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August 03, 2006
Negative Symptoms of Schizophrenia Are Pervasive
The Harvard Mental Health Letter this month has a good overview of the current knowledge of "negative symptoms" in schizophrenia. Following is a summary of their article:
Many people think of positive symptoms (hallucinations and delusions) when schizophrenia comes to mind. But negative symptoms are maybe more common, detrimental, pervasive, and even have a greater effect on the individual's quality of life. Negative symptoms are described as an absence of normal responses, including:
"Inexpressive faces, blank looks, monotone and monosyllabic speech, few gestures, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously."
An estimated 25% of people with schizophrenia have "the deficit syndrome", marked by "severe and persistent negative symptoms." These negative symptoms are related to the individuals inability to socialize, and are connected to the cognitive deficits seen in many patients. Its difficult to determine where negative symptoms end and cognitive deficits begin; is a patient exhibiting a negative symptom, like choosing not to talk (alogia) or a cognitive deficit, like inability to find the words. These negative symptoms are also the markers for any schizophrenia spectrum disorder (such as schizoptypal personality, and schizoid personality), as well as early markers for full schizophrenia prior to the first psychotic break.
Not only are these negative symptoms common and detrimental, little is available for treatment. Most antipsychotic medications work mainly on positive symptoms, and patients with mostly negative symptoms are often deemed "treatment resistant".
The Harvard Mental Health Letter suggests that
"the best we can do for negative symptoms is to provide education, psychotherapy, behavioral training, and help with employment, housing, and family relations. Supportive therapy offers reassurance, morale building, companionship, commonsense advice, and sometimes help with practical problems. Family therapy helps patients with schizophrenia and their families avoid both angry confrontations and equally harmful emotional distancing. In two studies, multiple family groups were particularly effective in reducing negative symptoms."
The goal of this is to educate the individual and family on the disorder (psychoeducation) in hopes of avoiding potentially harmful emotional reactions, and assisting in the coping process. It also includes daily life skill training and assistance in socializing for the individual with schizophrenia. This helps to treat both negative symptoms as well as potential cognitive deficits. Recently Cognitive Behavioral Therapy (CBT) is receiving wide spread support for the most effective, and long lasting therapeutic treatment of schizophrenia.
One form of CBT designed specifically for schizophrenia (Cognitive Rehabilitation, Remediation, or Enhancement) is based on the theory that patients become isolated because others are distant due to their negative symptoms (inability to express emotion and understand feelings). This therapy tries to teach the individual social skills, with; exercises on reading social cues, communicating their own needs, and showing understanding. But we must reiterate that any successful psychotherapeutic treatment for schizophrenia is always evaluated with medication/drug therapy.
Because of new research focusing on biological markers called endophenotypes ("endo" means internal and a "phenotype" is the visible expression of a genetic type), scientists are now saying schizophrenia may not be one disorder but several. Positive symptoms, negative symptoms, and cognitive deficits may differ in genetic origin as well as brain abnormalities. Obviously this research is in its earliest stages and more time will help to unravel the connections, and differences between not only schizophrenia but other psychiatric disorders.
"The negative symptoms of schizophrenia" Harvard Mental Health letter, July 1st 2006. (payment required to read full article).
Posted by Michelle Roberts at August 3, 2006 10:45 AM
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