The historical evolution of the concept of negative symptoms in schizophrenia

Article Abstract:

In the late 1880s, a model of the mind was assumed which concluded that negative or deficit symptoms were caused by a loss of normal functions, while positive symptoms were related to disinhibition and exaggerations of normal functions. Theorists continue to debate the nature of the properties of negative and positive phenomena. Deficiency theories became more influential when the Viennese psychiatrist Berze divided schizophrenia into primary process symptoms (e.g., thought disorder, incoherence, altered activity, hallucinations, and altered feeling states), which he felt stemmed from the basic psychotic disturbance, and secondary deficit symptoms caused by brain lesions (e.g., bizarre thinking, negativism, delusions, stereotyped mannerisms, loss of interest and emotional blunting). In the 1950s, dynamistic theories of schizophrenia which emphasized mood, drive and emotions began to develop. In this approach, three types of dynamic derailments were possible: expansion (resulting in manic states), restriction (resulting in depressive states), and rapid fluctuations between states. Since 1959, the structural dynamic approach has made distinctions between positive states of dynamic fluctuations, which respond well to treatment with antipsychotic drugs (neuroleptics), and negative states of restriction or deficiency, which tend not to respond to neuroleptic treatment. It is thought that the dynamistic-related approaches, which entail overlappings between positive and negative symptoms, fit well with recent psychological and neurological findings, while approaches that adopt the earlier division between positive and negative symptoms do not sufficiently describe chronological schizophrenic phenomena. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Cognition disorders, Cognitive disorders

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The concept of negative symptoms

Article Abstract:

In the late 1950s, a distinction based on nurse ratings of schizophrenic behavior was made between patients who demonstrated predominantly positive or paranoid features (e.g., delusions and hallucinations), overactivity, inappropriate emotions, oddness or violence, and patients who demonstrated predominantly negative (nonparanoid), social withdrawal (SW) symptoms (e.g., slowness, underactivity, poverty of speech, and poor self-care). Later, a relationship between the chronic nature of the illness, SW symptoms and blunt or flattened emotions was noted, leading to the speculation that some schizophrenic symptoms were subject to environmental influence. This theory was tested by a study which found that social reinforcement and stimulation improved the work performance of severely ill schizophrenics, although improvements lasted only while the stimulation was ongoing. Several follow-up studies of schizophrenic patients in the 1960s found that many patients deteriorated when their social environment became too understimulating. Further studies led to the conclusion that rehabilitation required efforts to sustain an optimal social environment, that relapse could occur if patients were pressured by unrealistic performance goals or life changes, and that critical comments made by family members could precipitate florid paranoid symptoms. More recent studies have shown that negative and positive symptoms can occur either separately or together over the course of illness and that negative symptoms are, in part, a protective reaction against thought disorder and social disappointments. Overall findings indicate that environmental factors play a crucial role in the course of schizophrenia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Environmental aspects

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The assessment of psychiatric disability in the community: a comparison of clinical, staff, and family interviews

Article Abstract:

Comparisons were made between different types of evaluative assessments of 145 long-term psychiatric patients (80 men and 65 women with an average age of 50) living in the community, who had been attending a psychiatric day-care center for at least one year. Almost half of the patients had diagnoses of schizophrenia or paranoid psychosis. Patients with severe mental retardation, addicted to drugs, or over 65 years of age with a diagnosis of dementia, were excluded from the study. Evaluative assessments for each patient included a clinical interview with the patient, and interviews with the day-care staff, a family member, or residential staff (e.g., a home-care nurse). Scales for rating attitudes and social contacts, and for assessing retardation, social interactions, neurotic problems and behavioral problems, were also administered. Estimates made by family members or residential staff members of symptoms and behavioral problems were higher than those made by day-care staff. Clinical interviews with patients provided lower estimates of retardation and social interaction deficits than other types of assessments. Estimates of neurotic problems from the clinical interview were equivalent to those provided by residential evaluators, but were significantly higher than estimates made by day-care staff. Overall reliability between the ratings of day-care observers and residential-care observers was very low, suggesting that mental health-care workers and researchers should be aware of limitations of assessments made during restricted observation periods. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Testing, Psychiatric disability evaluation, Interviewing in psychiatry, Psychiatric interviewing

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