The current conceptualization of negative symptoms in schizophrenia

Abstract

Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.

Exploratory comparison of auditory verbal hallucinations and other psychotic symptoms among youth with borderline personality disorder or schizophrenia spectrum disorder

“…In line with this, Slotema et al () reported that the mean age of AVH onset was 16 years in adults with BPD, compared with 20 years in adults with SZ. Fifth, the PANSS has been criticized for not comprehensively covering all relevant negative symptom dimensions (ie, blunted affect, alogia, anhedonia, asociality and avolition) (Marder & Galderisi, ). Finally, this is a cross‐sectional study.…”

Negative symptoms of psychosis: A life course approach and implications for prevention and treatment

“…Based on factor analysis studies, they can be divided into deficits of expression and motivation/pleasure (Lyne, Renwick, Grant, et al, ), and recently developed scales have reflected this negative symptom structure (Barch, ; Strauss et al, ). Deficits of expression include affective flattening and alogia, whereas motivation/pleasure domain symptoms include avolition, anhedonia and asociality (Marder & Galderisi, ). Some studies have suggested different correlates for each domain and domain‐based research is ongoing (Strauss et al, ).…”

Anhedonia in depression and schizophrenia: A transdiagnostic challenge

“…SZ is also a heterogeneous disorder, marked by the variable presentation of positive symptoms (ie, hallucinations and delusions), negative symptoms (ie, amotivation and diminished expression), and cognitive deficits. Historically, the core negative symptoms consisted of anhedonia, asociality, alogia, avolition, and affective flattening . However, the current conceptualization of negative symptoms outlines two separate but interrelated subdomains: amotivation (within which anhedonia is subsumed) and diminished expression (including alogia and affective flattening) .…”

“…Patients with MDD are unable to adequately utilize rewarding or positive feedback to optimize reward outcomes; however, they do not differ from controls in their ability to utilize punishment information to avoid loss . Further, patients with SZ often experience memory deficits which may impede normal reward learning and pleasure recall, contributing to inaccurate appraisals of rewards and impaired decision‐making in pursuit of such rewards …”