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Negative symptoms in early-onset psychosis and their association with antipsychotic treatment failure

Research output: Contribution to journalArticle

Johnny Downs, Harry Dean, Suzannah Lechler, Nicola Sears, Rashmi Patel, Hitesh Shetty, Matthew Hotopf, Tamsin Ford, Marinos Kyriakopoulos, Covadonga M. Diaz-Caneja, Celso Arango, James H. MacCabe, Richard D. Hayes, Laura Pina-Camacho

Original languageEnglish
Pages (from-to)69-79
Number of pages11
JournalSchizophrenia Bulletin
Issue number1
Early online date24 Jan 2018
Accepted/In press19 Dec 2017
E-pub ahead of print24 Jan 2018
Published1 Jan 2019


King's Authors


The prevalence of negative symptoms (NS) at first episode of early-onset psychosis (EOP), and their effect on psychosis prognosis is unclear. In a sample of 638 children with EOP (aged 10-17 y, 51% male), we assessed (1) the prevalence of NS at first presentation to mental health services and (2) whether NS predicted eventual development of multiple treatment failure (MTF) prior to the age of 18 (defined by initiation of a third trial of novel antipsychotic due to prior insufficient response, intolerable adverse-effects or non-adherence). Data were extracted from the electronic health records held by child inpatient and community-based services in South London, United Kingdom. Natural Language Processing tools were used to measure the presence of Marder Factor NS and antipsychotic use. The association between presenting with ≥2 NS and the development of MTF over a 5-year period was modeled using Cox regression. Out of the 638 children, 37.5% showed ≥2 NS at first presentation, and 124 (19.3%) developed MTF prior to the age of 18. The presence of NS at first episode was significantly associated with MTF (adjusted hazard ratio 1.62, 95% CI 1.07-2.46; P = .02) after controlling for a number of potential confounders including psychosis diagnostic classification, positive symptoms, comorbid depression, and family history of psychosis. Other factors associated with MTF included comorbid autism spectrum disorder, older age at first presentation, Black ethnicity, and family history of psychosis. In EOP, NS at first episode are prevalent and may help identify a subset of children at higher risk of responding poorly to antipsychotics.

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