Association of prominent positive and prominent negative symptoms and functional health, well-being, healthcare-related quality of life and family burden: A CATIE analysis

Background: There is an increased interest in evaluating the impact of core symptoms of schizophrenia, both positive and negative, on functioning and burden of disease. Objective: To examine the extent to which prominent positive and prominent negative symptoms impact functional health, well-being, health-related quality of life (HRQoL), and family burden. Methods: Data on symptomatology, HRQoL, and resource use from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) were analyzed (n = 1447). Patients were divided into four groups based on the Positive and Negative Syndrome Scale (PANSS) using published criteria as having (a) neither prominent positive nor prominent negative symptoms (n = 575; 39.7%); (b) only prominent negative symptoms (n = 274; 18.9%); (c) only prominent positive symptoms (n = 295; 20.4%); or (d) both prominent positive and negative symptoms (n = 303; 20.9%). Differences were examined for overall significance between the groups and for a linear trend. Results: There was a significant linear decline in the outcome measures with each subsequent symptom group, with the combination of prominent positive and negative symptoms incrementing the decline further on quality-adjusted life-years derived from the PANSS, Short-Form-12, Index of Functioning, HRQoL measures, and number of workdays missed by caregiver during the month prior to CATIE (all p < 0.001). Conclusions: Both prominent positive and prominent negative symptoms of schizophrenia are independently associated with significant decline in functionality, HRQoL, and caregiver lost workdays. An increased burden is observed in patients with highest symptomatology. Further research is needed to determine predictors of poor outcomes and burden of schizophrenia.