Persistent negative symptoms (PNS) contribute to impairment in psychosis. The characteristics of PNS seen in youth remained under-investigated. We aimed to demonstrate clinical, treatment-related, and psychosocial characteristics of PNS in early-onset schizophrenia-spectrum disorders (EOSD). 132 patients with EOSD were assessed with Positive and Negative Symptom Scale, Brief Negative Symptom Scale, Calgary Depression Scale for Schizophrenia, and Simpson-Angus Scale. Parenting skills and resilience were evaluated using Parental Attitude Research Instrument and Child and Youth Resilience Measure-12. Longer duration of untreated psychosis (DUP) and prodromal phase were found in primary and secondary PNS groups, compared to the non-PNS group. The primary PNS group was characterized by earlier age-onset, lower smoking rates, and more common clozapine use. Resilience and egalitarian/democratic parenting were negatively correlated with symptoms related to motivation/pleasure and blunted expression. More blunted expression-related symptoms and longer DUP in the first episode significantly predicted primary/secondary PNS at follow-up. Using the data from total negative symptom scores and DUP, Receiver Operating Characteristic analyses significantly differentiated primary/secondary PNS groups from the non-PNS counterparts. PNS associated with blunted expression and low motivation/pleasure in the first episode could persist into clinical follow-up. Effective pharmacological treatment and psychosocial interventions are needed in youth.
AddingtonD.AddingtonJ.Maticka-TyndaleE.JoyceJ. (1992). Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research, 6(3), 201–208. https://doi.org/10.1016/0920-9964(92)90003-n
2.
AlphsL.PanagidesJ.LancasterS. (2007). Asenapine in the treatment of negative symptoms of schizophrenia: Clinical trial design and rationale. Psychopharmacology Bulletin, 40(2), 41-53. https://pubmed.ncbi.nlm.nih.gov/17514185/.
3.
AmareshaA. C.VenkatasubramanianG. (2012). Expressed emotion in schizophrenia: An overview. Indian Journal of Psychological Medicine, 34(1), 12–20. https://doi.org/10.4103/0253-7176.96149
4.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
5.
BlanchardJ. J.CohenA. S. (2006). The structure of negative symptoms within schizophrenia: Implications for assessment. Schizophrenia Bulletin, 32(2), 238–245. https://doi.org/10.1093/schbul/sbj013
6.
BoonstraN.KlaassenR.SytemaS.MarshallM.De HaanL.WunderinkL.WiersmaD. (2012). Duration of untreated psychosis and negative symptoms–a systematic review and meta-analysis of individual patient data. Schizophrenia Research, 142(1–3), 12–19. https://doi.org/10.1016/j.schres.2012.08.017
7.
BoraE.YalincetinB.AkdedeB. B.AlptekinK. (2018). Duration of untreated psychosis and neurocognition in first-episode psychosis: A meta-analysis. Schizophrenia Research, 193, 3-10. https://doi.org/10.1016/j.schres.2017.06.021.
8.
BucciP.MucciA.van RossumI. W.AielloC.ArangoC.BaandrupL.BuchananR. W.DazzanP.DemjahaA.Díaz-CanejaC. M.GiordanoG. M.GlenthøjB. Y.LeuchtS.McGuireP.Rodriguez-JimenezR.VignapianoA.KahnR. S.GalderisiS. (2020). Persistent negative symptoms in recent-onset psychosis: Relationship to treatment response and psychosocial functioning. European Neuropsychopharmacology, 34, 76-86. https://doi.org/10.1016/j.euroneuro.2020.03.010.
9.
BuchananR. W. (2007). Persistent negative symptoms in schizophrenia: An overview. Schizophrenia Bulletin, 33(4), 1013–1022. https://doi.org/10.1093/schbul/sbl057
10.
ButlerR.BerryK.VareseF.BucciS. (2018). Are family warmth and positive remarks related to outcomes in psychosis? A systematic review. Psychological Medicine, 48(8), 1250–1265. https://doi.org/10.1017/S0033291718003768
11.
ButzlaffR. L.HooleyJ. M. (1998). Expressed emotion and psychiatric relapse: A meta-analysis. Archives of General Psychiatry, 55(6), 547–552. https://doi.org/10.1001/archpsyc.55.6.547
12.
ChangW. C.HuiC. L.TangJ. Y.WongG. H.LamM. M.ChanS. K.ChenE. Y. (2011). Persistent negative symptoms in first-episode schizophrenia: A prospective three-year follow-up study. Schizophrenia Research, 133(1–3), 22–28. https://doi.org/10.1016/j.schres.2011.09.006
13.
ChenH.XuJ.MaoY.SunL.SunY.ZhouY. (2019). Positive Coping and resilience as mediators between negative symptoms and disability among patients with schizophrenia. Frontiers of Psychiatry, 10, 641. https://doi.org/10.3389/fpsyt.2019.00641
14.
CorrellC. U.SchoolerN. R. (2020). Negative symptoms in schizophrenia: A review and clinical guide for recognition, assessment, and treatment. Neuropsychiatric Disease and Treatment, 16, 519–534. https://doi.org/10.2147/NDT.S225643
15.
DownsJ.DeanH.LechlerS.SearsN.PatelR.ShettyH.HotopfM.FordT.KyriakopoulosM.Diaz-CanejaC. M.ArangoC.MacCabeJ. H.HayesR. D.Pina-CamachoL. (2019). Negative symptoms in early-onset psychosis and their association with antipsychotic treatment failure. Schizophrenia Bulletin, 45(1), 69–79. https://doi.org/10.1093/schbul/sbx197
16.
ElisO.CaponigroJ. M.KringA. M. (2013). Psychosocial treatments for negative symptoms in schizophrenia: Current practices and future directions. Clinical Psychology Review, 33(8), 914–928. https://doi.org/10.1016/j.cpr.2013.07.001
17.
ErgulC.UcokA. (2015). Negative symptom subgroups have different effects on the clinical course of schizophrenia after the first episode: A 24-month follow up study. European Psychiatry, 30(1), 14–19. https://doi.org/10.1016/j.eurpsy.2014.07.005
18.
GalderisiS.MucciA.BitterI.LibigerJ.BucciP.FleischhackerW. W.KahnR. S. (2013). Persistent negative symptoms in first episode patients with schizophrenia: Results from the European first episode schizophrenia trial. European Neuropsychopharmacology, 23(3), 196–204. https://doi.org/10.1016/j.euroneuro.2012.04.019
19.
GeorgeD.MalleryP. (2019). IBM SPSS statistics 26 step by step: A simple guide and reference (16th ed.). Routledge.
20.
GoetzR. R.CorcoranC.YaleS.StanfordA. D.KimhyD.AmadorX.MalaspinaD. (2007). Validity of a ‘proxy’ for the deficit syndrome derived from the positive and negative syndrome scale (PANSS). Schizophrenia Research, 93(1–3), 169–177. https://doi.org/10.1016/j.schres.2007.02.018
21.
HunterR.BarryS. (2012). Negative symptoms and psychosocial functioning in schizophrenia: Neglected but important targets for treatment. European Psychiatry, 27(6), 432–436. https://doi.org/10.1016/j.eurpsy.2011.02.015
22.
IzydorczykB.Sitnik-WarchulskaK.Kühn-DymeckaA.LizińczykS. (2019). Resilience, sense of coherence, and coping with stress as predictors of psychological well-being in the course of schizophrenia. The study design. International Journal of Environmental Research and Public Health, 16(7), 1266. https://doi.org/10.3390/ijerph16071266
23.
JahnD. R.BennettM. E.ParkS. G.GurR. E.HoranW. P.KringA. M.BlanchardJ. J. (2016). The interactive effects of negative symptoms and social role functioning on suicide ideation in individuals with schizophrenia. Schizophrenia Research, 170(2–3), 271–277. https://doi.org/10.1016/j.schres.2015.12.011
24.
JangS. K.ChoiH. I.ParkS.JaekalE.LeeG. Y.ChoY. I.ChoiK. H. (2016). A two-factor model better explains heterogeneity in negative symptoms: Evidence from the positive and negative syndrome scale. Frontiers Psychology, 7, 707. https://doi.org/10.3389/fpsyg.2016.00707
25.
JohnsonJ.GoodingP. A.WoodA. M.TaylorP. J.PrattD.TarrierN. (2010). Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness. Behaviour Research and Therapy, 48(9), 883–889. https://doi.org/10.1016/j.brat.2010.05.013
26.
KirkpatrickB.BuchananR. W.BreierA.CarpenterW. T.Jr. (1993). Case identification and stability of the deficit syndrome of schizophrenia. Psychiatry Research, 47(1), 47–56. https://doi.org/10.1016/0165-1781(93)90054-k
27.
KirkpatrickB.StraussG. P.NguyenL.FischerB. A.DanielD. G.CienfuegosA.MarderS. R. (2011). The brief negative symptom scale: Psychometric properties. Schizophrenia Bulletin, 37(2), 300–305. https://doi.org/10.1093/schbul/sbq059
28.
KoutraK.TrilivaS.RoumeliotakiT.BastaM.LionisC.VgontzasA. N. (2016). Family functioning in first-episode and chronic psychosis: The role of patient’s symptom severity and psychosocial functioning. Community Mental Health Journal, 52(6), 710–723. https://doi.org/10.1007/s10597-015-9916-y
29.
LeCompteG.LeCompteA.OzerS. A. (1978). Child raising attitudes of mothers at three socioeconomic levels in Ankara: A scale adaptation. Turkish Journal of Psychology, 1(1), 5–8. Article in Turkish.
30.
LiebenbergL.UngarM.LeBlancJ. C. (2013). The CYRM-12: A brief measure of resilience. Canadian Journal of Public Health, 104(2), e131–e135. https://doi.org/10.1007/bf03405676
31.
LyneJ.O'DonoghueB.RocheE.RenwickL.CannonM.ClarkeM. (2018). Negative symptoms of psychosis: A life course approach and implications for prevention and treatment. Early Intervention in Psychiatry, 12(4), 561–571. https://doi.org/10.1111/eip.12501
32.
MakowskiC.BodnarM.MallaA. K.JooberR.LepageM. (2016). Age-related cortical thickness trajectories in first episode psychosis patients presenting with early persistent negative symptoms. NPJ Schizophrenia, 2(1), 16029. https://doi.org/10.1038/npjschz.2016.29
33.
MallaA. K.NormanR. M.TakharJ.ManchandaR.TownsendL.ScholtenD.HaricharanR. (2004). Can patients at risk for persistent negative symptoms be identified during their first episode of psychosis?The Journal of Nervous and Mental Disease, 192(7), 455–463. https://doi.org/10.1097/01.nmd.0000131804.34977.c1
34.
RabinowitzJ.WerbeloffN.CaersI.MandelF. S.StaufferV.MenardF.KinonBJKapurS (2013). Negative symptoms in schizophrenia – the remarkable impact of inclusion definitions in clinical trials and their consequences. Schizophrenia Research, 150(2–3), 334–338. https://doi.org/10.1016/j.schres.2013.06.023
ShafferD.GouldM. S.BrasicJ.AmbrosiniP.FisherP.BirdH.AluwahliaS. (1983). A children's global assessment scale (CGAS). Arch Gen Psychiatry, 40(11), 1228–1231. https://doi.org/10.1001/archpsyc.1983.01790100074010
SinghS. P.HarleyK.SuhailK. (2013). Cultural specificity of emotional overinvolvement: A systematic review. Schizophrenia Bulletin, 39(2), 449–463. https://doi.org/10.1093/schbul/sbr170
39.
StarlingJ.WilliamsL. M.HainsworthC.HarrisA. W. (2013). The presentation of early-onset psychotic disorders. The Australian and New Zealand Journal of Psychiatry, 47(1), 43–50. https://doi.org/10.1177/0004867412463615
40.
StaufferV. L.SongG.KinonB. J.Ascher-SvanumH.ChenL.FeldmanP. D.ConleyR. R. (2012). Responses to antipsychotic therapy among patients with schizophrenia or schizoaffective disorder and either predominant or prominent negative symptoms. Schizophrenia Research, 134(2–3), 195–201. https://doi.org/10.1016/j.schres.2011.09.028
41.
Stentebjerg-OlesenM.PagsbergA. K.Fink-JensenA.CorrellC. U.JeppesenP. (2016). Clinical characteristics and predictors of outcome of schizophrenia-spectrum psychosis in children and adolescents: A systematic review. Journal of Child Adolescent Psychopharmacology, 26(5), 410–427. https://doi.org/10.1089/cap.2015.0097
StraussG. P.HoranW. P.KirkpatrickB.FischerB. A.KellerW. R.MiskiP.BuchananR. W.GreenM. F.CarpenterW. T. (2013). Deconstructing negative symptoms of schizophrenia: Avolition-apathy and diminished expression clusters predict clinical presentation and functional outcome. Journal of Psychiatric Research, 47(6), 783–790. https://doi.org/10.1016/j.jpsychires.2013.01.015
44.
TorgalsbøenA. K.FuS.CzajkowskiN. (2018). Resilience trajectories to full recovery in first-episode schizophrenia. European Psychiatry, 52, 54–60. https://doi.org/10.1016/j.eurpsy.2018.04.007
45.
ÜnalF.ÖktemF.Çetin ÇuhadaroğluF.Çengel KültürS. E.AkdemirD.Foto ÖzdemirD.ÇakH. T.ÜnalD.TıraşK.AslanC.KalaycıB. M.AydosB. S.KütükF.TaşyürekE.KaraokurR.KarabucakB.KarakökB.KaraerY.ArtıkA. (2019). Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, DSM-5 november 2016-Turkish adaptation (K-SADS-PL-DSM-5-T). Turk Psikiyatri Dergisi, 30(1), 42–50. https://doi.org/10.5080/u23408
46.
ÜçokAErgülC. (2014). Persistent negative symptoms after first episode schizophrenia: A 2-year follow-up study. Schizophrenia Research, 158(1–3), 241–246. https://doi.org/10.1016/j.schres.2014.07.021
47.
VelliganD. I.RobertsD.MintzJ.MaplesN.LiX.MedellinE.BrownM. (2015). A randomized pilot study of MOtiVation and Enhancement (MOVE) training for negative symptoms in schizophrenia. Schizophrenia Research, 165(2–3), 175–180. https://doi.org/10.1016/j.schres.2015.04.008
48.
WambuaG. N.KilianS.NtlantsanaV.ChilizaB. (2020). The association between resilience and psychosocial functioning in schizophrenia: A systematic review and meta-analysis. Psychiatry Research, 293, 113374. https://doi.org/10.1016/j.psychres.2020.113374
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
