Negative Symptoms in First Episode Psychosis (FEP) Predict Antipsychotic Treatment Failure: A Natural Language Processing (NLP) Electronic Health Record Study

TY - JOUR

T1 - Negative Symptoms in First Episode Psychosis (FEP) Predict Antipsychotic Treatment Failure

T2 - A Natural Language Processing (NLP) Electronic Health Record Study

AU - Patel, Rashmi

AU - Colling, Craig

AU - Jyoti, Jyoti

AU - Jackson, Richard George

AU - Stewart, Robert James

AU - McGuire, Philip

PY - 2018/9/17

Y1 - 2018/9/17

N2 - Background: Negative symptoms contribute towards substantial disability in people with schizophrenia. However, less is known about their impact compared to other symptoms in first episode psychosis (FEP). We sought to investigate how psychosis symptom clusters are associated with clinical outcomes in people with FEP using a large electronic health record (EHR) dataset.Methods: Data were obtained from pseudonymised EHRs of 1,835 people with FEP in South London. Five psychosis symptom clusters (positive, negative, disorganisation, mania and depression) were identified using CRIS‐CODE NLP software. Data on subsequent hospital admission and the number of unique antipsychotics prescribed in the 5 years following presentation were obtained. Their relationship with psychosis symptom clusters was analysed using multivariable negative binomial regression with age, gender and ethnicity as covariates.Results: Mania (IRR 6.37, 95% CI 3.24 to 12.5) and positive symptoms (3.87, 1.98 to 7.58) were more strongly associated with increased hospital admission than disorganisation (1.68, 0.46 to 6.15), depression (1.55, 0.71 to 3.39) or negative symptoms (1.51, 0.51 to 4.48). Negative symptoms were more strongly associated with increased antipsychotic treatment failure (4.49, 2.35 to 8.59) than mania (3.65, 2.42 to 5.52), positive symptoms (3.35, 2.22 to 5.06), disorganisation (2.64, 1.23 to 5.68) or depression (2.18, 1.36 to 3.49).Conclusion: Increased mania and positive symptom burden predict greater hospitalisation than negative symptoms. However, negative symptoms are more strongly associated with increased antipsychotic treatment failure. These findings illustrate that although mania and positive symptoms result in increased hospitalisation, negative symptoms are less responsive to antipsychotic treatment.

AB - Background: Negative symptoms contribute towards substantial disability in people with schizophrenia. However, less is known about their impact compared to other symptoms in first episode psychosis (FEP). We sought to investigate how psychosis symptom clusters are associated with clinical outcomes in people with FEP using a large electronic health record (EHR) dataset.Methods: Data were obtained from pseudonymised EHRs of 1,835 people with FEP in South London. Five psychosis symptom clusters (positive, negative, disorganisation, mania and depression) were identified using CRIS‐CODE NLP software. Data on subsequent hospital admission and the number of unique antipsychotics prescribed in the 5 years following presentation were obtained. Their relationship with psychosis symptom clusters was analysed using multivariable negative binomial regression with age, gender and ethnicity as covariates.Results: Mania (IRR 6.37, 95% CI 3.24 to 12.5) and positive symptoms (3.87, 1.98 to 7.58) were more strongly associated with increased hospital admission than disorganisation (1.68, 0.46 to 6.15), depression (1.55, 0.71 to 3.39) or negative symptoms (1.51, 0.51 to 4.48). Negative symptoms were more strongly associated with increased antipsychotic treatment failure (4.49, 2.35 to 8.59) than mania (3.65, 2.42 to 5.52), positive symptoms (3.35, 2.22 to 5.06), disorganisation (2.64, 1.23 to 5.68) or depression (2.18, 1.36 to 3.49).Conclusion: Increased mania and positive symptom burden predict greater hospitalisation than negative symptoms. However, negative symptoms are more strongly associated with increased antipsychotic treatment failure. These findings illustrate that although mania and positive symptoms result in increased hospitalisation, negative symptoms are less responsive to antipsychotic treatment.

M3 - Meeting abstract

SN - 1751-7893

VL - 12

SP - 120

JO - Early Intervention in Psychiatry

JF - Early Intervention in Psychiatry

IS - S1

ER -