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Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment

Authors Correll CU, Schooler NR

Received 1 August 2019

Accepted for publication 29 January 2020

Published 21 February 2020 Volume 2020:16 Pages 519—534

DOI https://doi.org/10.2147/NDT.S225643

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Roger Pinder


Christoph U Correll, 1–3 Nina R Schooler 4

1The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA; 2The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, New York, NY, USA; 3Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany; 4State University of New York, Downstate Medical Center, Brooklyn, NY, USA

Correspondence: Christoph U Correll
The Zucker Hillside Hospital, Division of Psychiatry Research, 75-59 263rd Street, Glen Oaks, NY 11004, USA
Tel +1 718 470-4812
Email ccorrell@northwell.edu

Abstract: Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptom constellations. The objective of this review was to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia. Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. The term negative symptoms describes a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal/emotional expression. The negative symptom domain consists of five key constructs: blunted affect, alogia (reduction in quantity of words spoken), avolition (reduced goal-directed activity due to decreased motivation), asociality, and anhedonia (reduced experience of pleasure). Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. While secondary negative symptoms can improve as a consequence of treatment to improve symptoms in other domains (ie, positive symptoms, depressive symptoms or extrapyramidal symptoms), primary negative symptoms generally do not respond well to currently available antipsychotic treatment with dopamine D 2 antagonists or partial D 2 agonists. Since some patients may lack insight about the presence of negative symptoms, these are generally not the reason that patients seek clinical care, and clinicians should be especially vigilant for their presence. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.

Keywords: schizophrenia, negative symptoms, prevalence, clinical presentation, diagnosis, treatment

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