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J Clin Psychiatry. 2017 Nov/Dec;78(9):1414-1422. doi: 10.4088/JCP.16m11122.

Persistent Negative Symptoms in First-Episode Psychosis: Early Cognitive and Social Functioning Correlates and Differences Between Early and Adult Onset.

Puig O1,2,3, Baeza I2,3,4,5, de la Serna E2,3, Cabrera B3,4, Mezquida G4,6, Bioque M3,4, Lobo A3,7, González-Pinto A3,8, Parellada M3,9, Corripio I3,10, Vieta E3,5,6,11, Bobes J3,12, Usall J3,6,13, Contreras F3,6,14, Cuesta MJ15, Bernardo M3,4,5,6,11, Castro-Fornieles J2,3,5,6,11; PEPs Group.

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Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic of Barcelona, Villarroel 170, 08036, Spain.
Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain.
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain .
Barcelona Clínic Schizophrenia Unit, Hospital Clínic of Barcelona, Catalonia, Spain.
CERCA-IDIBAPS, Barcelona, Catalonia, Spain.
University of Barcelona, Barcelona, Catalonia, Spain.
Instituto Investigación Sanitaria Aragón (IIS-Aragón), Universidad de Zaragoza, Zaragoza, Spain.
Servicio de Psiquiatría, Hospital Universitario Araba (sede Santiago), BIOARABA, UPV/EHU, Vitoria, Spain.
Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain.
Department of Psychiatry, Sant Pau Hospital, Barcelona, Autonomous University of Barcelona, Barcelona, Spain.
Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain.
Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain.
Research Unit Parc Sanitari Sant Joan de Déu, Barcelona, Catalonia, Spain.
Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.
Department of Psychiatry, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain.



To characterize the early cognitive and social functioning characteristics of a sample of first-episode psychosis patients with and without persistent negative symptoms (PNS) and to examine the prevalence and cognitive and functional correlates of PNS in patients with early-onset versus adult-onset first-episode psychosis.


Participants were 235 patients with first-episode psychosis (51 early-onset, 184 adult-onset) and 240 healthy controls from a multicenter longitudinal study (recruited between 2009 and 2011). Standard instruments were used to evaluate symptoms, cognition, and social functioning. Diagnoses were determined according to DSM-IV criteria. PNS proxy was derived from clinical assessments (Positive and Negative Syndrome Scale and Montgomery-Asberg Depression Scale) at 2-, 6-, and 12-month follow-up. Association tests were used to compare the prevalence of PNS in the early-onset versus adult-onset groups. Multivariate analysis of variance was used to examine differences in early cognitive and social functioning (at the 2-month assessment) between patients with and without PNS and between early-onset and adult-onset patients with PNS.


Thirty-eight patients (16.2%) met criteria for PNS during the first year. This PNS group showed a selective deficit in executive functions and in global, community, and occupational functioning (P < .05). Having PNS was associated with a diagnosis of a schizophrenia spectrum disorder at the 12-month follow-up. The prevalence of PNS was almost double for those patients with an early-onset (0.25 vs 0.14; OR = 2.18; 95% CI, 1.02-4.64), and this was associated with greater cognitive (P < .05) but not social deficits.


There was an early, detectable, social and executive dysfunction associated with PNS in first-episode psychosis and a high risk of having PNS in early-onset first-episode psychosis, which in turn was associated with more widespread cognitive impairment. Specific therapeutic interventions for PNS in early-onset first-episode psychosis might be needed.


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