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Persistent Negative Symptoms: Characterization of an Unmet Need in a Learning Health System for First-Episode
Deepak K Sarpal1, Swati Nayar2, Robert W Buchanan3
1Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
Schizophrenia Bulletin
|May 9, 2026
Summary
Persistent negative symptoms (PNS) in first-episode psychosis (FEP) are linked to poorer functioning. Early service engagement in coordinated specialty care (CSC) may improve social and role outcomes for individuals with PNS.
Area of Science:
- Psychiatry
- Clinical Psychology
- Neuroscience
Background:
- Persistent negative symptoms (PNS) are common in schizophrenia spectrum disorders, impacting long-term outcomes.
- PNS manifest early and are challenging to treat, with limited effective interventions.
- Understanding PNS in first-episode psychosis (FEP) within coordinated specialty care (CSC) is crucial.
Purpose of the Study:
- To characterize negative symptoms in individuals with FEP receiving CSC.
- To identify subgroups with PNS and compare their outcomes.
- To explore the role of service engagement in mediating outcomes for PNS.
Main Methods:
- Practice-based data collected over 2 years from 1289 participants in 23 CSC programs.
- Core Assessment Battery (CAB) used for clinician-rated and self-report measures.
- Participants categorized into PNS (n=79) and non-PNS (n=455) groups for comparison and mediation analyses.
Main Results:
- PNS group showed higher rates of schizophrenia and lower social/role functioning.
- Service engagement at 6 months mediated the negative relationship between PNS and 12-month functioning.
- Findings highlight challenges and opportunities in treating PNS in FEP.
Conclusions:
- PNS present a significant challenge for individuals with FEP in CSC.
- Early service engagement is vital for improving social and role functioning.
- Targeted interventions are needed to refine treatment for this subgroup.
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