Abstract
Research suggests a two factor structure for negative symptoms in patients with psychotic disorders: social amotivation (SA) and expressive deficits (ED). Applying this two-factor structure in clinical settings may provide valuable information with regard to outcomes and to target treatments. We aimed to investigate 1) whether the factor structure is also supported in chronically ill patients with a psychotic disorder and 2) what the relationship is between these factors and functioning (overall functioning and living situation), depressive symptoms and quality of life. 1157 Patients with a psychotic disorder and a duration of illness of 5 years or more were included in the analysis (data selected from the Pharmacotherapy Monitoring Outcome Survey; PHAMOUS). A confirmatory factor analysis was performed using items of the Positive and Negative Syndrome Scale that were previously identified to reflect negative symptoms (N1-4, N6, G5, G7, G13, G16). Subsequently, regression analysis was performed on outcomes. The results confirmed the distinction between SA (N2, N4, G16) and ED (N1, N3, N6, G5, G7, G13) in chronically ill patients. Both factors were related to worse overall functioning as measured with the Health of the Nation Outcome Scales, ED was uniquely associated with residential living status. Higher scores for SA were associated with more depressive symptoms and worse quality of life. Thus, SA is most strongly related to level of social-emotional functioning, while ED are more related to living situation and thereby are indicative of level of everyday functioning. This subdivision may be useful for research purposes and be a valuable additional tool in clinical practice and treatment development.
Highlights
Negative symptoms, such as flattened affect, social withdrawal, apathy and avolition, are core symptoms of psychotic disorders, most notably schizophrenia
The procedures were in accordance with local and international rules, as confirmed by the local ethical committee of the University Medical Center of Groningen, who stated that use of anonymized data from the Pharmacotherapy Monitoring Outcome Survey (PHAMOUS) protocol for research purposes does not fall under the scope of the Medical Research Involving Human Subjects Act and does not need to undergo a prior review by the medical ethical committee
Patients were mostly male with a mean age of 45 years and they had been ill for 18,5 years on average
Summary
Negative symptoms, such as flattened affect, social withdrawal, apathy and avolition, are core symptoms of psychotic disorders, most notably schizophrenia. At least half of the patients with schizophrenia suffers from negative symptoms [1], which are often already present in the prodromal phase [2] and are relatively stable across the course of illness [3]. Negative symptoms have an invalidating impact on patients’ functioning [4,5,6] and are associated with lower quality of life [7]. Many patients are left with negative symptoms after their positive symptoms have been partially or completely managed by antipsychotic medication [8]. The lack of substantial improvement in everyday functioning after antipsychotic treatment may be impeded by enduring negative symptoms [9]
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