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01-08-2013 | Mental health | Article

Negative schizophrenia symptoms worthy treatment target

Abstract

Free abstract

medwireNews: Targeting either prominent positive or negative symptoms when treating patients with schizophrenia could significantly improve their health-related quality of life (HRQoL), a CATIE analysis suggests.

“It has been previously recognized that treating positive symptoms may result in improved HRQoL; however, results of the current analysis suggest a distinct improvement in HRQoL as a consequence of treating prominent negative symptoms as well,” say the study researchers Jonathan Rabinowitz (Bar-Ilan University, Ramat Gan, Israel) and colleagues.

The findings also indicate an additive effect of symptoms, with the healthcare burden greatest for those with both prominent positive and negative schizophrenia symptoms.

Among the 1447 CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) participants analyzed, 575 (40%) had neither prominent positive nor negative symptoms, 274 (19%) had only prominent negative symptoms, 295 (20%) had only prominent positive symptoms, and 303 (21%) had both prominent positive and negative symptoms.

Symptoms were defined as prominent when scores were 4 or more on at least three, or 5 or more on at least two negative or positive subscale items on the Positive and Negative Syndrome Scale (PANSS).

Total scores on the PANSS increased in line with the level of symptomatology, from 62 for participants with no prominent symptoms to 78 and 80 for those with either prominent positive or negative symptoms, respectively, and 95 for patients with both symptoms prominent.

Similarly, functional mental health, health utility and wellbeing, HRQoL, and caregiver burden all worsened significantly in line with increasing symptomatology.

Individuals with neither prominent positive nor negative symptoms had the highest quality-adjusted life–years, followed by individuals with only prominent negative symptoms, those with only prominent positive symptoms, and then patients with both prominent positive and negative symptoms.

Functional impairment on the HRQoL scale was also significantly greater in those with negative rather than positive symptoms, according to the researchers.

This is “consistent with studies that have demonstrated that negative symptoms, particularly apathy and avolition, are related to poor community outcomes such as poor social functioning,” they comment in Schizophrenia Research.

The presence of both prominent negative and positive schizophrenia symptoms had the same additive effect, however.

The researchers conclude: “Outpatients with prominent positive, prominent negative, or both prominent positive and negative symptoms of schizophrenia may experience an improvement in HRQoL by treating either domain of psychopathology.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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