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Clinical evaluation of negative symptoms in schizophrenia

Published online by Cambridge University Press:  23 May 2007

Hans-Jürgen Möller
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Abstract

The florid positive symptoms of schizophrenia (hallucinations, delusions, grossly disordered thinking) are often obvious. By comparison, negative symptoms (flattened affect, impoverished speech, apathy, avolition, anhedonia) are subtler and more difficult to recognize and diagnose. However, there is increasing recognition of the importance of negative symptoms in patients with schizophrenia. Secondary negative symptoms attributable to such factors as unrelieved positive symptoms, the adverse effects of antipsychotic pharmacotherapy, or social isolation may subside with resolution of such factors. In contrast, primary negative symptoms are an intrinsic aspect of schizophrenia; they are persistent and have been associated with poorer clinical outcomes. Although the lack of a reliably effective treatment for negative symptoms is a serious unmet need in this patient population, accurate diagnosis is still important. Assessment of suspected negative symptoms, using validated rating scales, can help to rule out comorbid affective or cognitive disorders that may mimic negative symptoms and to distinguish primary negative symptoms from potentially reversible secondary negative symptoms. This article reviews the definitions and classification of negative symptoms, compares the tools available for their assessment, and offers practical clinical algorithms for sorting through the differential diagnosis.

Keywords

AlgorithmDiagnosisPersistent negative symptomsSchizophrenia
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 6 , September 2007 , pp. 380 - 386
Copyright
Copyright © Elsevier Masson SAS 2007

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References

Alphs, L., Daniel, D.G., Velligan, D., Bartko, J., Panagides, J., Davis, J.Training for assessment of negative symptoms of schizophrenia across languages and cultures utilizing the Negative Symptom Assessment Scale. Neuropsychopharmacology 2005;30(Suppl. 1):S113.Google Scholar
Alphs, L.D., Summerfelt, A., Lann, H., Muller, R.J.The negative symptom assessment: a new instrument to assess negative symptoms of schizophrenia. Psychopharmacol Bull 1989;25(2):159–163.Google ScholarPubMed
Amador, X.F., Kirkpatrick, B., Buchanan, R.W., Carpenter, W.T., Marcinko, L., Yale, S.A.Stability of the diagnosis of deficit syndrome in schizophrenia. Am J Psychiatry 1999 Apr;156(4):637–639.Google Scholar
Andreasen, N.C.Scale for the Assessment of Negative Symptoms (SANS). Iowa City, IA: University of Iowa; 1981.Google Scholar
Andreasen, N.C.Negative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry 1982;39(7):784–788.CrossRefGoogle ScholarPubMed
Andreasen, N.C., Olsen, S.Negative v positive schizophrenia. Definition and validation. Arch Gen Psychiatry 1982;39(7):789–794.CrossRefGoogle Scholar
Bell, M.D., Mishara, A.L.Does negative symptom change relate to neurocognitive change in schizophrenia? Implications for targeted treatments. Schizophr Res 2006 Jan 01;81(1):17–27.CrossRefGoogle ScholarPubMed
Berk, M., Ichim, C., Brook, S.Efficacy of mirtazapine add on therapy to haloperidol in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled study. Int Clin Psychopharmacol 2001 Mar;16(2):87–92.CrossRefGoogle ScholarPubMed
Bottlender, R., Sato, T., Groll, C., Jager, M., Kunze, I., Moller, H.J.Negative symptoms in depressed and schizophrenic patients: how do they differ?. J Clin Psychiatry 2003;64(8):954–958.CrossRefGoogle ScholarPubMed
Bottlender, R., Wegner, U., Wittmann, J., Strauss, A., Moller, H.J.Deficit syndromes in schizophrenic patients 15 years after their first hospitalisation: preliminary results of a follow-up study. Eur Arch Psychiatry Clin Neurosci 1999;249(Suppl. 4):27–36.CrossRefGoogle ScholarPubMed
Bow-Thomas, C.C., Velligan, D.I., Miller, A.L., Olsen, J.Predicting quality of life from symptomatology in schizophrenia at exacerbation and stabilization. Psychiatry Res 1999;86(2):131–142.CrossRefGoogle ScholarPubMed
Buchanan, R.W.Persistent negative symptoms in schizophrenia: an overview. Schizophr Bull 2006 Nov 10.Google ScholarPubMed
Carpenter, W.T. Jr., Heinrichs, D.W., Wagman, A.M.Deficit and nondeficit forms of schizophrenia: the concept. Am J Psychiatry 1988;145(5):578–583.Google ScholarPubMed
Csernansky, J.G.Treatment of schizophrenia: preventing the progression of disease. Psychiatr Clin North Am 2003 Jun;26(2):367–379.CrossRefGoogle ScholarPubMed
Delamillieure, P., Ochoa-Torres, D., Vasse, T., Brazo, P., Gourevitch, R., Langlois, S.et al.The subjective quality of life in deficit and nondeficit schizophrenic patients. Eur Psychiatry 2005 Jun;204346–348.CrossRefGoogle ScholarPubMed
Fitzgerald, P.B., de Castella, A.R., Filia, K., Collins, J., Brewer, K., Williams, C.L.et al.A longitudinal study of patient- and observer-rated quality of life in schizophrenia. Psychiatry Res 2003;119(1–2):55–62.CrossRefGoogle Scholar
Fitzgerald, P.B., Williams, C.L., Corteling, N., Filia, S.L., Brewer, K., Adams, A.et al.Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand 2001;103(5):387–392.CrossRefGoogle Scholar
Gorecka, J.E., Czernikiewicz, A.[The relationship between quality of life of schizophrenic patients and clinical parameters of psychosis]. Wiad Lek 2004;57(9–10):408–412.Google Scholar
Harvey, P.D., Koren, D., Reichenberg, A., Bowie, C.R.Negative symptoms and cognitive deficits: what is the nature of their relationship?. Schizophr Bull 2006 Apr;32(2):250–258.CrossRefGoogle ScholarPubMed
Iancu, I., Poreh, A., Lehman, B., Shamir, E., Kotler, M.The Positive and Negative Symptoms Questionnaire: a self-report scale in schizophrenia. Compr Psychiatry 2005;46(1):61–66.CrossRefGoogle Scholar
Kay, S.R., Fiszbein, A., Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13(2):261–276.CrossRefGoogle Scholar
Keefe, R.S., Bilder, R.M., Harvey, P.D., Davis, S.M., Palmer, B.W., Gold, J.M.et al.Baseline neurocognitive deficits in the CATIE schizophrenia trial. Neuropsychopharmacology 2006 Sep;31(9):2033–2046.CrossRefGoogle ScholarPubMed
Kirkpatrick, B., Buchanan, R.W., McKenney, P.D., Alphs, L.D., Carpenter, W.T. Jr.The Schedule for the deficit syndrome: an instrument for research in schizophrenia. Psychiatry Res 1989 Nov;30(2):119–123.CrossRefGoogle Scholar
Kirkpatrick, B., Fenton, W.S., Carpenter, W.T. Jr., Marder, S.R.The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 2006 Apr;32(2):214–219.CrossRefGoogle ScholarPubMed
Lublin, H., Eberhard, J., Levander, S.Current therapy issues and unmet clinical needs in the treatment of schizophrenia: a review of the new generation antipsychotics. Int Clin Psychopharmacol 2005;20(4):183–198.CrossRefGoogle ScholarPubMed
Malla, A., Payne, J.First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull 2005 Jul;31(3):650–671.CrossRefGoogle ScholarPubMed
Moller, H.J.Atypical neuroleptics: a new approach in the treatment of negative symptoms. Eur Arch Psychiatry Clin Neurosci 1999;249(Suppl. 4):99–107.Google ScholarPubMed
Moller, H.J.Management of the negative symptoms of schizophrenia: new treatment options. CNS Drugs 2003;17(11):793–823.CrossRefGoogle ScholarPubMed
Moller, H.J.Non-neuroleptic approaches to treating negative symptoms in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2004 Apr;254(2):108–116.CrossRefGoogle Scholar
Moller, H.J., Bottlender, R., Wegner, U., Wittmann, J., Strauss, A.Long-term course of schizophrenic, affective and schizoaffective psychosis: focus on negative symptoms and their impact on global indicators of outcome. Acta Psychiatr Scand Suppl 2000;407:54–57.CrossRefGoogle Scholar
Perkins, D.O., Gu, H., Boteva, K., Lieberman, J.A.Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 2005 Oct;162(10):1785–1804.CrossRefGoogle ScholarPubMed
Rudnick, A., Kravetz, S.The relation of social support-seeking to quality of life in schizophrenia. J Nerv Ment Dis 2001;189(4):258–262.CrossRefGoogle Scholar
Svirskis, T., Korkeila, J., Heinimaa, M., Huttunen, J., Ilonen, T., Ristkari, T.et al.Quality of life and functioning ability in subjects vulnerable to psychosis. Compr Psychiatry 2007 Mar–Apr;48(2):155–160.CrossRefGoogle ScholarPubMed
Tremeau, F.A review of emotion deficits in schizophrenia. Dialogues Clin Neurosci 2006;8(1):59–70.Google Scholar
Velligan, DI, Wang, M, Haig, G, Lancaster, S, Taylor, TN, Alphs, L.Association between changes in negative symptoms and functional outcome measures in a stable schizophrenic population. American Psychiatric Association 159th Annual Meeting, 2006 May 20–25, Toronto, Ontario, Canada; 2006.Google Scholar
Winograd-Gurvich, C., Fitzgerald, P.B., Georgiou-Karistianis, N., Bradshaw, J.L., White, O.B.Negative symptoms: a review of schizophrenia, melancholic depression and Parkinson's disease. Brain Res Bull 2006 Oct 16;70(4–6):312–321.CrossRefGoogle ScholarPubMed
Yon, V., Loas, G., Brien, D.Subjective experiences and the psychopathological dimensions in schizophrenia. Psychiatry Res 2005 Nov 15;137(1–2):93–102.CrossRefGoogle Scholar
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