Positive and negative symptoms and and adjustment in severely mentally ill outpatients

Studying the relationships among clinical symptoms and adjustment can clarify prognostic factors in severe mental disorders, highlight syndromes that may be the focus of different treatments, and illuminate causal relationships connecting premorbid, 'acute', and long-term psychopathological features. This article examines the relationship between positive and negative symptoms and community adjustment in 398 community mental health center outpatients maintained on neuroleptic medication. Outcome measures include psychiatric hospitalization, employment, and social involvement. Affective symptomatology, premorbid social competence, and three neuropsychological measures are additional independent variables. Positive and negative symptoms are significantly correlated with separate aspects of contemporaneous adjustment, as well as with subsequent hospitalization. Negative symptoms are predominantly related to prior hospitalization, employment, and social interactions; positive symptoms are primarily related to subsequent hospitalization. Disordered attention is most related to global neuropsychological impairment; avolition is mainly associated with degree of employment. Findings are separable from the effects of schizophrenic vs. non-schizophrenic diagnosis. Special attention is paid to a central group of negative symptoms, to separating negative symptoms from neuropsychological deficits, and to distinguishing premorbid from current social functioning.