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Latent Trajectories of Positive, Negative Symptoms and Functioning in Early Intervention Services for First-Episode
Olivier Percie du Sert1,2, Joshua Unrau1, Manish Dama1
1Prevention and Early Intervention Program for Psychoses, Douglas Research Centre, Montreal, Quebec, H4H 1R3, Canada.
Background:
From the first episode (FEP), the course of psychosis is marked by substantial heterogeneity of clinical and functional outcomes which poses significant challenges in providing prognostic guidance to patients and families. To better understand such heterogeneity within the context of early intervention services (EIS), this study aimed to examine latent trajectories of positive and negative symptoms and functioning among FEP individuals undergoing EIS.
Study Design:
The Prevention and Early Intervention Program for Psychoses (PEPP-Montreal) is a 2-year EIS for FEP that conducted longitudinal assessments of 689 individuals aged 14-35, including sociodemographics, cognition, psychopathology, and functioning. Latent growth mixture modeling was used to identify distinct patterns of clinical and functional trajectories. The inter-relationship between trajectories, and the association of trajectory membership with baseline characteristics and distal outcomes were investigated using the manual 3-step approach.
Study Results:
Two positive symptom trajectories (Stable-low-32%, Fluctuating-68%,), 3 negative symptom trajectories (Decreasing-41%, Fluctuating-15%, and Stable-high-44%), and 2 functioning trajectories (Increasing-57%, Stable-moderate-43%) were identified. Early treatment response, particularly on negative symptoms, consistently and strongly predicted better outcome trajectories (OR = [3.4-5.5]). Trajectories of higher symptom severity were associated with trajectory of worse functioning (RR = [1.5-2.2]), which exhibited lower rates of clinical and functional remission.
Conclusion:
These findings offer insights into clinically meaningful subgroups of individuals that could inform the prognosis of FEP and the development of individually tailored EIS. Individuals who do not show early improvement in negative symptoms may benefit from earlier psychosocial interventions specifically targeting actionable factors that contribute to secondary negative symptoms.
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