Skip to Main Content
 

Global Search Box

 
 
 
 

ETD Abstract Container

Abstract Header

Uncovering Differential Symptom Courses with Multiple Repeated Outcome Measures: Interplay between Negative and Positive Symptom Trajectories in the Treatment of Schizophrenia

Abstract Details

2012, PhD, University of Cincinnati, Medicine: Biostatistics (Environmental Health).
Background: Schizophrenia is a highly heterogeneous disorder with positive and negative symp-toms construed as distinct characteristic manifestations of the disease. Current antipsychotics work primarily by relieving positive symptoms; while negative symptoms are thought hard to treat. However, little is known about the heterogeneity and pattern of negative symptom response with respect to its linkage with the change in positive symptoms. This research work examined the temporal interplay between positive- and negative-symptom trajectories over a 1-year period in schizophrenic patients under antipsychotic treatment, and evaluated the potential utility of patient subgroups defined by the combined symptom trajectories. Methods: This post hoc analysis used data from an open-label, randomized, 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 the medications were pooled with 399 patients having complete data on both the positive- and negative- subscale scores from the Positive and Negative Syndrome Scale (PANSS). Individual-based, growth mixture modeling combined with a interplay matrix was used to identify the latent trajectory subgroups in term of both the negative and positive symptoms. Baseline demographics, clinical and functional characteristics were examined among the above identified trajectory subgroups. Results: The negative- and positive-symptom trajectory interplay matrix suggests changes in negative and positive symptoms occurred mostly in tandem in the individual patient. Three ma-jor clinical subgroups were identified: (1) dramatic and sustained early improvement in both negative and positive symptoms (DSI); (2) mild and sustained improvement in negative and positive symptoms (MSI), with greater early improvement in positive rather than in negative symptoms, and (3) no improvement in negative and/or positive symptoms (NI). Comparison among the three trajectory subgroups indicates that at baseline, the DSI subgroup were less likely to have substance use disorder; the MSI subgroup were psychopathogically less severe at baseline; and the NI subgroup was associated with worse functioning . Conclusions: The study demonstrated that 1) positive and negative symptoms are not necessarily independent, 2) there are identifiable subgroups of patients with similar symptom courses as defined by the combined negative- and positive-symptom trajectories, and there exist clinical differences at baseline that may permit identification of these subgroups a-priori. Further exami-nation of the underlying biological determinants of these trajectory subgroups might be useful to aid efforts of developing the targeted treatment for schizophrenia.
Paul Succop, PhD (Committee Chair)
Haya Ascher-Svanum, PhD (Committee Member)
Melissa Delbello, MD (Committee Member)
Kim Dietrich, PhD (Committee Member)
111 p.

Recommended Citations

Citations

  • Chen, L. (2012). Uncovering Differential Symptom Courses with Multiple Repeated Outcome Measures: Interplay between Negative and Positive Symptom Trajectories in the Treatment of Schizophrenia [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1342729413

    APA Style (7th edition)

  • Chen, Lei. Uncovering Differential Symptom Courses with Multiple Repeated Outcome Measures: Interplay between Negative and Positive Symptom Trajectories in the Treatment of Schizophrenia. 2012. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1342729413.

    MLA Style (8th edition)

  • Chen, Lei. "Uncovering Differential Symptom Courses with Multiple Repeated Outcome Measures: Interplay between Negative and Positive Symptom Trajectories in the Treatment of Schizophrenia." Doctoral dissertation, University of Cincinnati, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1342729413

    Chicago Manual of Style (17th edition)