<p>Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment</p>

Neuropsychiatric Disease and Treatment, Journal Year: 2020, Volume and Issue: Volume 16, P. 519 - 534

Published: Feb. 1, 2020

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

Language: Английский

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Negative symptoms of schizophrenia: new developments and unanswered research questions

The Lancet Psychiatry, Journal Year: 2018, Volume and Issue: 5(8), P. 664 - 677

Published: March 27, 2018

Language: Английский

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The clinical characterization of the patient with primary psychosis aimed at personalization of management

World Psychiatry, Journal Year: 2021, Volume and Issue: 20(1), P. 4 - 33

Published: Jan. 12, 2021

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica­tion prescribed, second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy rarely used in the vast majority countries, although there evidence support its efficacy. Psychosocial interventions are provided, especially chronic cases, but those applied frequently not validated by research. Evidence‐based family and supported employment programs seldom implemented ordinary practice. Although notion that at increased risk for cardiovascular diseases diabetes mellitus widely shared, it frequent appropriate measures be address this problem. view patient should personalized endorsed clinicians, personalization lacking or inadequate most clinical contexts. many mental health services would declare themselves “recovery‐oriented”, common a focus on empowerment, identity, meaning resilience ensured present paper aims situation. It describes systematically salient domains considered characterization individual aimed management. These include positive negative symptom dimensions, other psychopathological components, onset course, neurocognition social cognition, neurodevelopmental indicators; functioning, quality life unmet needs; staging, antecedent concomitant psychiatric conditions, physical comorbidities, history, history obstetric complications, early recent environmental exposures, protective factors resilience, internalized stigma. For each domain, simple assessment instruments identified could use practice included standardized decision tools. A encouraged which takes into account available treatment modalities whose efficacy research evidence, selects modulates them basis characterization, addresses patient’s needs terms employment, housing, self‐care, relationships education, offers resilience.

Language: Английский

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Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis

European Archives of Psychiatry and Clinical Neuroscience, Journal Year: 2018, Volume and Issue: 268(7), P. 625 - 639

Published: Jan. 24, 2018

Language: Английский

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EPA guidance on assessment of negative symptoms in schizophrenia

European Psychiatry, Journal Year: 2021, Volume and Issue: 64(1)

Published: Jan. 1, 2021

Abstract Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by increased awareness that they interfere severely with real-life functioning, particularly when are primary and persistent. Methods In this guidance paper, we provide systematic review of evidence elaborate several recommendations conceptualization assessment NS in clinical trials practice. Results Expert consensus reviews have provided optimal persistent symptoms; second-generation rating scales, which better experiential domains, available; however, still poorly assessed both research settings. This European Psychiatric Association (EPA) recommends use (PNS) construct context highlights need further efforts to make definition PNS consistent across studies order exclude as much possible secondary symptoms. We also encourage clinicians at least complement first-generation ones. The EPA evidence-based exclusion items included scales from any summary or factor score improve measurement Self-rated instruments suggested observer-rated assessment. Several identification Conclusions dissemination paper may promote development national guidelines on symptom ultimately care people schizophrenia.

Language: Английский

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Neuroscience of Psychotherapy

American Psychiatric Association Publishing eBooks, Journal Year: 2022, Volume and Issue: unknown

Published: Sept. 21, 2022

Language: Английский

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EPA guidance on treatment of negative symptoms in schizophrenia

European Psychiatry, Journal Year: 2021, Volume and Issue: 64(1)

Published: Jan. 1, 2021

Abstract Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there growing evidence base regarding effects biological psychosocial interventions on negative symptoms. importance distinction between primary secondary for selection might seem evident, but currently available remains limited. Good clinical practice recommended Antipsychotic should be optimized to avoid due side positive For most interventions, further needed formulate sound recommendations primary, persistent, or predominant However, based undifferentiated (including both symptoms) are provided. Although it has proven difficult an evidence-based recommendation choice antipsychotic, switch second-generation antipsychotic considered patients who treated with first-generation antipsychotic. Antidepressant add-on option. Social skills training as well cognitive remediation also show impairment. Exercise have shown promise. Finally, access rehabilitation ensured Overall, definitive field, research clearly develop specific treatments

Language: Английский

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The Latent Structure of Negative Symptoms in Schizophrenia

JAMA Psychiatry, Journal Year: 2018, Volume and Issue: 75(12), P. 1271 - 1271

Published: Sept. 12, 2018

Negative symptoms are associated with a range of poor clinical outcomes, and currently available treatments generally do not produce clinically meaningful response. Limited treatment progress may be owing in part to clarity regarding latent structure. Prior studies have inferred structure using exploratory factor analysis, which has led the conclusion that there 2 dimensions reflecting motivation pleasure (MAP) diminished expressivity (EXP) factors. However, whether these conclusions statistically justified remains unclear because analysis does test Confirmatory (CFA) is needed competing models construct.To evaluate fit 4 negative schizophrenia CFA.Three cross-sectional were conducted on outpatients who rated 3 most conceptually contemporary measures: Scale for Assessment Symptoms (SANS), Brief Symptom (BNSS), Clinical Interview (CAINS). evaluated following models: (1) 1-factor model; (2) 2-factor model EXP MAP factors; (3) 5-factor separate factors 5 domains National Institute Mental Health consensus development conference (blunted affect, alogia, anhedonia, avolition, asociality); (4) hierarchical second-order first-order domains.Outcomes included CFA statistics derived from symptom severity scores SANS, BNSS, CAINS.The study population 860 (68.0% male; mean [SD] age, 43.0 [11.4] years). was each scale, including 268 patients 192 400 CAINS. The 1- provided CAINS as indicated by comparative indexes (CFIs) Tucker Lewis (TLIs) less than 0.950, RMSEAs exceeded 0.080 threshold, WRMRs greater 1.00. excellent fit, being more parsimonious. CFIs TLIs met 0.95 threshold 1.00 both all measures. Interestingly, fell under 0.08 BNSS but SANS.These findings suggest recent trend toward conceptualizing distinct adequately capture complexity construct. best conceptualized relation domains. Implications identifying pathophysiological mechanisms targeted discussed.

Language: Английский

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Anhedonia in depression and schizophrenia: A transdiagnostic challenge

CNS Neuroscience & Therapeutics, Journal Year: 2018, Volume and Issue: 24(7), P. 615 - 623

Published: April 23, 2018

Summary Background Anhedonia, as a dysregulation of the reward circuit, is present in both Major Depressive Disorder (MDD) and schizophrenia (SZ). Aims To elucidate clinical neurobiological differences between ( SZ ) depression MDD regard to anhedonia, while reconciling challenges benefits assessing anhedonia transdiagnostic feature under Research Domain Criteria RD oC) framework. Methods In this review, we summarize data from publications examining or its underlying deficits MDD. A literature search was conducted OVID Medline, PsycINFO EMBASE databases 2000 2017. Results While certain subgroups share commonalities, there are also important differences. may be characterized by disorganization, rather than deficiency, processing cognitive function, including inappropriate energy expenditure focus on irrelevant cues. contrast, has been anticipatory pleasure, development associations, integration information past experience. Understanding roles neurotransmitters aberrant brain circuitry necessary appreciate function . Conclusion Anhedonia presentation circuit an relatively undertreated symptom order improve patient outcomes quality life, it consider how fits into diagnoses.

Language: Английский

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Cross-cultural Validation of the 5-Factor Structure of Negative Symptoms in Schizophrenia

Schizophrenia Bulletin, Journal Year: 2018, Volume and Issue: 45(2), P. 305 - 314

Published: April 4, 2018

Negative symptoms are currently viewed as having a 2-dimensional structure, with factors reflecting diminished expression (EXP) and motivation pleasure (MAP). However, several factor-analytic studies suggest that the consensus around model is premature. The current study investigated cross-culturally validated factorial structure of BNSS-rated negative across range cultures languages.Participants included individuals diagnosed psychotic disorder who had been rated on Brief Symptom Scale (BNSS) from 5 cross-cultural samples, total N = 1691. First, exploratory factor analysis was used to extract up 6 data. Next, confirmatory evaluated fit models: (1) 1-factor model, 2) 2-factor MAP EXP, 3) 3-factor inner world, external, alogia factors; 4) 5-factor separate for blunted affect, alogia, anhedonia, avolition, asociality, 5) hierarchical 2 second-order EXP MAP, well first-order aforementioned domains.Models 4 or less were mediocre fits 5-factor, 6-factor, models provided excellent an edge model. demonstrated invariance samples.Findings support validity diverse languages. These findings have important implications diagnosis, assessment, treatment symptoms.

Language: Английский

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