Updated perspectives on the clinical significance of negative symptoms in patients with schizophrenia

ABSTRACT

Introduction

Negative symptoms in schizophrenia are associated with poor response to available treatments, poor quality of life, and functional outcome. Therefore, they represent a substantial burden for people with schizophrenia, their families, and health-care systems.

Areas covered

In this manuscript, we will provide an update on the conceptualization, assessment, and treatment of this complex psychopathological dimension of schizophrenia.

Expert opinion

Despite the progress in the conceptualization of negative symptoms and in the development of state-of-the-art assessment instruments made in the last decades, these symptoms are still poorly recognized, and not always assessed in line with current conceptualization. Every effort should be made to disseminate the current knowledge on negative symptoms, on their assessment instruments and available treatments whose efficacy is supported by research evidence. Longitudinal studies should be promoted to evaluate the natural course of negative symptoms, improve our ability to identify the different sources of secondary negative symptoms, provide effective interventions, and target primary and persistent negative symptoms with innovative treatment strategies. Further research is needed to identify pathophysiological mechanisms of primary negative symptoms and foster the development of new treatments.

KEYWORDS:

• Primary negative symptoms
• secondary negative symptoms
• avolition
• assessment
• treatment

Article highlights

• Negative symptoms are associated with poor functional outcome and represent a substantial burden for people affected from schizophrenia, their families, and health-care systems.

• Negative symptoms are currently conceptualized as five individual domains: blunted affect, alogia, avolition, asociality, and anhedonia.

• Second-generation rating scales are available for the assessment of negative symptoms, in line with current conceptualizations.

• Despite the progress made in the last decades in the conceptualization of negative symptoms and development of second-generation rating scales, these symptoms are still poorly recognized, and not always assessed in line with their current conceptualization.

• The development of specific assessment instruments for negative symptoms in subjects at risk to develop psychosis and in those with a first episode of psychosis should represent a priority within early intervention settings.

• Clear procedures for the differentiation between primary and secondary negative symptoms should be developed, in order to plan appropriate interventions.

• Limited treatment options are available for negative symptoms and, therefore, they remain an unmet therapeutic need for the care of people with schizophrenia.

• Further research studies are needed in order to improve the knowledge on the negative symptom pathophysiology to foster the development of innovative treatment strategies.

Declaration of interests

S Galderisi has been consultant and/or advisor to and/or received honoraria or grants from Millennium Pharmaceutical, Innova Pharma-Recordati Group, Janssen Pharmaceutica NV, Sunovion Pharmaceuticals, Gedeon Richter-Recordati, Lundbeck and Angelini. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.