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Prediction and Patterns of Change

Stephan Arndt, PhD; Nancy C. Andreasen, MD, PhD; Michael Flaum, MD; Del Miller, PharmD, MD; Peg Nopoulos, MD

Arch Gen Psychiatry. 1995;52(5):352-360.

Abstract
Background
Factor analytic studies have suggested that the symptoms of schizophrenia may be divided into three uncorrelated dimensions. This study examines the longitudinal course of the symptoms of schizophrenia using this three-dimensional perspective.

Methods
The sample was composed primarily ofneuroleptic-naive patients suffering from schizophrenia. Subjects were studied in a prospective longitudinal design, with comprehensive structured assessments at index, discharge, and 6-month intervals after discharge over a 2-year period.

Results
Negative symptoms were already relatively prominent at the time of index evaluation; they tended to remain stable throughout the follow-up period. The two dimensions of positive symptoms, psychoticism and disorganization, although prominent at index evaluation, declined over the course of the follow-up period and tended to be less stable. A longitudinal factor analysis was conducted to determine whether the changes in symptoms followed any consistent pattern. We observed that all three groups of symptoms tended to change in unison and independently from one another.

Conclusions
These results suggest that these three dimensions of psychopathology show different patterns of exacerbation and remission during the course of schizophrenia. This independent pattern of evolution suggests that these three dimensions should be studied further with respect to response to treatment, cognitive mechanisms, psychosocial correlates, and neural substrates.

Author Affiliations
From the Mental Health Clinical Research Center (Drs Arndt, Andreasen, Flaum, Miller, and Nopoulos) and the Departments of Preventive Medicine and Environmental Health (Dr Arndt) and Psychiatry (Drs Andreasen, Flaum, Miller, and Nopoulos), The University of Iowa Hospitals and Clinics, Iowa City.

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