Identifying clinical and psychological correlates of persistent negative symptoms in early-onset psychotic disorders

Abstract

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.

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

“… 36 Interestingly, children and adolescents with EOP who had never attempted suicide had more negative symptoms during the first episode than those with previous attempts ( P < 0.05), 37 and the percentage with a history of suicide attempts was higher among those without persistent negative symptoms ( P = 0.002). 38 There was an association between negative symptoms in males and a delayed puberty ( P = 0.001), which did not appear in females. 39 A family history of psychosis 40 , 41 or family burden 42 did not seem to have an effect on negative symptoms ( P > 0.05).…”

“… 61 Duration of untreated psychosis was higher in those with persistent negative symptoms ( P = 0.022). 38 Negative symptoms at baseline was the only variable that predicted functional outcome at 2-year follow-up ( P = 0.010). 62 Negative symptoms at baseline also predicted lower maximum levels of functioning achieved at 1-year (β = 0.6, P = 0.005) and 2-year follow-up (β = 0.5, P = 0.003).…”

“…To the best of our knowledge, this is the first systematic review to provide a comprehensive evaluation of the evidence regarding negative symptoms and diagnostic, prognostic and therapeutic factors in children and adolescents with EOP or at CHR-P. Additionally, this is the first quantitative meta-analysis on this topic. We systematically reviewed 133 studies evaluating 6776 children and adolescents with EOP and 2138 children and adolescents at CHR-P, and conducted the first meta-analysis on the prevalence of negative 47 Maki (2008) 141 Fleischhaker (2005) 40 Mensi (2021) 142 Bahn (2002) 115 Zakowicz (2022) 143 Kim (2009) 74 Reddy (1996) 144 Rapado-Castro (2010) 58 Jarbin (2004) 37 Karakus (2022) 38 Kafali (2019) 146 Downs (2019) 6 McClellan (1999) 63 DeVylder (2013) 49 0.25 0.5 Proportion 0.75 1…”

“…Some children and adolescents with EOP or at CHR-P present with clinical risk factors for poor outcomes (e.g. prominent negative symptoms at baseline 61 or long duration of untreated psychosis) 38 or neurobiological risk factors for poor outcomes (e.g. frontal cortical thinness, changes in the cerebrospinal fluid) 64 .…”