Patterns, predictors and outcomes of the joint trajectories of positive and negative symptoms in patients with early psychosis: 12-year follow-up of the randomized controlled trial on extended early intervention.
Positive and negative symptoms are considered core features of psychotic disorders. However, no study has identified joint trajectories of positive and negative symptoms in early psychosis with long-term follow-up.
We conducted 12-year follow-up of a randomized-controlled trial on extended early intervention for first-episode psychosis in order to identify joint positive and negative symptom trajectories over 12 years, their baseline predictors and associations with 12-year outcomes. Participants who completed Positive and Negative Syndrome Scale (PANSS) at three or more timepoints, including baseline, and 1-, 2-, 3- and 12-year follow-up, were included in the study. Premorbid adjustment, illness characteristics, symptom severity, functioning, and treatment profiles were assessed. Multivariate latent growth-mixture modelling was employed to derive joint symptom trajectories based on PANSS.
A total of 151 participants were included in this study, with 105 patients completed 12-year follow-up. Our results identified four distinct trajectories, including concordant-low (35.1%,n = 53), concordant-improved (11.3%,n = 17), worsening positive/improving negative symptoms (21.2%,n = 32) and persistently-high positive/improving negative symptoms (32.5%,n = 49) classes. Poorer insight, worse quality of life and potentially longer duration of untreated psychosis could predict poorer joint symptom trajectories. Patients in worsening positive/improving negative symptoms and persistently-high positive/improving negative symptoms classes exhibited worse functional and recovery outcomes at 12-year follow-up.
Our results indicate heterogeneous trajectory patterns of positive and negative symptoms. Concurrent improvement in both symptoms over the illness course is important for better long-term functional outcomes. Further longitudinal research is warranted to facilitate development of interventions to optimize concurrent improvement in both symptoms in early psychosis patients.
We conducted 12-year follow-up of a randomized-controlled trial on extended early intervention for first-episode psychosis in order to identify joint positive and negative symptom trajectories over 12 years, their baseline predictors and associations with 12-year outcomes. Participants who completed Positive and Negative Syndrome Scale (PANSS) at three or more timepoints, including baseline, and 1-, 2-, 3- and 12-year follow-up, were included in the study. Premorbid adjustment, illness characteristics, symptom severity, functioning, and treatment profiles were assessed. Multivariate latent growth-mixture modelling was employed to derive joint symptom trajectories based on PANSS.
A total of 151 participants were included in this study, with 105 patients completed 12-year follow-up. Our results identified four distinct trajectories, including concordant-low (35.1%,n = 53), concordant-improved (11.3%,n = 17), worsening positive/improving negative symptoms (21.2%,n = 32) and persistently-high positive/improving negative symptoms (32.5%,n = 49) classes. Poorer insight, worse quality of life and potentially longer duration of untreated psychosis could predict poorer joint symptom trajectories. Patients in worsening positive/improving negative symptoms and persistently-high positive/improving negative symptoms classes exhibited worse functional and recovery outcomes at 12-year follow-up.
Our results indicate heterogeneous trajectory patterns of positive and negative symptoms. Concurrent improvement in both symptoms over the illness course is important for better long-term functional outcomes. Further longitudinal research is warranted to facilitate development of interventions to optimize concurrent improvement in both symptoms in early psychosis patients.
Authors
Fung Fung, Chu Chu, Chu Chu, Fung Fung, Lei Lei, Wong Wong, Chan Chan, Lee Lee, Hui Hui, Chen Chen, Chang Chang
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