Natural History of Schizophrenia Subtypes: II. Positive and Negative Symptoms and Long-term Course

doi:10.1001/archpsyc.1991.01810350018003

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Vol. 48 No. 11, November 1991

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Natural History of Schizophrenia Subtypes

II. Positive and Negative Symptoms and Long-term Course

Wayne S. Fenton, MD; Thomas H. McGlashan, MD

Arch Gen Psychiatry. 1991;48(11):978-986.

Abstract

• The natural history and long-term course of schizophreniadivided by pervasiveness of positive and negative symptoms wasexplored among 187 schizophrenic patients from the ChestnutLodge follow-up study. Schizophrenia with many negative symptomswas associated with poor premorbid functioning, insidious onset,partial or no remissions during the first several years of illness,and in most cases a progressive course leading to permanentdisability. Schizophrenia with few negative symptoms was associatedwith good premorbid functioning, acute onset, intermittent earlycourse, and a better prognosis. Positive symptoms predictedfuture hospitalizations but were less powerful and specificas indicators of differential illness history, course, and long-termfunctional incapacity. As predictors of long-term outcome, negativesymptoms were of greater value measured at index admission severalyears after illness onset than at first hospital admission.Multivariate analyses indicated that two negative symptoms (anhedoniaand affective flattening) contribute significantly to outcomevariance independent of their association with premorbid functioningor positive symptoms. Patients with the poorest long-term outcometended to show an increase in negative symptoms during the earlyyears of their illness. Progressive negative symptoms earlyin the course of schizophrenia may thus reflect or signal aprocess leading to long-term functional disability.

Author Affiliations

From the Chestnut Lodge Research Institute, Rockville, Md (Dr Fenton); and the Yale Psychiatric Institute, New Haven, Conn (Dr McGlashan).

Footnotes

Accepted for publication March 4, 1991.

Reprint requests to Chestnut Lodge Research Institute, 500 WMontgomery Ave, Rockville, MD 20850 (Dr Fenton).

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