Positive and negative symptoms and adjustment in severely mentally ill outpatients

Studying the relationships among clinical symptoms and adjustment can clari fy prognostic factors in severe mental disorders, highlight syndromes that may be the focus of different treatments, and illuminate causal relationshi ps connecting premorbid, 'acute', and long-term psychopathological features . This article examines the relationship between positive and negative symp toms and community adjustment in 398 community mental health center outpati ents maintained on neuroleptic medication. Outcome measures include psychia tric hospitalization, employment, and social involvement. Affective symptom atology, premorbid social competence, and three neuropsychological measures are additional independent variables. Positive and negative symptoms are s ignificantly correlated with separate aspects of contemporaneous adjustment , as well as with subsequent hospitalization. Negative symptoms are predomi nantly related to prior hospitalization, employment, and social interaction s; positive symptoms are primarily related to subsequent hospitalization. D isordered attention is most related to global neuropsychological impairment ; avolition is mainly associated with degree of employment. Findings are se parable from the effects of schizophrenic vs. non-schizophrenic diagnosis. Special attention is paid to a central group of negative symptoms, to separ ating negative symptoms from neuropsychological deficits, and to distinguis hing premorbid from current social functioning. (C) 1999 Elsevier Science I reland Ltd. All rights reserved.