How to Identify Prominent Negative Symptoms in Schizophrenia
How can clinicians identify patients with schizophrenia who have prominent or predominantly negative symptoms using the criteria applied in this analysis?
Negative symptoms in schizophrenia are associated with poor functioning and remain difficult to treat. This guide applies when a clinician wants to distinguish patients with a high burden of negative symptoms, including those whose presentation is predominantly negative rather than mainly driven by positive psychosis.
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Score the Marder Negative Factor at baseline
Assess negative symptoms using the Marder Negative Factor at baseline. In this analysis, patients were classified as having prominent or high negative symptoms if the baseline Marder Negative Factor score was 24 or higher.
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Classify prominent negative symptoms
If the baseline Marder Negative Factor score is 24 or higher, classify the patient as having prominent or high negative symptoms according to the study definition. This was the threshold used for the subgroup analysis of patients with greater baseline negative symptom burden.
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Check key PANSS negative symptom items
To assess whether symptoms are predominantly negative, rate the PANSS items for blunted affect, passive/apathetic social withdrawal, and lack of spontaneity and flow of conversation. The study required scores of 4 or higher on at least 2 of these 3 items in addition to a high Marder Negative Factor score.
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Assess positive symptom burden with the Mohr Positive Factor
Rate positive symptoms using the PANSS Mohr Positive Factor. In this analysis, predominant negative symptoms required a Mohr Positive Factor score of 19 or lower, indicating low positive symptom burden.
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Define predominant negative symptoms only when both conditions are met
Classify the patient as having predominantly negative symptoms only if all criteria are present: Marder Negative Factor score 24 or higher, scores of 4 or higher on 2 of the 3 specified PANSS negative items, and a PANSS Mohr Positive Factor score of 19 or lower. The authors used this combined definition to explore negative symptom change that may be relatively independent of improvement in positive symptoms.
Clinical Considerations
- These subgroup definitions were used for a post hoc research analysis and were based on previously published analyses rather than being presented as a validated clinical diagnostic algorithm.
- The study population consisted of adults with acute exacerbation or relapse of schizophrenia who met ENLIGHTEN-1 enrollment criteria, so applicability to stable outpatient populations may be limited.
- The predominant negative symptoms subgroup was relatively small at 48 patients.
Bottom Line
In this analysis, prominent negative symptoms were defined by a Marder Negative Factor score of 24 or higher, and predominant negative symptoms required that threshold plus high scores on selected PANSS negative items and low positive symptom burden.
