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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.

Chen L, Johnston JA, Kinon BJ, Stauffer V, Succop P, Marques TR, Ascher-Svanum H - BMC Psychiatry (2013)

Bottom Line: Correlation coefficients for changes in negative and positive symptom subscale scores were positive and statistically significant (P < 0.05).Overall, the combined trajectories indicated three major distinct patterns: (1) dramatic and sustained early improvement in both negative and positive symptoms (n = 70, 18%), (2) mild and sustained improvement in negative and positive symptoms (n = 237, 59%), and (3) no improvement in either negative or positive symptoms (n = 82, 21%).This study of symptom trajectories over 1 year shows that changes in negative and positive symptoms were neither inversely nor independently related with each other.

View Article: PubMed Central - HTML - PubMed

Affiliation: Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. Chen_lei_lc@lilly.com.

ABSTRACT

Background: Schizophrenia is a highly heterogeneous disorder with positive and negative symptoms being characteristic manifestations of the disease. While these two symptom domains are usually construed as distinct and orthogonal, little is known about the longitudinal pattern of negative symptoms and their linkage with the positive symptoms. This study assessed the temporal interplay between these two symptom domains and evaluated whether the improvements in these symptoms were inversely correlated or independent with each other.

Methods: This post hoc analysis used data from a multicenter, randomized, open-label, 1-year pragmatic trial of patients with schizophrenia spectrum disorder who were treated with first- and second-generation antipsychotics in the usual clinical settings. Data from all treatment groups were pooled resulting in 399 patients with complete data on both the negative and positive subscale scores from the Positive and Negative Syndrome Scale (PANSS). Individual-based growth mixture modeling combined with interplay matrix was used to identify the latent trajectory patterns in terms of both the negative and positive symptoms. Pearson correlation coefficients were calculated to examine the relationship between the changes of these two symptom domains within each combined trajectory pattern.

Results: We identified four distinct negative symptom trajectories and three positive symptom trajectories. The trajectory matrix formed 11 combined trajectory patterns, which evidenced that negative and positive symptom trajectories moved generally in parallel. Correlation coefficients for changes in negative and positive symptom subscale scores were positive and statistically significant (P < 0.05). Overall, the combined trajectories indicated three major distinct patterns: (1) dramatic and sustained early improvement in both negative and positive symptoms (n = 70, 18%), (2) mild and sustained improvement in negative and positive symptoms (n = 237, 59%), and (3) no improvement in either negative or positive symptoms (n = 82, 21%).

Conclusions: This study of symptom trajectories over 1 year shows that changes in negative and positive symptoms were neither inversely nor independently related with each other. The positive association between these two symptom domains supports the notion that different symptom domains in schizophrenia may depend on each other through a unified upstream pathological disease process.

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Interplay matrix of negative and positive symptom trajectories. Abbreviations: DSI = dramatic and sustained early improvement, MSI = mild and sustained improvement, NI = no improvement. The pink cells reflect DSI, the green cells reflect MSI, the gray cells reflect NI, and the uncolored cells reflect idiosyncratic trajectories.
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Figure 3: Interplay matrix of negative and positive symptom trajectories. Abbreviations: DSI = dramatic and sustained early improvement, MSI = mild and sustained improvement, NI = no improvement. The pink cells reflect DSI, the green cells reflect MSI, the gray cells reflect NI, and the uncolored cells reflect idiosyncratic trajectories.

Mentions: Figure 3 shows the negative and positive symptom trajectory matrix. The four (negative symptom trajectory classes) by three (positive symptom trajectory classes) matrix formed 12 cells with one empty cell (cell 1–1, no patient fell into this category), three cells (cells 3–1, 3–3, and 4–3) with only one patient each, one cell (cell 3–2) with seven patients, and the remaining seven cells with at least 14 patients each.


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.

Chen L, Johnston JA, Kinon BJ, Stauffer V, Succop P, Marques TR, Ascher-Svanum H - BMC Psychiatry (2013)

Interplay matrix of negative and positive symptom trajectories. Abbreviations: DSI = dramatic and sustained early improvement, MSI = mild and sustained improvement, NI = no improvement. The pink cells reflect DSI, the green cells reflect MSI, the gray cells reflect NI, and the uncolored cells reflect idiosyncratic trajectories.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219503&req=5

Figure 3: Interplay matrix of negative and positive symptom trajectories. Abbreviations: DSI = dramatic and sustained early improvement, MSI = mild and sustained improvement, NI = no improvement. The pink cells reflect DSI, the green cells reflect MSI, the gray cells reflect NI, and the uncolored cells reflect idiosyncratic trajectories.
Mentions: Figure 3 shows the negative and positive symptom trajectory matrix. The four (negative symptom trajectory classes) by three (positive symptom trajectory classes) matrix formed 12 cells with one empty cell (cell 1–1, no patient fell into this category), three cells (cells 3–1, 3–3, and 4–3) with only one patient each, one cell (cell 3–2) with seven patients, and the remaining seven cells with at least 14 patients each.

Bottom Line: Correlation coefficients for changes in negative and positive symptom subscale scores were positive and statistically significant (P < 0.05).Overall, the combined trajectories indicated three major distinct patterns: (1) dramatic and sustained early improvement in both negative and positive symptoms (n = 70, 18%), (2) mild and sustained improvement in negative and positive symptoms (n = 237, 59%), and (3) no improvement in either negative or positive symptoms (n = 82, 21%).This study of symptom trajectories over 1 year shows that changes in negative and positive symptoms were neither inversely nor independently related with each other.

View Article: PubMed Central - HTML - PubMed

Affiliation: Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. Chen_lei_lc@lilly.com.

ABSTRACT

Background: Schizophrenia is a highly heterogeneous disorder with positive and negative symptoms being characteristic manifestations of the disease. While these two symptom domains are usually construed as distinct and orthogonal, little is known about the longitudinal pattern of negative symptoms and their linkage with the positive symptoms. This study assessed the temporal interplay between these two symptom domains and evaluated whether the improvements in these symptoms were inversely correlated or independent with each other.

Methods: This post hoc analysis used data from a multicenter, randomized, open-label, 1-year pragmatic trial of patients with schizophrenia spectrum disorder who were treated with first- and second-generation antipsychotics in the usual clinical settings. Data from all treatment groups were pooled resulting in 399 patients with complete data on both the negative and positive subscale scores from the Positive and Negative Syndrome Scale (PANSS). Individual-based growth mixture modeling combined with interplay matrix was used to identify the latent trajectory patterns in terms of both the negative and positive symptoms. Pearson correlation coefficients were calculated to examine the relationship between the changes of these two symptom domains within each combined trajectory pattern.

Results: We identified four distinct negative symptom trajectories and three positive symptom trajectories. The trajectory matrix formed 11 combined trajectory patterns, which evidenced that negative and positive symptom trajectories moved generally in parallel. Correlation coefficients for changes in negative and positive symptom subscale scores were positive and statistically significant (P < 0.05). Overall, the combined trajectories indicated three major distinct patterns: (1) dramatic and sustained early improvement in both negative and positive symptoms (n = 70, 18%), (2) mild and sustained improvement in negative and positive symptoms (n = 237, 59%), and (3) no improvement in either negative or positive symptoms (n = 82, 21%).

Conclusions: This study of symptom trajectories over 1 year shows that changes in negative and positive symptoms were neither inversely nor independently related with each other. The positive association between these two symptom domains supports the notion that different symptom domains in schizophrenia may depend on each other through a unified upstream pathological disease process.

Show MeSH
Related in: MedlinePlus