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New insights into the relationships between different symptom domains
What are the relationships between different domains of symptoms of schizophrenia in acute schizophrenia and in schizophrenia with predominant negative symptoms? Is there a relationship between depressive symptoms and negative symptoms, such as blunted affect, alogia and anhedonia in schizophrenia? Network analyses presented by Professor Christoph Correll at EPA 2022 provide new insights into these relationships.
Negative, cognitive and affective symptoms contribute to poor functional outcomes in schizophrenia,1–4 said Professor Christoph U. Correll, Berlin, Germany.
Network analyses evaluating the relationship between symptom domains may help identify patient subgroups
Network analyses investigating the relationship between these different symptom domains may help in the identification of patient subgroups, added Professor Correll, who described network analyses he has carried out with his colleagues.
These analyses provide new insights into the relationship between symptom domains in acute schizophrenia and schizophrenia with predominant negative symptoms (PNS), and the relationship between depressive symptoms and negative symptoms.
What are the relationships between symptom domains in acute schizophrenia and in schizophrenia with predominant negative symptoms?
Negative symptoms correlate with other PANSS symptoms in patients with acute schizophrenia, but not in patients with predominant negative symptoms5
Network structures were estimated for all 30 items of the Positive and Negative Syndrome Scale (PANSS) using baseline data from a population of 2193 patients with acute schizophrenia and 460 patients with PNS,5 explained Professor Correll. The aims were:
- To visualize connections between PANSS items
- To investigate how well the network analysis supports the Mohr-5 factor model of schizophrenia — i.e., positive symptoms, negative symptoms, cognitive impairment, mood disorder, and hostility6
- To identify the most central symptoms in the two populations5
Among patients with acute schizophrenia, the two strongest symptoms were delusions and uncooperativeness5
The network analyses revealed that:
- Negative symptoms correlate with other PANSS symptoms in patients with an acute exacerbation of schizophrenia, but not in patients with PNS
- All five Mohr factors were well supported by the network analysis for the acute population, but only three (positive symptoms, hostility, and mood) were supported by the network analysis for the PNS population
- The two strongest symptoms based on the number and strength of interactions were delusions and uncooperativeness in the acute population and delusions and hostility in the PNS population5
In the predominant negative symptoms population, the two strongest symptoms were delusions and hostility5
Is there a relationship between depressive symptoms and negative symptoms in schizophrenia?
Professor Correll also presented a network analysis of data from 460 PNS schizophrenia patients designed to gain insights into the relationship between depressive symptoms and symptoms of schizophrenia.7
Negative symptoms are an independent symptom cluster distinct from depressive symptoms
The most frequent and most intense connections were for depression measured by the PANSS followed by depression measured by the Calgary Depression Scale for Schizophrenia, anxiety, lack of judgment and insight, and tension,7 said Professor Correll.
Negative symptoms were an independent symptom cluster distinct from depressive symptoms, and the Mohr-5 factor model was recognized in the overall clustering of symptoms.7
This symposium was sponsored by Gedeon Richter and Recordati.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
- Millan MJ, Fone K, Steckler T, Horan WP. Negative symptoms of schizophrenia: clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. Eur Neuropsychopharmacol. 2014;24(5):645–92.
- Millan MJ, Agid Y, Brüne M, et al. Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nat Rev Drug Discov. 2012;11(2):141–68.
- Jääskeläinen E, Juola P, Hirvonen N, et al. A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull. 2013 Nov;39(6):1296–306.
- Ventriglio A, Gentile A, Bonfitto I, et al. Suicide in the early stage of schizophrenia. Front Psychiatry. 2016;7:116.
- Demyttenaere K, Leenaerts N, Acsai K, et al. Disentangling the symptoms of schizophrenia: Network analysis in acute phase patients and in patients with predominant negative symptoms. Eur Psychiatry. 2021;65(1):e18.
- Mohr PE, Cheng CM, Claxton K, et al. The heterogeneity of schizophrenia in disease states. Schizophr Res. 2004;71:83–95
- Demyttenaere K, Anthonis E, Acsai K, Correll CU. Depressive symptoms and PANSS symptom dimensions in patients with predominant negative symptom schizophrenia: A network analysis. Front Psychiatry. 2022;13:795866.