The positive-negative distinction in drug-free schizophrenic patients. Stability, response to neuroleptics, and prognostic significance.

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.