Negative symptom configuration in patients with first episode affective psychosis: findings from the 1-year follow-up of the “Parma Early Psychosis” program.

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Lorenzo Pelizza
Davide Maestri
Emanuela Leuci
Emanuela Quattrone
Silvia Azzali
Giuseppina Paulillo
Pietro Pellegrini


Affective Psychosis; Early Psychosis; Factor Analysis; First Episode Psychosis; Negative Symptoms.


Background and aim - Evidence on discrete dimensions underlining negative symptoms in First Episode Affective Psychosis (FEAP) may be useful for their treatment strategy, but is still relatively scarce. Aim of this study was to examine the negative symptom configuration in patients with FEAP using both exploratory and confirmatory factor analysis methods on the Positive And Negative Syndrome Scale (PANSS). Methods - Seventy-eight participants, aged 13-35 years, completed the PANSS within the “Parma Early Psychosis” (Pr-EP) program, a specialized protocol of early detection and intervention in psychosis implemented since January 2013 in all public adolescent and adult mental health services of the Parma Department of Mental Health (Northern Italy). Results - A 3-factor model (i.e. “Alogia”, “Social Withdrawal” and “Motor/Affective Expression Poverty” domains) was identified. As an alternative, a 2-factor solution previously proposed in patients with first episode schizophrenia (always within the Pr-EP program) also showed good fit indices in our FEAP sample. Conclusions - Our results suggest the crucial importance of identifying discrete negative symptom domains already at the onset of affective psychosis in order to implement specific early intervention strategies aiming to improve prognosis and long-term outcomes also in this young FEAP help-seeking population.


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1. Gee B, Hodgekins J, Fowler D et al. The course of negative symptom in first episode psychosis and the relationship with social recovery. Schizophr Res 2016; 174: 165-71.
2. Blanchard JJ, Cohen AS. The structure of negative symptoms within schizophrenia: implications for assessment. Schizophr Bull 2006; 32: 238-45.
3. Ahmed AO, Kirkpatrick B, Galderisi S, Mucci A, Rossi A, Bertolino A. Cross-cultural validation of the 5-factor structure of negative symptoms in schizophrenia. Schizophr Bull 2019; 45: 305-14.
4. Pelizza L, Landi G, Pellegrini C et al. Negative symptom configuration in first episode schizophrenia: findings from the “Parma Early Psychosis” program. Nord J Psychiatry 2020; 74: 251-8.
5. Pelizza L, Azzali S, Paterlini F et al. Characterization of young people with first episode psychosis or at ultra-high risk: the Reggio Emilia At-Risk Mental States (ReARMS) program. Riv Psichiatr 2019; 54: 254-63.
6. Lyne J, Renwick L, Grant T, Kinsella A, McCarthy P, Malone K. Scale for the Assessment of Negative Symptoms structure in first episode psychosis. Psychiatry Res 2013; 210: 1191-7.
7. Andreasen NC. Negative symptoms in schizophrenia: definition and reliability. Arch Gen Psychiatry 1982; 39: 784-8.
8. Dollfus S, Lyne J. Negative symptoms: history of the concept and their position in diagnosis of schizophrenia. Schizophr Res 2017; 186: 3-7.
9. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261-76.
10. Leuci E, Quattrone E, Pellegrini P, Pelizza L. The “Parma-Early Psychosis” program: general description and process analysis after 5 years of clinical activity. Early Interv Psychiatry 2020; 14: 356-64.
11. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, IV edition, Text Revision (DSM-IV-TR). APA Press, Washington, DC, 2000.
12. Ran MS, Xiao Y, Chui CHK et al. Duration of untreated psyhosis (DUP) and outcome of people with schizophrenia in rural China: 14-year follow-up. Psychiatry Res 2018; 267: 340-5.
13. Landi G, Leuci E, Quattrone E et al. The ‘Parma‐Early Psychosis’ programme: characterization of help‐seekers with first episode psychosis. Early Interv Psychiatry,
14. Yung AR, Yuen YP, McGorry PD et al. Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry 2005; 39: 964-71.
15. Jang SK, Choi HI, Park S, Jaekal E, Lee GY, Cho YI. A two-factor model better explains heterogeneity in negative symptoms: evidence from the Positive and Negative Syndrome Scale. Front Psychol 2016; 7: 707.
16. Pancheri P, Brugnoli R, Carilli L, Delle Chiaie R, Marconi PL, Petrucci RM. Valutazione dimensionale della sintomatologia schizofrenica: validazione della versione italiana della Scala per la Valutazione dei Sintomi Positivi e Negativi (PANNS). G Ital Psicopatol 1995; 1: 60-75.
17. Poletti M, Pelizza L, Azzali S et al. Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project. Eur Child Adolesc Psychiatry 2018; 28: 957-71.
18. Shafer A, Dazzi F. Meta-analysis of the Positive And Negative Syndrome Scale (PANSS) factor structure. J Psychiatr Res 2019; 115: 113-20.
19. Khan A, Lindenmayer A, Opler M, Yavorsky C, Rothman B, Lucic L. A new integrated negative symptom structure of the Positive and Negative Syndrome Scale (PANSS) in schizophrenia using item response analysis. Schizophr Res 2013; 150: 185-96.
20. Marder SR, Daniel DG, Alphs L, Awad AG, Keefe RSE. Methodological issues in negative symptom trials. Schizophr Bull 2011; 37: 250-4.
21. Andreoli V, Cassano GB, Rossi R. DSM-IV-TR: manuale diagnostico e statistico dei disturbi mentali, IV Edizione, Text Revision. Masson, Milano, 2007.
22. Pelizza L, Azzali S, Garlassi S, et al. Adolescents at ultra-high risk of psychosis in Italian neuropsychiatry services: prevalence, psychopathology and transition rate. Eur Child Adolesc Psychiatry 2018; 27: 725-37.
23. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV-TR axis I Disorders (SCID-I). New York State Psychiatric Institute, New York, NY, 2002.
24. SPSS Inc. Statistical Package for Social Science (SPSS) for Windows, version 15.0. SPSS Inc. Press, Chicago, IL, 2010.
25. Rosseel Y. Lavaan: an R package for structural equation modeling. J Stat Software 2012; 48: 1-36.
26. Kline P. Handbook of psychological testing, 2nd Edition. Routledge, London, 2000.
27. Marsh HW, Morin AJ, Parker PD, Kaur G. Exploratory structural equation modeling: an integration of the best features of exploratory and confirmatory factor analysis. Ann Rev Clin Psychol 2014; 10: 85-110.
28. Hair J, Anderson R, Tatham W, Black W. Multivariate data analysis, 5th Edition. Prentice Hall International, London, 1998.
29. Galderisi S, Farden A, Kaiser S. Dissecting negative symptoms of schizophrenia: history, assessment, pathophysiological mechanisms and treatment. Schizophr Res 2017; 186: 1-2.
30. Brown TA. Confirmatory factor analysis for applied research, 2nd Edition. The Guilford Press, New York, NY, 2015.
31. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 1999; 6: 1‐55.
32. Kirkpatrick B, Buchanan RW, McKenney PD, Alphs LD, Carpenter WT. The schedule for the deficit syndrome: an instrument for research in schizophrenia. Psychiatry Res 1989; 30: 119-23.
33. Bonferroni CE. Teoria statistica delle classi e calcolo delle probabilità. Pubblicazioni del Regio Istituto Superiore di Scienze Economiche e Commerciali di Firenze, Firenze, 1936.
34. Kirschner M, Aleman A, Kaiser S. Secondary negative symptoms: a review of mechanisms, assessment and treatment. Schizophr Res 2017; 186: 29-38.
35. Galderisi S, Mucci A, Buchanan RW, Arango C. Negative symptoms of schizophrenia: new developments and unanswered research questions. Lancet Psychiatry 2018; 5: 664-77.
36. Ahmed AO, Strauss GP, Buchanan RW, Kirkpatrick B, Carpenter WT. Schizophrenia heterogeneity revised: clinical, cognitive, and psychosocial correlates of statistically-derived negative symptoms subgroups. J Psychiatr Res 2018; 97: 8-15.
37. Kirkpatrick B, Strauss GP, Nguyen L et al. The Brief Negative Symptom Scale: psychometric properties. Schizophr Bull 2011; 37: 300-5.