Patterns, predictors and outcomes of the joint trajectories of positive and negative symptoms in patients with early psychosis: 12-year follow-up of the randomized controlled trial on extended early intervention.

In 30 seconds

This 12-year follow-up of a randomized controlled trial of extended early intervention examined joint positive and negative symptom trajectories in people with first-episode psychosis. The analysis included 151 participants with symptom assessments at baseline and at least two further timepoints; 105 completed the 12-year follow-up. Latent growth-mixture modelling identified four trajectory groups. The largest was concordant-low (35.1%, n = 53), while 32.5% (n = 49) had persistently high positive symptoms with improving negative symptoms. Two groups with worsening or persistently high positive symptoms had worse functional and recovery outcomes at 12 years.

Key findings

• Four joint symptom trajectories were identified: concordant-low (35.1%, n = 53), concordant-improved (11.3%, n = 17), worsening positive/improving negative (21.2%, n = 32), and persistently-high positive/improving negative (32.5%, n = 49).
• Poorer insight, worse quality of life, and potentially longer duration of untreated psychosis predicted poorer joint symptom trajectories.
• The worsening-positive and persistently-high-positive trajectory groups had worse functional and recovery outcomes at 12-year follow-up.

Why it matters

Positive and negative symptoms did not follow a single shared course over time, and improvement in one symptom domain did not necessarily accompany improvement in the other. The association between less favourable positive-symptom trajectories and poorer long-term functioning and recovery highlights the value of assessing both symptom domains and functional outcomes across the course of early psychosis.

What to keep in mind

The trajectory analysis included 151 participants, while 105 completed 12-year follow-up; findings are based on participants with symptom data at multiple timepoints.