|Year : 2015 | Volume
| Issue : 1 | Page : 48-52
Positive and negative symptoms in patients of schizophrenia: A cross sectional study
Atiqul H Mazumder1, Md T Alam1, Hatsumi Yoshii2, Riitta-Liisa Kortesluoma3, Mohammad S.I Mullick4, Md W.A Chowdhury5
1 Assistant Professor, National Institute of Mental Health, Dhaka, Bangladesh
2 Lecturer, School of Health Sciences, Faculty of Medicine, Tohoku University, Miyagi, Japan
3 Development Manager, Extension School/University of Oulu, Finland
4 Chairman and Professor of Psychiatry, Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
5 Director and Professor of Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
|Date of Web Publication||4-Jul-2017|
Atiqul H Mazumder
Assistant Professor, National Institute of Mental Health, Dhaka
Source of Support: None, Conflict of Interest: None
Background: Analysis of positive and negative symptoms of schizophrenia has been increasingly needed for a systematic management plan. Unfortunately, this type of study was lacking in Bangladesh. Aims: The study aims were to find out the predominant symptom pattern and associating factors in schizophrenia. Methods: This was a cross sectional, analytical and descriptive study done in a tertiary care hospital with a sample size of 78. The SCID-I and pre designed socio demographic questionnaire was applied. Positive and negative symptoms were assessed by using the Positive and Negative Symptom Scale (PANSS). Statistical analysis was done through SPSS version 17. Results: Among 78 patients, schizophrenics with positive symptoms (57.7%) were predominant over schizophrenics with negative symptoms (42.3%). Delusion (64.1%) and blunted affect (55.1%) were the most frequent positive and negative symptoms respectively. Negative symptoms were significantly associated with poverty, unemployment and lack of education. Limitations: Single centered cross sectional study with small sample size. Conclusions: Schizophrenic patients with positive symptoms visit clinicians more readily than those with negative symptoms.
Keywords: Negative symptoms, Positive symptoms, Schizophrenia
|How to cite this article:|
Mazumder AH, Alam MT, Yoshii H, Kortesluoma RL, Mullick MS, Chowdhury MW. Positive and negative symptoms in patients of schizophrenia: A cross sectional study. Acta Med Int 2015;2:48-52
| Background|| |
The annual incidence of schizophrenia ranges from 0.16 to 1.00 per 10,000 people. In Bangladesh, the prevalence of schizophrenia is 1.10% in adult population and 0.10 % in children. In a rural community survey of Bangladesh, the prevalence rate of schizophrenia was found 2.54/1000 of the population.
Schizophrenia is a universal disorder having great impact on the quality of life. According to the Global Burden of Disease Study, schizophrenia causes a high degree of disability accounting for 1.1% of the total DALYs (Disability-Adjusted Life Years) and 2.8% of YLDs (Years Lived with Disability). Evaluation of positive and negative symptom patterns of schizophrenia is necessary for the assessment of prognosis and treatment outcome. As per researcher's knowledge, no reported studies in Bangladesh have yet been observed about positive and negative symptoms of schizophrenia. In 1989, one study was done in the OPD of former IPGMR to find out the frequency of First Rank Symptoms (FRS) in patients with psychotic illness. According to that study, somatic passivity was the most frequently occurring first rank symptom followed by thought broadcasting, made impulse and made volitional act. Another study done in 1994 in the psychiatry OPD of Chitt agong Medical College, showed that among the first rank symptoms, Somatic passivity was the most frequent followed by thought broadcasting, made volitional act, delusional perception and voices arguing. In Bangladesh, it has been observed that majority of the patients with schizophrenia attending psychiatric hospitals suffers from positive symptoms. Patients with negative symptoms visit clinicians less frequently because their caregivers are not aware of the negative symptoms.
| Aims|| |
- To find out positive or negative symptoms to be present predominantly.
- To find out the frequency distribution of positive and negative symptoms.
- To find out association of socio demographic and relevant variables with positive and negative symptoms.
| Methods|| |
This is a cross sectional, analytical and descriptive study done in Bangabandhu Sheikh Mujib Medical University (BSMMU), a tertiary care hospital in Dhaka, Bangladesh.
- Diagnosed cases of schizophrenia aged 18 years or above of either sex attending the Out Patient Department (OPD) of Psychiatry of BSMMU, Dhaka as they show both positive and negative symptoms.
- Patients having symptoms duration for at least one year or above.
- Patients with any physical illness from that he/ she is unable to communicate with the researcher/ interviewer.
- Inpatients of Psychiatry of BSMMU, Dhaka as they show mainly positive symptoms.
By purposive sampling method, 90 consecutive patients who fulfilled the selection criteria were interviewed during the study period from July 2009 to June 2011 but 12 patient's information was not adequate for analysis, so finally 78 samples were taken.
The SCID-I and pre designed socio demographic questionnaire was applied. Positive and negative symptoms were assessed by using the Positive and Negative Symptom Scale (PANSS). Statistical analysis was done through SPSS version 17.
| Results|| |
Among the patients with schizophrenia positive symptoms (57.7%) were predominant over negative symptoms (42.3%) [Chart 1]. The most frequent positive symptom is delusion (64.1%), the most frequent negative symptom is blunted affect (55.1%) and the most frequent general psychopathology symptom is lack of judgment and insight (87.2%) [Table 1] and [Table 2]. 63.6% illiterate patients show negative symptoms and 66.1% literate patients show positive symptoms (p-value=0.017) [Table 3]. 71.4% patients with 20,001-30,000 taka monthly income show positive symptoms, 56.5% patients with 10,001-20,000 taka monthly income show negative symptoms and 54.5% patients with <10,000 taka monthly income show negative symptoms [Chart 2]. This results are statistically significant (p-value=0.036). 62.5% unemployed patients show negative symptoms and 57.7% literate patients show positive symptoms (p-value=0.003) [Chart 3].
|Table 1: Number of symptoms among the subjects according to PANSS (n=78)|
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|Table 2: Frequency distribution of symptoms among the subjects according to PANSS (n=78)|
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|Table 3: Association of education with positive and negative syndrome groups (n=78)|
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| Discussion|| |
This study finds that 44.9% patients are 20-29 years old and 30.8% are 30-39 years old. 67.9% patients are male and 32.1% are female. 61.5% patients come from rural areas and 38.5% from urban areas of Dhaka city. 52.6% patients come from nuclear family and 47.4% from joint family.
Most of the patients are unemployed (41.0%) followed by housewives (16.7%), students (15.4%), cultivators (10.3%), household workers (6.4%), service holders (5.1%), self- employed (2.6%), business persons (1.3%) and menial workers (1.3%). 33.3% Patients are married. 53.8% patients earn 10001-20000 taka per month and 14.1% earns more than 30000 taka per month. Mean age of onset of schizophrenia is 22.14 years with a standard deviation of 5.828; mean age of first psychiatric treatment is 23.60 years with a standard deviation of 5.521.
Positive and Negative Symptoms of Schizophrenia
In the present study positive symptoms are predominant (57.7%) over negative symptoms (42.3%) [Chart 1]. In an Indian study conducted by Srinivasan in 2005, it was also found that positive symptoms were more predominant.
Frequency Distribution of Positive and Negative Symptoms
Among positive symptoms delusion is the most frequent (64.1%) followed by suspiciousness/persecution (53.8%), hostility (53.8%), excitement (47.7%), conceptual disorganization (47.7%), hallucinatory behavior (35.9%) and grandiosity (24.4%) [Table 2]. Among negative symptoms blunted affect is the most frequent (55.1%) followed by poor rapport (50.0%), emotional withdrawal (46.2%), difficulty in abstract thinking (44.9%), apathetic social withdrawal (43.6%), lack of spontaneity and flow of conversations (38.5%), stereotyped thinking (12.8%) [Table 2]. In Lahore, Pakistan, a study conducted in 2006 on 140 diagnosed schizophrenic patients to evaluate evolution of symptoms by using PANSS revealed that delusion was the most frequent (58%) positive symptom and hallucinatory behavior was present in 32% of patients. These findings were very much consistent with our current study findings.
In the same Pakistani study, among negative symptoms, avolition was present in 40% study subjects, alogia was present in 22% study subjects, and affective flattening was present in 39% study subjects. These findings were not consistent with our current study findings. This may be due to socio cultural difference in observational analysis of negative symptoms. Another study conducted in the United States in 2010 by Bobes et al. showed that among 1,108 schizophrenic patients, the most frequent negative symptom items were social withdrawal (45.8%), emotional withdrawal (39.1%), poor rapport (35.8%), and blunted affect (33.1%). This result shows some differences with that found in our study. The differentiating factor might be that, assessment of social passivity in the United States was more specific. In our cultural context social withdrawal is sometime under evaluated.
Association of Socio Demographic and Relevant Variables with Positive and Negative Syndromes of Schizophrenia
The current study shows that negative symptoms are more frequent (63.6%) in illiterate patient group and positive symptoms are more frequent (66.1%) in literate patient group [Table 3]. This result is statistically significant. In deficit schizophrenia cognitive impairment may lead to poor educational achievement.
In this study it is found that negative symptoms are more frequent (62.5%) in unemployed patients and positive symptoms are more frequent (57.7%) in employed patients [Chart 3]. This result was statistically significant (p-value=.003). In a similar study done by Bobes et al. in 2010 in the U.S.A., it was found that negative symptoms were more prevalent among unemployed/inactive patients (P<.001). An Indian study also found that disability in social functioning in schizophrenia was related to work functioning, securing and maintaining jobs.
Present study result also depicts that positive symptoms are more frequent (71.4%) in 20,001-30,000TK monthly income group of patient, negative symptoms are more frequent in lower monthly income groups of patients, that is 56.5% in 10,001-20,000TK monthly income group and 54.5% in <10,000 TK monthly income group [Chart 2], [Table 4]. This result is statistically significant (p-value=.036). This finding may reflect the truth that poor social functioning in schizophrenia with negative symptoms also lead to poor monthly income which is also consistent with other study findings like that of Srinivasan et al.
|Table 4: Association of monthly income with positive and negative syndrome groups (n=78)|
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Negative symptoms are intrinsic to the pathology of schizophrenia and are associated with significant deficits in motivation, verbal and nonverbal communication, affect, cognitive and social functioning. For a long time, clinical attention was focused on the improvement of positive symptoms as they are directly related to the safety of the patient and the caregivers. Negative symptoms are now a days getting more importance because they are associated with poor social functioning and occupational impairment.
The study was carried out in a single center and its sample size was small. This study was cross sectional, so researcher could not provide the cause-effect relationship between symptoms and other variables longitudinally. Due to the same reason temporal course of positive and negative symptoms along with treatment outcome could not be evaluated.
| Conclusions|| |
The present study demonstrates that schizophrenic patients with positive symptoms frequently visit clinicians because positive symptoms are more visible and easily draw attention to the caregiver or relatives of the patients though negative symptoms are largely associated with illiteracy, poverty and unemployment.
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[Table 1], [Table 2], [Table 3], [Table 4]