Negative symptoms in patients with schizophrenia are associated with an increased likelihood of hospital admission, longer duration of admission, and an increased likelihood of re-admission following discharge, according to a new study by researchers at King’s College London.
Negative symptoms include poor motivation, poor eye contact, and a reduction in speech and activity. As a result, people with schizophrenia often appear emotionless, flat, and apathetic. These contrast with the positive symptoms of hallucinations or delusions, which are typically the first targets of treatment.
The study is the largest ever to investigate a relationship between negative symptoms and clinical outcomes, pulling from a sample of more than 7,500 patients.
“Hospital admissions are the main drivers of cost in the care of patients with schizophrenia — yet they have traditionally been linked to the severity of positive psychotic symptoms,” said Dr. Rashmi Patel from the Department of Psychosis Studies.
“Our data indicate that negative symptoms are an equally important factor, and suggest that a greater emphasis on assessing and treating these features of schizophrenia may have significant health economic benefits.”
“However, as our findings are drawn from observational data, interventional clinical studies are required to determine whether an effective treatment for negative symptoms would lead to better clinical outcomes.”
For the study, researchers used the Clinical Record Interactive Search (CRIS) application, a text-mining tool, to analyze anonymous patient data on negative symptoms. Natural Language Processing (NLP) was used to detect statements within the clinical records that determined references to specified negative symptoms.
Ten negative symptoms were identified, including poor motivation, blunted or flattened mood, poor eye contact, emotional withdrawal, poor rapport, social withdrawal, poverty of speech (excessively short speech with minimal elaborations), inability to speak, apathy, and concrete thinking (the inability to think in abstract terms).
The researchers found that 41 percent of patients exhibited two or more negative symptoms. Negative symptoms across the sample were associated with an increased likelihood of hospital admission, longer duration of admission, and an increased likelihood of re-admission following discharge from hospital.
In fact, patients with two or more negative symptoms were 24 percent more likely to have been admitted to the hospital. In addition, each of their admissions were, on average, an extra 21 days in duration and, when discharged, these individuals had a 58 percent higher risk of re-admission within 12 months.
The most frequently recorded negative symptoms were poor motivation (31 percent), blunted or flattened mood (27 percent), poor eye contact (26 percent), and emotional withdrawal (24 percent).
The findings are published in the journal BMJ Open.
Source: King’s College London