Psychological treatments for negative symptoms

Article Abstract:

Psychological treatment approaches to the negative symptoms of schizophrenia (e.g., blunted emotions, poverty of speech and loss of drive) are described. Token economies which involve behavior modification and operant conditioning were extensively utilized in the 1950s. When patients behaved well, they were given tokens, which could later be exchanged for positive reinforcers such as cigarettes, candy or extra television time. Still used, this method does improve some negative symptoms in long-term patients, but the rewarding social interactions between staff and patients rather than the token rewards are now thought to be the strongest treatment factor. Social skills training programs, developed in the early 1980s, have been tried, but have only reported short-term benefits. Life skills training approaches, which focus on money management, interpersonal skills, nutrition, hygiene, community resources and social networks, have also demonstrated significant favorable short-term effects, although long-term effects have not been assessed. Cognitive behavior modification techniques involve self-instructional training (SIT). SIT teaches patients to first instruct themselves out loud, then quietly on how to plan and control their own behavior. SIT has been shown to improve the cognitive performance of patients with negative symptoms. Interpersonal problem-solving approaches are more recent. A study which trained patients to identify social problems, define goals, generate solutions, evaluate alternatives and pick the best solution produced positive effects at one- and four-month follow-up periods. It is concluded that designing therapeutic regimens for specific symptoms and specific patient populations would enhance the efficacy of existing treatment approaches. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Evaluation, Psychiatric hospital care, Psychiatric hospitals, Cognitive psychology

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Psychological and social aspects of negative symptoms

Article Abstract:

Relatively few research endeavors have examined the psychological and social aspects of the negative symptoms of schizophrenia (e.g., social withdrawal, poverty of speech and slow motor responses). A review of several studies, patient-reports and clinical observations led to the formulation of two theories of negative symptoms: (1) they can be defensive responses to difficult psychosocial situations; and (2) they may have a psychosocial impact on the course of illness. Several case reports portray how social withdrawal can occur in response to the fear of psychotic relapse or of acting impulsively or bizarrely, loss of hope and self-esteem, or else result from frustration when confronting a need to find an identity other than that of a sick person. For many patients, social and occupational situations can be extremely stressful. Giving up can be adaptive, since it can lead to the possibility of getting help from others. Negative symptoms have been associated with long-term institutionalization in nonstimulating environments. There have been anecdotal reports of severely ill schizophrenics who take leading roles in rescuing others during floods and fires and who respond well to a variety of crises. Other contributors to negative symptoms are thought to be the stigma attached to mental illness and the fact that benefit systems (e.g. welfare) often consider patients who show signs of improvement ineligible for further benefits. A developmental disease model is proposed which views mental illness as the result of complex interactive biological, social and psychological factors. It is felt that a biopsychosocial approach will lead to more effective treatment regimens. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Environmental aspects

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• Abstracts: Do negative symptoms respond to pharmacological treatment? Changes in the positive and negative symptoms of schizophrenic in-patients in China

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