Cited by 1,311Schizophrenia research and treatmentMental Health and PsychiatryBipolar Disorder and Treatment

The NIMH-MATRICS Consensus Statement on Negative Symptoms

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Kirkpatrick, B., Fenton, W. S, Carpenter, W. T, Marder, S. R·2006·Schizophrenia Bulletin

Abstract

The impairments now called negative symptoms have long been noted as common features of schizophrenia, and the concept of negative symptoms itself has a long history.1,2 Patients who exhibit significant negative symptoms have particularly poor function and quality of life,3–8 and this aspect of schizophrenia has been proposed as a separate domain with distinctive pathophysiological and therapeutic implications since at least 1974.9 Despite the attention these problems receive, no drug has received Food and Drug Administration (FDA) approval for an indication of negative symptoms, and available data indicate that second-generation antipsychotic medications have not met early hopes for a highly effective treatment for alleviation of negative symptoms.10 Because of limited progress in the development of effective treatments for negative symptoms, under the auspices of the National Institute of Mental Health (NIMH), Drs. Steve Marder, Wayne Fenton, William T. Carpenter, Jr, and Brian Kirkpatrick initiated a process to examine issues that may interfere with treatment development. The NIMH had previously focused attention on impaired cognition as a therapeutic target with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) project. The success of the MATRICS process suggested similar progress could be made in the area of negative symptoms and provided a possible model for proceeding in the area of negative symptoms. Marder, Fenton, Carpenter, and Kirkpatrick organized a consensus development conference, which was held at the NIMH Neuroscience Center in Rockville, Maryland, on January 26–27, 2005. Those attending are listed in the appendix. The mission statement of the meeting was: To review the data relating to the existence of separate domains within negative symptoms, as a prerequisite for choosing appropriate measures of these domains in clinical trials. To initiate a process for developing or identifying widely acceptable, evidence-based measures and methodologies needed to establish the efficacy of treatments that target negative symptoms. Prior to the meeting, the organizers asked experts to address a series of questions: What are the separate components of negative symptoms? Are they independent, or components of the same latent construct? Which aspect of each domain belongs to the negative symptom construct? Does this area need a separate assessment? What is the best assessment method for clinical trials? Since research has suggested that both negative symptoms and cognitive impairments were significant determinants of poor outcome in schizophrenia, an additional set of questions related to the relationship between these domains of psychopathology was also addressed at the conference: Which aspects of cognition are part of the negative symptom construct? Which are independent? Which are uncertain? Articles that more fully address the topics of these presentations can be found in this issue of Schizophrenia Bulletin. Those articles address regulatory issues and negative symptoms,11 negative symptoms as a therapeutic target,12 the factor structure of negative symptoms,13 restricted affect,14 anhedonia,15 and the relationship between negative symptoms and cognitive impairment.16 At the conference other presentations were also made: Wayne Fenton spoke on “Meeting Goals and Objectives: The NIMH Perspective,” Robert Buchanan on “Summary of the MATRICS Process,” William Carpenter, Jr, on “Study Design and the “Pseudospecificity' Problem,” Michael Green on “Social Cognition,” Nancy Andreasen on “Alogia,” and Jeffrey Cummings on “Apathy.” Conference participants achieved consensus on 11 points. 1. Negative symptoms constitute a distinct therapeutic indication area. One purpose of this first statement is to encourage those involved in treatment development to target negative symptoms as a primary outcome variable in treatment trials. Historically, the main strategy for drug development has been to target “positive” psychotic symptoms (hallucinations, delusions, and disorganization) and hope that antipsychotic efficacy will extend to other aspects of schizophrenia, including negative symptoms. The underlying assumption of this approach is that positive and negative symptoms share an underlying pharmacology and hence will have a similar treatment response. The relative lack of success in developing pharmacological treatments for negative symptoms suggests this strategy is not sufficient and brings into question the assumption of a common neuropharmacology. 2. Negative symptoms and cognitive impairments represent separate domains. Aspects of interaction and overlap may be defined in the future, but documentation of substantial separation is available in current data. There is some evidence for a relationship between cognitive impairment and negative symptoms. (For further discussion of this issue, see the accompanying article by Harvey et al.16) The question therefore arose whether n

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  • Long-term social functioning deficits have been associated with increased severity of negative symptoms such as social withdrawal, avolition and apathy.

    “Long‐term social functioning deficits have also been associated with an increased severity of negative symptoms such as social withdrawal, avolition and apathy (Kirkpatrick et al. 2006; Marder and Galderisi 2017).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Kirkpatrick et al. 2006

    The Areas of Agreement section (page not provided) says negative symptoms can represent a loss of normal function and reduced quality of life. Section 5 (page not provided) identifies social withdrawal as a form of asociality and lists avolition among negative symptoms. The paper does not establish the claimed association between greater symptom severity and long-term social functioning deficits. (LLM, conf=0.82)

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Research works printed but not linked: 23

  1. Shitij Kapur, M.D., University of Toronto Brian Kirkpatrick, M.D., M.S.P.H., University of Maryland, Baltimore Ann Kring, Ph.D., University of California, Berkeley Thomas Laughren, M.D., Food and Drug Administra- tion Robert Levin, M.D., Food and Drug Administration Dolores Malaspina, M.D., Columbia University Steve Marder, M.D., University of California, Los Angeles Ellen Stover, Ph.D., National Institute of Mental Health Presentations at the Consensus Development Conference on Negative Symptoms, January 26-27, 2005 Meeting Goals and Objectives: The NIMH Perspective Wayne Fenton, M.D. Regulatory Issues and Negative Symptoms Thomas Laughren, M.D. Negative Symptoms as a Therapeutic Target Steve Marder, M.D. Summary of the MATRICS Process Robert Buchanan, M.D. Study Design and the ''Pseudospecificity'' Problem William Carpenter, M.D Factor structure and Psychometrics Jack Blanchard, Ph.D. Social Cognition Michael Green, Ph.D. Alogia Nancy Andreasen, M.D., Ph.D. Restricted Affect Brian Kirkpatrick, M.D., M.S.P.H. Anhedonia William Horan, Ph.D. Are Negative Symptoms and Cognitive Impairment Distinct? Philip Harvey, Ph.D. Apathy Jeffrey Cummings, M.D. FDA Comment Thomas Laughren, M.D. References 1. Kraepelin E. Demential praecox and paraphrenia. Barclay RM, trans. Edinburgh, Scotland: E S Livingston; 1919.
  2. Berrios GE. Positive and negative symptoms and Jackson: a conceptual history. Arch Gen Psychiatry. 1985;42:95-97.
  3. Wegener S, Redoblado-Hodge MA, Lucas S, Fitzgerald D, Harris A, Brennan J. Relative contributions of psychiatric symptoms and neuropsychological functioning to quality of life in first-episode psychosis. Aust N Z J Psychiatry. 2005;39:487-492.
  4. Lysaker PH, Lancaster RS, Nees MA, Davis LW. Attribu- tional style and symptoms as predictors of social function in schizophrenia. J Rehabil Res Dev. 2004;41:225-232.
  5. Lysaker PH, Davis LW. Social function in schizophrenia and schizoaffective disorder: associations with personality, symptoms, and neurocognition. Health Qual Life Outcomes. 2004;2:15.
  6. Orsel S, Akdemir A, Daq I. The sensitivity of quality-of-life scale WHOQOL-100 to psychopathological measures in schizophrenia. Compr Psychiatry. 2004;45:57-61.
  7. Norman RM, Malla AK, McLean T, et al. The relationship of symptoms and level of functioning in schizophrenia to gen- eral well-being and the Quality of Life Scale. Acta Psychiatr Scand. 2000;102:303-309.
  8. Strauss JS, Carpenter WT, Bartko JJ. An approach to the di- agnosis and understanding of schizophrenia: part III. specula- tions on the processes that underlie schizophrenic symptoms and signs. Schizophr Bull. 1974;11:61-75.
  9. Keefe RS, Harvey PD, Lenzenweger MF, Davidson M, Apter SH, Schmeidler J, Mohs RC, Davis KL. Efficacy and extra- pyramidal side-effects of the new antipsychotics olanzapine, quetaipaine, risperidone, and sertindole compared to conven- tional antipsychotics and placebo: a meta-analysis of random- ized controlled trials. Schizophr Res. 1999;35:51-68.
  10. Laughren T, Levin R. Food and Drug Administration Per- spective on Negative Symptoms in Schizophrenia as a Target for a Drug Treatment Claim. Schizophr Bull. 2006;32(2). First published on August 3, 2005, doi:10.1093/schbul/sbi039. · DOI
  11. Blanchard JJ, Cohen AS. The Structure of Negative Symp- toms Within Schizophrenia: Implications for Assessment. Schizophr Bull. 2006;32(2). First published on October 27, 2005, doi:10.1093/schbul/sbj013. · DOI
  12. Horan WP, Kring AM, Blanchard JJ. Anhedonia in Schizo- phrenia: A Review of Assessment Strategies. Schizophr Bull. 2006;32(2). First published on October 12, 2005, doi:10.1093/ schbul/sbj009. · DOI
  13. Harvey PD, Koren D, Reichenberg A, Bowie CR. Negative Symptoms and Cognitive Deficits: What Is the Nature of Their Relationship? Schizophr Bull. 2006;32(2). First pub- lished on October 12, 2005, doi:10.1093/schbul/sbj011. · DOI
  14. Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry. 1996;153:321-330.
  15. Carpenter WT, Heinrichs DW, Wagman AMI. Deficit and non-deficit forms of schizophrenia: the concept. Am J Psychi- atry. 1988;145:578-583.
  16. Kirkpatrick B, Buchanan RW, Ross DE, Carpenter WT. A separate disease within the syndrome of schizophrenia. Arch Gen Psychiatry. 2001;58:165-171.
  17. Kirkpatrick B, Kopelwicz A, Buchanan RW, Carpenter WT. Assessing the efficacy of treatments for the deficit syndrome of schizophrenia. Neuropsychopharmacology. 2000;22:303-310.
  18. Green MF, Olivier B, Crawley J, Penn D, Silverstein S. Social cognition in schizophrenia: recommendations from the MATRICS New Approaches Conference. Schizophr Bull. In press.
  19. Andreasen NC. Negative symptoms in schizophrenia: definition and reliability. Arch Gen Psychiatry. 1982;39: 784-788.
  20. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261-276.
  21. Buchanan RW, Carpenter WT. Domains of psychopathol- ogy: an approach to the reduction of heterogeneity in schizo- phrenia. J Nerv Ment Dis. 1994;182:193-204.
  22. Kimhy D, Yale S, Goetz RR, McFarr LM, Malaspina D. The Factorial Structure of the Schedule for the Deficit Syndrome in Schizophrenia. Schizophr Bull. 2006;32(2). First published on September 21, 2005, doi:10.1093/schbul/sbi064. · DOI
  23. Kirkpatrick B, Buchanan RW, McKenney PD, Alphs LD, Carpenter WT Jr. The Schedule for the Deficit Syndrome: an instrument for research in schizophrenia. Psychiatry Res. 1989;30:119-123.

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Authors
Kirkpatrick, B., Fenton, W. S., Carpenter, W. T., & Marder, S. R.
Affiliations
  • Augusta University (US)
  • National Institutes of Health (US)
  • University of Maryland, Baltimore (US)
  • University of California, Los Angeles (US)
Venue
Schizophrenia Bulletin
Published
2006-02-15
Volume
32
Issue
2
Pages
214-219
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
OpenAlex
W2121313171
Cited by
1,311
References
0
Citations by year
2026: 58 · 2025: 81 · 2024: 65 · 2023: 82 · 2022: 87 · 2021: 77 · 2020: 98 · 2019: 65 · 2018: 75 · 2017: 74 · 2016: 84 · 2015: 87 · 2014: 73 · 2013: 76 · 2012: 43
FWCI
21.29
Type
journal article
Language
en
Open access
Locations
  • Schizophrenia Bulletin (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
negative symptoms, schizophrenia
MeSH terms
Clinical Trials as Topic, Humans, National Institute of Mental Health (U.S.), Schizophrenia, Schizophrenic Psychology, Social Perception, Antipsychotic Agents, United States

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