There has been a debate in the literature about the distinction between primary and secondary negative symptoms of schizophrenia. Our aim was to study the associations between negative symptoms and potential sources of secondary negative symptoms over time. A sample of 275 participants with at least mid-moderate negative symptoms was randomized into body psychotherapy or Pilates class in a previous study. No significant differences were found between groups over time and changes in the symptom domains were modest. The present investigation considers the longitudinal correlation between variables of interest at baseline, 3 and 9 months follow-up. Measures were the Clinical Assessment Interview for Negative Symptoms (CAINS), the Positive and Negative Symptom Scale (PANSS), the Calgary Depression Scale (CDSS) and the Simpson–Angus Extrapyramidal side-effects Scale (SAS). Mixed models were computed to test the longitudinal association between these variables. In a sensitivity analysis, the dosages of antipsychotic, illness duration and allocated intervention were taken into account. Overall, the course of extrapyramidal side-effects, depressive and positive symptoms was significantly related to the course of negative symptoms. Only extrapyramidal effects were longitudinally correlated to expressive negative symptoms. The sensitivity analyses showed unaltered results for positive symptoms and depression but a lack of association between extrapyramidal effects and the CAINS outcomes. In conclusion, the unambiguous interpretation between primary and secondary negative symptoms may lead to refined treatment approaches for schizophrenia and to increased effects of the interventions.
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Conflict of interest
The authors declare that they have no conflict of interest.
The data was collected as part of the NESS study, a trial funded by a grant from the National Institute for Health Research-Health Technology Assessment programme (REF: 08/116/68). The funding source had no role in the present study design, analysis, interpretation or manuscript submission.
Chen L, Johnston JA, Kinon BJ et al (2013) The longitudinal interplay between negative and positive symptom trajectories in patients under antipsychotic treatment: a post hoc analysis of data from a randomized, 1-year pragmatic trial. BMC Psychiatry 13:320. doi:10.1186/1471-244X-13-320CrossRefPubMedPubMedCentralGoogle Scholar
Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276CrossRefPubMedGoogle Scholar
Marder SR, Davis JM, Chouinard G (1997) The effects of risperidone on the five dimensions of schizophrenia derived by factor analysis: combined results of the North American trials. J Clin Psychiatry 58:538–546CrossRefPubMedGoogle Scholar
Addington D, Addington J, Maticka-Tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry Suppl 22:39–44CrossRefGoogle Scholar
Simpson GM, Angus JW (1970) A rating scale for extrapyramidal side effects. Acta Psychiatr Scand Suppl 212:11–19CrossRefPubMedGoogle Scholar
WHO Collaborating Centre for Drug Statistics Methodology (2013) Guidelines for ATC classification and DDD assignment. Norwegian Institute of Public Health, Oslo. doi:10.1021/la902623cCrossRefGoogle Scholar
Sweileh WM, Odeh JB, Shraim NY et al (2014) Evaluation of defined daily dose, percentage of British National Formulary maximum and chlorpromazine equivalents in antipsychotic drug utilization. Saudi Pharm J 22:127–132. doi:10.1016/j.jsps.2013.03.003CrossRefPubMedGoogle Scholar
IBM SPSS statistics for windows 22.0 (2013) IBM Corp, Armonk, New YorkGoogle Scholar
Klaassen RMC, Heins M, Luteijn LB et al (2013) Depressive symptoms are associated with (sub)clinical psychotic symptoms in patients with non-affective psychotic disorder, siblings and healthy controls. Psychol Med 43:747–756. doi:10.1017/S0033291712001572CrossRefPubMedGoogle Scholar
Peralta V, Cuesta MJ, Martinez-Larrea A, Serrano JF (2000) Differentiating primary from secondary negative symptoms in Schizophrenia: a study of neuroleptic-naive patients before and after treatment. Am J Psychiatry 157:1461–1466. doi:10.1176/appi.ajp.157.9.1461CrossRefPubMedGoogle Scholar
Tandon R, DeQuardo JR, Taylor SF et al (2000) Phasic and enduring negative symptoms in schizophrenia: biological markers and relationship to outcome. Schizophr Res 45:191–201CrossRefPubMedGoogle Scholar
Artaloytia JF, Arango C, Lahti A et al (2006) Negative signs and symptoms secondary to antipsychotics: a double-blind, randomized trial of a single dose of placebo, haloperidol, and risperidone in healthy volunteers. Am J Psychiatry 163:488–493. doi:10.1176/appi.ajp.163.3.488CrossRefPubMedGoogle Scholar
Strauss JS, Carpenter WT, Bartko JJ (1974) The diagnosis and understanding of schizophrenia. Part III. Speculations on the processes that underlie schizophrenic symptoms and signs. Schizophr Bull 11:61–69CrossRefGoogle Scholar