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Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment

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Correll, Christoph U, Schooler, Nina R·2020·Neuropsychiatric Disease and Treatment
DOI 10.2147/ndt.s225643PMC PMC7041437
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Abstract

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

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Cited by

Sorted by citations

Authors
Correll, C. U., & Schooler, N. R.
Affiliations
  • Northwell Health (US)
  • SUNY Downstate Health Sciences University (US)
Corresponding author
Correll, Christoph U
ORCID
Venue
Neuropsychiatric Disease and Treatment
Publisher
Informa UK Limited
Published
2020-02
Volume
Volume 16
Pages
519-534
ISSN
  • 1176-6328 (ISSN-L)
  • 1178-2021
DOI
10.2147/ndt.s225643
PMC
PMC7041437
OpenAlex
W3007830452
Cited by
911
References
9
Citations by year
2026: 160 · 2025: 207 · 2024: 187 · 2023: 133 · 2022: 133 · 2021: 76 · 2020: 14
FWCI
14.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Allergan
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 › Pharmacology › Treatment of Major Depression
Keywords
schizophrenia, negative symptoms, blunted affect, alogia, avolition, asociality, anhedonia, primary negative symptoms, secondary negative symptoms, antipsychotic drugs, dopamine D2 receptor antagonists, functional outcome

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