1103 Clinical Sciences
Publication Status: Published
Article Number: 320
Appears in Collections:Clinical Sciences
Imaging Sciences
Faculty of Medicine



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