Depressive Symptoms and PANSS Symptom Dimensions in Patients With Predominant Negative Symptom Schizophrenia: A Network Analysis

Abstract

IntroductionSchizophrenia is a severe psychiatric disorder with a large symptomatic heterogeneity. Moreover, many patients with schizophrenia present with comorbid psychiatric symptoms or disorders. The relation between depressive symptoms and negative symptoms, such as blunted affect, alogia, anhedonia, asociality and avolition, is particularly intriguing. The negative symptoms can be primary or secondary of depression or overlapping with depressive symptoms. The aim of the present network analysis was to better understand the interactions between depressive symptoms and the different symptoms of schizophrenia and to investigate whether negative symptoms and depressive symptoms can be better delineated.MethodsA network analysis on the baseline item scores of the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) from the cariprazine-risperidone study in patients with predominant negative symptoms (PNS) was performed. The connections between all these symptoms (PANSS and CDSS) were investiged: node strength and network centrality were estimated and the Mohr 5-factor model of the PANSS was applied to test the validity of its different symptoms clusters.ResultsAcross 460 patients with schizophrenia and PNS, the most central symptom (largest node strength) was depression (PANSS) followed by depression (CDSS), anxiety, lack of judgment and insight and tension. The PANSS negative symptom cluster together and was only poorly connected with CDSS depresson symptoms. The Mohr 5 factor model was clearly recognized in the overall clustering of symptoms.ConclusionThis network analysis suggests that depression and anxiety symptoms are the most central in this PNS patient population, despite the baseline low depression scores, and that negative symptoms are a clearly independent symptom cluster that can be delineated from depressive symptoms.

Negative symptoms in children and adolescents with early-onset psychosis and at clinical high-risk for psychosis: systematic review and meta-analysis

“…134 These distinctions are not always easy for clinicians to make, but as a recent network analysis in adults with schizophrenia and predominant negative symptoms showed, negative symptoms appear to be an independent symptom cluster that can be delineated from depressive symptoms in the network. 135 Psychometric instruments or digital tools that clearly differentiate these symptoms are required since the presence and severity of negative symptoms may overlap or covary with the severity of other symptoms (e.g. with depressive symptoms but also with positive symptoms or anxiety symptoms) and with functional impairment.…”