Positive and negative subtypes in acute schizophrenia

Abstract

This study examined the validity of the positive-negative dimension for the subtyping of young acute schizophrenics with under two years of illness. From a survey of 37 consecutively admitted acute schizophrenic inpatients with a mean age of 23.6 years, 9 were classified as having a positive syndrome and 8 a negative syndrome. They were compared on multiple psychopathological ratings, an affect scale, a test of attention and psychomotor rate, demographic, historic, and treatment variables, and drug side effects. A significant inverse relationship between positive and negative symptoms was found. The two groups were reliably distinguished on most criterion symptoms. The positive schizophrenics more commonly carried a paranoid subdiagnosis and also rated higher on symptoms associated with paranoid status. The negative patients showed an accurnulation of deficit symptoms that included impairments in affect, social relations, spontaneous thinking, attention, and motorium. Premorbidly they had less education and poorer work adjustment. Demographic variables, age and mode of onset of illness, duration since onset, global psychopathology, prevalence of extrapyramidal symptoms, and neuroleptic doses were essentially comparable in both groups. The data supported the presentation of a negative syndrome among young acute schizophrenics and its distinction from the positive subtype. The negative syndrome apparently was not secondary to progression of the disorder, prolonged institutionalization, severity of illness, neuroleptic dosage, or drug side effects. Processes accounting for the differentiation of these two syndromes early in the course of illness were discussed in the relation to developmental and biochemical hypotheses.