A prospective longitudinal 10-year study of schizophrenia's three major factors and depression

This study investigated the nature, independence, and stability of schizophrenia's syndrome factors and depression at 2, 4.5, 7.5 and 10 years post-index hospitalization. At the four follow-ups, 71 patients (48 with schizophrenia and 23 with schizoaffective disorder) were assessed for symptoms hypothesized to constitute the reality distortion, disorganized, and negative factors of schizophrenia. At the last three follow-ups, the patients were also assessed for symptoms of depression. Factor analyses of schizophrenia symptoms revealed more than three syndrome factors at each follow-up. Longitudinally, reality distortion was a stable and relatively independent factor. The negative syndrome was independent but was bifurcated into two dimensions, interpreted as social/emotional withdrawal and diminished movement/expressiveness. Although signs of disorganization were not unified or independent early in schizophrenia's course, speech/thought disorder, disorganized affect, and poverty of speech content coalesced to form a disorganization factor by the 7.5-year follow-up. When depressive symptoms were added to the analyses, depression constituted an independent and stable dimension of schizophrenia over time. Each schizophrenia factor demonstrated a unique longitudinal course. Courses included stable symptom consistency (reality distortion), evolving symptom convergence (disorganization), and recurrent bifurcation and symptom instability (the negative syndrome).

[1]  V. Peralta,et al.  An empirical analysis of latent structures underlying schizophrenic symptoms: a four-syndrome model , 1994, Biological Psychiatry.

[2]  T. Crow,et al.  Molecular pathology of schizophrenia: more than one disease process? , 1980, British medical journal.

[3]  W T Carpenter,et al.  The Prediction of Outcome in Schizophrenia IV: Eleven‐Year Follow‐Up of the Washington IPSS Cohort , 1991, The Journal of nervous and mental disease.

[4]  H. Meltzer,et al.  DEPARTMENT OF HEALTH AND HUMAN SERVICES , 1992, Disaster Medicine and Public Health Preparedness.

[5]  S. Klimidis,et al.  Positive and negative symptoms in the psychoses: principal components analysis of items from the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. , 1994, Comprehensive psychiatry.

[6]  T. McGlashan,et al.  Antecedents, symptom progression, and long-term outcome of the deficit syndrome in schizophrenia. , 1994, The American journal of psychiatry.

[7]  M. Harrow,et al.  The Influence of Depression on the Course, Functioning, and Treatment of Patients With Schizophrenia , 2000 .

[8]  P. McGorry,et al.  The dimensional structure of first episode psychosis: an exploratory factor analysis , 1998, Psychological Medicine.

[9]  P. Liddle.  The Symptoms of Chronic Schizophrenia , 1987, British Journal of Psychiatry.

[10]  D. Allen,et al.  Empirical validation of primary negative symptoms: independence from effects of medication and psychosis. , 1999, The American journal of psychiatry.

[11]  G. Simpson,et al.  Does akathisia influence psychopathology in psychotic patients treated with clozapine? , 1999, Biological Psychiatry.

[12]  J. Waddington,et al.  Developmental trajectory and disease progression in schizophrenia: the conundrum, and insights from a 12-year prospective study in the Monaghan 101 , 1997, Schizophrenia Research.

[13]  P. Liddle,et al.  Syndromes of Chronic Schizophrenia , 1990, British Journal of Psychiatry.

[14]  S. Siris.  Diagnosis of secondary depression in schizophrenia: implications for DSM-IV. , 1991, Schizophrenia bulletin.

[15]  M. Müller,et al.  Dimensionality of depression in acute schizophrenia: a methodological study using the Bech-Rafaelsen Melancholia Scale (BRMES). , 1998, Journal of psychiatric research.

[16]  M. Harrow,et al.  Schizophrenic thought disorder at follow-up. A persistent or episodic course? , 1987, Archives of general psychiatry.

[17]  Jae-On Kim,et al.  Factor Analysis: Statistical Methods and Practical Issues , 1978 .

[18]  M. Harrow,et al.  Negative and positive symptoms in schizophrenia and depression: a followup. , 1984, Schizophrenia bulletin.

[19]  T. Okura,et al.  Two factors of experienced deficits in schizophrenia and their relationships with positive, negative, and depressive symptoms. , 1998, Comprehensive psychiatry.

[20]  A. MacDonald,et al.  Vulnerability to delusions over time in schizophrenia and affective disorders. , 1995, Schizophrenia bulletin.

[21]  J. Waddington,et al.  Executive (frontal) dysfunction and negative symptoms in schizophrenia: Apparent gender differences in ‘static’ v. ‘progressive’ profiles , 1997, British Journal of Psychiatry.

[22]  P. McGorry,et al.  The dimensionality of schizophrenia concepts in first‐episode psychosis , 1998, Acta psychiatrica Scandinavica.

[23]  R. Bilder,et al.  Meta-analysis of symptom factors in schizophrenia , 1998, Schizophrenia Research.

[24]  R. Bornstein,et al.  Neuropsychological correlates of negative, disorganized and psychotic symptoms in schizophrenia , 1998, Schizophrenia Research.

[25]  P. Nopoulos.  Resident's Guide to Treatment of People With Chronic Mental Illness: Report 136 , 1995 .

[26]  J. Strauss,et al.  The prediction of outcome in schizophrenia. II. Relationships between predictor and outcome variables: a report from the WHO international pilot study of schizophrenia. , 1974, Archives of general psychiatry.

[27]  W. Eaton,et al.  Structure and course of positive and negative symptoms in schizophrenia. , 1995, Archives of general psychiatry.

[28]  Alexander L. Miller,et al.  Executive-frontal lobe cognitive dysfunction in schizophrenia: A symptom subtype analysis , 1998, Psychiatry Research.

[29]  W. Carpenter,et al.  Syndromes of Schizophrenia , 1994, British Journal of Psychiatry.

[30]  New diagnostic issues in schizophrenic disorders. , 1995, Clinical neuroscience.

[31]  M. Harrow,et al.  Longitudinal courses of thought disorder in schizophrenia and schizoaffective disorder. , 1997, Schizophrenia bulletin.

[32]  N C Andreasen,et al.  Symptoms of Schizophrenia: Methods, Meanings, and Mechanisms , 1995 .

[33]  Flat affect in schizophrenia does not reflect diminished subjective experience of emotion. , 1993 .

[34]  D. Campbell,et al.  Convergent and discriminant validation by the multitrait-multimethod matrix. , 1959, Psychological bulletin.

[35]  A. Malla,et al.  Aspects of dysphoria and symptoms of schizophrenia , 1998, Psychological Medicine.

[36]  S. Kay,et al.  The positive and negative syndrome scale (PANSS) for schizophrenia. , 1987, Schizophrenia bulletin.

[37]  T. Wassink,et al.  Prevalence of depressive symptoms early in the course of schizophrenia. , 1999, The American journal of psychiatry.

[38]  M. Harrow,et al.  Evaluating bizarre-idiosyncratic thinking: a comprehensive index of positive thought disorder. , 1986, Schizophrenia bulletin.

[39]  P. Sham,et al.  Psychopathological syndromes in the functional psychoses: associations with course and outcome , 1996, Psychological Medicine.

[40]  C. Gorst-Unsworth,et al.  Psychological sequelae of torture and organised violence suffered by refugees from Iraq , 1998, British Journal of Psychiatry.

[41]  Depressive Signs and Symptoms in Schizophrenia: A Prospective Blinded Trial of Olanzapine and Haloperidol , 1998 .

[42]  N C Andreasen,et al.  Negative v positive schizophrenia. Definition and validation. , 1982, Archives of general psychiatry.

[43]  W. Carpenter,et al.  Domains of Psychopathology: An Approach to the Reduction of Heterogeneity in Schizophrenia , 1994, The Journal of nervous and mental disease.

[44]  W. Carpenter,et al.  Deficit and nondeficit forms of schizophrenia: the concept. , 1988, The American journal of psychiatry.

[45]  J. Lindenmayer,et al.  Psychopathology of Schizophrenia: initial validation of a 5-factor model. , 1995, Psychopathology.

[46]  M. Harrow,et al.  Negative symptoms in schizophrenia: their longitudinal course and prognostic importance. , 1985, Schizophrenia bulletin.

[47]  J. Marengo,et al.  Classifying the courses of schizophrenia. , 1994, Schizophrenia bulletin.

[48]  R. Buchanan,et al.  The neuroanatomies of schizophrenia. , 1997, Schizophrenia bulletin.

[49]  R. Buchanan,et al.  Case identification and stability of the deficit syndrome of schizophrenia , 1993, Psychiatry Research.

[50]  J. Strauss,et al.  Evaluating Signs and Symptoms: Comparison of Structured Interview and Clinical Approaches , 1976, British Journal of Psychiatry.

[51]  J. Strauss,et al.  Diagnostic criteria and five-year outcome in schizophrenia. A report from the International Pilot Study of schizophrenia. , 1975, Archives of general psychiatry.

[52]  C. Frith,et al.  Validation of three dimensions of schizophrenic symptoms in a large unselected sample of patients , 1996, Psychological Medicine.

[53]  Robert W. Buchanan,et al.  The schedule for the deficit syndrome: An instrument for research in schizophrenia , 1989, Psychiatry Research.

[54]  P. McGorry,et al.  The Influence of Illness Duration on Syndrome Clarity and Stability in Functional Psychosis: Does the Diagnosis Emerge and Stabilise with Time? , 1994, The Australian and New Zealand journal of psychiatry.

[55]  E. Robins,et al.  Research diagnostic criteria: rationale and reliability. , 1978, Archives of general psychiatry.

[56]  S. Patten,et al.  Depression in people with first-episode schizophrenia , 1998, British Journal of Psychiatry.

[57]  Philip D. Harvey,et al.  Convergence of cognitive and adaptive decline in late-life schizophrenia , 1999, Schizophrenia Research.

[58]  P. Holzman,et al.  Schizophrenic pathology in young adults. A clinical study. , 1973, Archives of general psychiatry.

[59]  J C Simpson,et al.  Negative, positive, and disorganized symptom dimensions in schizophrenia, major depression, and bipolar disorder. , 1998, The Journal of nervous and mental disease.

[60]  M. Harrow,et al.  Depression during the longitudinal course of schizophrenia. , 1999, Schizophrenia bulletin.

[61]  V. Peralta,et al.  Factor structure and clinical validity of competing models of positive symptoms in schizophrenia , 1998, Biological Psychiatry.

[62]  T. Crow,et al.  Familial associations of subsyndromes of psychosis in affected sibling pairs with schizophrenia and schizoaffective disorder , 1998, Psychiatry Research.

[63]  V. Peralta,et al.  Negative symptoms in schizophrenia: a confirmatory factor analysis of competing models. , 1995, The American journal of psychiatry.

[64]  S. Breckler.  Applications of covariance structure modeling in psychology: cause for concern? , 1990, Psychological bulletin.

[65]  N. Andreasen,et al.  A longitudinal study of symptom dimensions in schizophrenia. Prediction and patterns of change. , 1995, Archives of general psychiatry.

[66]  A. Serretti,et al.  Dopamine receptor D2 Ser/Cys311 variant associated with disorganized symptomatology of schizophrenia , 1998, Schizophrenia Research.

[67]  Rex B. Kline,et al.  Principles and Practice of Structural Equation Modeling , 1998 .

[68]  L. Ciompi.  The natural history of schizophrenia in the long term. , 1980, The British journal of psychiatry : the journal of mental science.

[69]  J. Endicott,et al.  A diagnostic interview: the schedule for affective disorders and schizophrenia. , 1978, Archives of general psychiatry.

[70]  D. Penn,et al.  Thought disorder and psychosocial functioning in schizophrenia: the concurrent and predictive relationships. , 1999, The Journal of nervous and mental disease.

[71]  R. Dworkin,et al.  Examining the underlying structure of schizophrenic phenomenology: evidence for a three-process model. , 1991, Schizophrenia bulletin.

[72]  M. Harrow,et al.  Depression in schizophrenia: are neuroleptics, akinesia, or anhedonia involved? , 1994, Schizophrenia bulletin.

[73]  A. Fiszbein,et al.  Positive and negative syndromes in schizophrenia as a function of chronicity , 1986, Acta psychiatrica Scandinavica.

[74]  M. Harrow,et al.  European versus U.S. data on the course of schizophrenia. , 1991, The American journal of psychiatry.

[75]  Ira H. Bernstein,et al.  Factoring items and factoring scales are different: Spurious evidence for multidimensionality due to item categorization. , 1989 .

[76]  K. Nuechterlein,et al.  Depressive symptoms in the early course of schizophrenia: relationship to familial psychiatric illness. , 1997, The American journal of psychiatry.

[77]  Yasuhiro Kawasaki,et al.  P300 and the thought disorder factor extracted by factor-analytic procedures in schizophrenia , 1998, Biological Psychiatry.

[78]  B. Everitt,et al.  Symptom Structure in Schizophrenia: Two-, Three- or Four-Factor Models? , 1998, Psychopathology.