Do negative symptoms respond to pharmacological treatment?

Article Abstract:

Therapeutic effects of antipsychotic (neuroleptic) drugs are usually related to their ability to reduce the positive symptoms of schizophrenia (e.g., delusions, hallucinations, thought disorder and hostility) and relapse rates. Neuroleptics do not usually improve the deficit or negative symptoms of chronic schizophrenia (e.g., emotional impoverishment, lack of drive, social withdrawal and joylessness). Pharmacological effects are often difficult to assess because some negative symptoms are thought to be defensive reactions to side-effects of neuroleptics, such as psychomotor agitation and movement disorders. It is also difficult to assess whether depression in schizophrenia is related to demoralization or biological causes. As well, some dimensions of the negative spectrum tend to respond to neuroleptics if they occur along with an acute onset of positive symptoms. However, after the resolution of acute positive symptoms, the majority of patients are left with chronic negative symptoms. Several studies have indicated that the tricyclic antidepressant imipramine successfully reduces depression and psychomotor agitation and enhances self-esteem in schizophrenic patients with negative symptoms. Clinical trials of different classes of neuroleptics have yielded inconsistent results. However, clozapine, an atypical neuroleptic, has been shown to improve both positive and negative symptoms. Because clozapine can induce agranulocytosis (a condition marked by a reduction of circulating white blood cells, chest pain and ulcerations), it has not been widely tested. Since neuroleptics typically block dopamine receptors, drugs such as L-dopa, which enhances the activity of the brain messenger dopamine, have been combined with neuroleptics to treat some patients with negative symptoms and to reduce the risk of side-effects. The pharmacological treatment of negative symptoms and the long-term effects of treatment require further exploration and evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Antipsychotic drugs, Antipsychotic agents, Psychopharmacology

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Changes in the positive and negative symptoms of schizophrenic in-patients in China

Article Abstract:

Early definitions of schizophrenia focused on positive and negative symptoms. Positive symptoms refer to symptoms such as hallucinations and delusions, while negative symptoms refer to such symptoms as flat affect (mood). Negative symptoms are the fundamental characteristics of schizophrenia, and positive symptoms are secondary. In more recent diagnostic criteria, positive symptoms have received greater emphasis because they are more easily recognizable. It is debatable whether or not this is appropriate. In the present investigation, 401 Chinese schizophrenic in-patients were assessed for positive and negative symptoms of schizophrenia on admission to the hospital and upon discharge. Males represented 56.6 percent of the total sample, and the average age of the patient was 31.0 years. Subjects had been ill an average of 7.1 years, and had been admitted to a hospital an average of 3.0 times. Neuroleptic medication, the drug-class of choice for many schizophrenics, had not been administered during the year prior to the study in 35.7 percent of cases, and 23.4 percent of subjects had never been medicated. Overall, the average improvement between admission and discharge for positive symptoms was 80 percent, compared with 47 percent improvement for negative symptoms. About 15 percent of the patients actually had an increase in negative symptoms. Patients who had never been treated with neuroleptics had fewer negative symptoms at admission than those with a history of drug treatment (47.9 percent versus 61.6 percent), but the severity of negative symptoms at admission did not differ. At discharge, both severity and number of negative symptoms were the same for both groups. Therefore, negative symptoms are an important component of schizophrenia, and they respond to drug treatment at least partially. It is recommended that negative symptoms be better incorporated into diagnostic criteria for schizophrenia. (Consumer Summary produced by Reliance Medical Information, Inc.)

China, Evaluation, Symptomatology, Signs and symptoms

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Schneider's first-rank symptoms of schizophrenia: prevalence and diagnostic use

Article Abstract:

Schneider's first-rank symptoms of schizophrenia, 11 symptoms that have been thought to be indicative of the illness as long as there are no organic brain diseases present, have been generally regarded as useful to the study and diagnosis of schizophrenia. But their validity has, at times, been questioned, and whether or not they can be used for prognostic purposes remains unclear. There are also cultural variations among symptoms, necessitating the standardization of the first-rank symptoms for each culture being studied and making cross-cultural comparisons difficult. To achieve this standardization among Pakistani schizophrenics, 75 patients in Pakistan diagnosed as schizophrenic using the Research Diagnostic Criteria were assessed by a psychiatrist upon admission to a hospital, before treatment had been administered. First-rank symptoms were elicited. There were 43 males in the study and 32 females; the average age was 29.8 years. Twenty-five patients showed no first-rank symptoms, while first-rank symptoms were present in 26/43 males and 24/32 females. Most common were somatic passivity, which was exhibited by 66 percent of the patients who had at least one first-rank symptom, thought broadcast (46 percent), and thought insertion (42 percent). Comparison to other cultures is made and it is concluded that despite cross-cultural differences, first-rank symptoms have high inter-rater reliability and are simple to use in everyday assessment. However, they may be more useful within cultures than across cultures for making comparisons. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pakistan, Cross-cultural studies, Cross cultural studies

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