August 1989

The Positive-Negative Distinction in Drug-Free Schizophrenic PatientsStability, Response to Neuroleptics, and Prognostic Significance

Author Affiliations

From the Department of Psychiatry, Albert Einstein College of Medicine/ Montefiore Medical Center and Bronx Psychiatric Center, Bronx, NY (Dr Kay), and the Department of Psychiatry, Southern Illinois University School of Medicine and McFarland Mental Health Center, Springfield, Ill (Dr Singh).

Arch Gen Psychiatry. 1989;46(8):711-718. doi:10.1001/archpsyc.1989.01810080041005

• Fundamental questions about the validity and significance of positive and negative syndromes in schizophrenia were addressed by a prospective, double-blind longitudinal study that involved a drug-free placebo baseline, three to four months of neuroleptic treatment, and a three-year poststudy follow-up. From pooled data on 62 schizophrenics, the following findings were observed: (1) a high stability of both syndromes during drug-free conditions; (2) significant correlations of syndrome ratings between the placebo baseline and final neuroleptic week; (3) significant neuroleptic-related improvement in both positive and negative syndromes, with a marginally greater reduction of positive features; (4) independence of the two syndromes during the drug-free baseline but not under neuroleptic conditions; (5) greater symptomatic improvement but more residual disorder portended by both positive and negative syndromes in the drug-free baseline; and (6) poorer functional reconstitution and earlier relapse predicted by a positive syndrome alone. These data supported the validity of the positive-negative distinction in schizophrenia but challenged basic assumptions about its import.