Persistent Negative Symptoms in First-Episode Psychosis Associated With Early Onset of Disease

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These findings suggest that there are critical periods of development associated with a higher risk of persistent negative symptoms.

Results from a study published in the Journal of Clinical Psychiatry found that in first-episode psychosis, there was an early and detectable executive dysfunction in those with persistent negative symptoms (PNS), and the risk for PNS was high.

PNS are associated with poor long-term functional outcomes in patients with schizophrenia. Early detection of PNS, defined as “those negative symptoms that lead to functional impairment, do not respond to usual treatments, and persist during periods of clinical stability,” might help prevent the development of further disability. Some have hypothesized that PNS is associated with a subgroup of patients who have early onset schizophrenia.

To explore this hypothesis, Olga Puig, PhD, and colleagues compared the early cognitive and functional characteristics of 235 people with first-episode psychosis with and without PNS, with the prevalence of PNS in 51 patients with early onset psychosis and 184 patients with adult-onset first-episode psychosis. They then examined the similarities and differences in cognitive and functional characteristics between patients with PNS who had early onset of illness and those who had adult onset. A total of 240 healthy subjects served as controls.

During the first year, 38 patients (16.2%) met the criteria for PNS. These patients showed a selective deficit in executive functions and in global, community, and occupational functioning (P <.05). Among patients with PNS, diagnosis of a schizophrenia spectrum disorder at 12-month follow-up was more likely. For patients with early onset disease, the prevalence of PNS was almost double that of those with adult-onset disease (0.25 vs 0.14; odds ratio 2.18). Furthermore, the presence of PNS was associated with greater cognitive (P <.05), though not social deficits.

The main limitations of the study were the small size of the early onset first-episode psychosis group and failure to apply statistical correction for multiple comparisons systematically.

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The authors concluded that adolescents who experience first-episode psychosis are at greater risk for PNS that may be associated with more cognitive deficits than are patients with adult onset of disease. These findings suggest that there are critical periods of development associated with a higher risk for PNS. Given the greater plasticity of the brain during adolescence, interventions for negative symptoms during this period may be particularly appropriate.


Puig O, Baeza I, de la Serna E, et al. Persistent negative symptoms in first-episode psychosis: early cognitive and social functioning correlates and differences between early and adult onset [published online September 12, 2017]. J Clin Psychiatry. doi:10.4088/JCP.16m11122