Symptom profile changes between first-episode and chronic schizophrenia

First-episode schizophrenia patients have more positive and fewer negative symptoms than chronic schizophrenia patients, and are more likely to report childhood sexual abuse, a team of researchers has discovered.

"What is most notable here is that in multivariate analysis, more severe positive and less severe negative symptoms distinctively characterize first-episode schizophrenia, suggesting that these differences in symptom patterns are inherent features of the different phases of the illness," say Zhimin Xue (Central South University, Changsha, China) and colleagues in Early Intervention in Psychiatry.

They may reflect such things as biological changes in the illness, the prolonged impact of medication, withdrawal, or a consistent behavioural response, the team suggests.

Xue and co-workers recruited 128 patients with first-episode schizophrenia, defined as an illness duration of less than 18 months, and 571 chronic schizophrenia patients, with an illness duration greater than 24 months.

The results indicate that first-episode patients were significantly younger than chronic patients, at an average age of 28.8 years versus 39.9 years. First-episode patients were also more likely to live alone, at 7.0% versus 16.1%. There were no other significant sociodemographic differences between the groups.

Although total Positive and Negative Syndrome Scale (PANSS) and general psychopathology scores were similar in the two groups, positive symptoms scores were significantly higher in first-episode versus chronic patients, by 6.3%, and negative symptom scores were significantly lower, by 16.3%.

Specifically, first-episode patients scored higher on hallucinatory behavior, and lower on items relating to blunted affect, poor rapport, passive/apathetic social withdrawal, difficulties in abstract thinking, and lack of spontaneity and flow of conversation.

While first-episode patients were more likely than chronic patients to experience childhood sexual abuse, at 27.3% versus 19.8%, they were less likely to report childhood emotional neglect, at 25.8% versus 37.8%. Only hallucinatory behavior in first-episode patients was associated with childhood trauma.

As a result, "future interventions should focus on the adequate care of families; more effective, rehabilitative treatment for negative symptoms; as well as the mitigation of childhood trauma, in an effort to avoid the incidence of chronic disability," the authors conclude.

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