Primary and Secondary Negative Symptoms in Schizophrenia

Abstract

The negative symptoms of schizophrenia include volitional (motivational) impairment manifesting as avolition, anhedonia, social withdrawal, and emotional disorders such as alogia and affective flattening. Negative symptoms worsen patients' quality of life and functioning. From the diagnostic point of view, it is important to differentiate between primary negative symptoms, which are regarded as an integral dimension of schizophrenia, and secondary negative symptoms occurring as a result of positive symptoms, comorbid depression, side effects of antipsychotics, substance abuse, or social isolation. If secondary negative symptoms overlap with primary negative symptoms, it can create a false clinical impression of worsening deficit symptoms and disease progression, which leads to the choice of incorrect therapeutic strategy with excessive dopamine blocker loading. Different longitudinal trajectories of primary and secondary negative symptoms in different schizophrenia stages are proposed as an important additional discriminating factor. This review and position paper focuses primarily on clinical aspects of negative symptoms in schizophrenia, their definition, phenomenology, factor structure, and classification. It covers the historical and modern concepts of the paradigm of positive and negative symptoms in schizophrenia, as well as a detailed comparison of the assessment tools and psychometric tests used for the evaluation of negative symptoms.

Assessment and Treatment of Negative Symptoms in Schizophrenia—A Regional Perspective

“…The literature collected by the participants of this regional project shows that negative symptoms are considered important, and the selected literature and expert opinions reflect highlevel interest in the negative symptoms of schizophrenia in CEE countries. In the majority of CEE, the terminology of negative symptoms is dominated by English, as summarized in the currently published European guidance paper on the evaluation of negative symptoms in schizophrenia (2) however, traditional German psychopathology [e.g., the work of Huber (13,14)] has a significant influence in the region, and Russian schools have a strong influence not only in Russia, but also in some other countries, especially in former republics of the Soviet Union (15,16). Table 1 includes the names and frequencies of negative symptoms listed by experts from 17 countries.…”

The Understandability of Diagnostic Criteria Towards the Latest Version of ICD: A National Participatory Research For a More Democratic Approach In The Conceptualization of the Term “Schizophrenia” Among Service Users In Greece

“…Factor analysis of symptoms using the SANS scale revealed three main factors: affective attening (reduced expressiveness), disturbed attention-alogia (poverty of speech) and reduced social motivation (abulia, apathy, anhedonia, asociality) (Mosolov &Yaltonskaya, 2022). This ve-factor model of negative symptoms in schizophrenia has recently further been con rmed with independent network analysis (Demyttenaere et al, 2021;Kirkpatrick et al, 2006;Mosolov & Yaltonskaya, 2022).…”

MDMA for the Treatment of Negative Symptoms in Schizophrenia

“…The terms “positive” and “negative” symptoms can be traced back to the mid-1800s, when British neurologists distinguished between distortions and deficits of motor and cognitive functions [ 16 ]. Over time, this became increasingly applied to mental disorders, eventually being described by Kraepelin as irreversible and progressive deficits in individuals with dementia praecox [ 17 ]. Shortly after coining the term “schizophrenia,” Bleuler emphasized negative symptoms as the core process of the illness, speculating that symptoms were rooted in the weakening of mental functions [ 18 ].…”

“…Over the next few decades, additional tools were developed, leading to various constructs. It became increasingly clear that negative symptoms research was limited by a lack of consensus [ 17 ]. As such, an NIMH-sponsored meeting was convened in 2005, leading to the construct that predominates to this day [ 20 , 21 ].…”