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Review
. 2022 Jan 3:12:766692.
doi: 10.3389/fpsyt.2021.766692. eCollection 2021.

Primary and Secondary Negative Symptoms in Schizophrenia

Sergey N Mosolov  1   2 , Polina A Yaltonskaya  1
Affiliations
Review

Primary and Secondary Negative Symptoms in Schizophrenia

Sergey N Mosolov et al. Front Psychiatry. .

Abstract

The negative symptoms of schizophrenia include volitional (motivational) impairment manifesting as avolition, anhedonia, social withdrawal, and emotional disorders such as alogia and affective flattening. Negative symptoms worsen patients' quality of life and functioning. From the diagnostic point of view, it is important to differentiate between primary negative symptoms, which are regarded as an integral dimension of schizophrenia, and secondary negative symptoms occurring as a result of positive symptoms, comorbid depression, side effects of antipsychotics, substance abuse, or social isolation. If secondary negative symptoms overlap with primary negative symptoms, it can create a false clinical impression of worsening deficit symptoms and disease progression, which leads to the choice of incorrect therapeutic strategy with excessive dopamine blocker loading. Different longitudinal trajectories of primary and secondary negative symptoms in different schizophrenia stages are proposed as an important additional discriminating factor. This review and position paper focuses primarily on clinical aspects of negative symptoms in schizophrenia, their definition, phenomenology, factor structure, and classification. It covers the historical and modern concepts of the paradigm of positive and negative symptoms in schizophrenia, as well as a detailed comparison of the assessment tools and psychometric tests used for the evaluation of negative symptoms.

Keywords: course trajectory; depression; extrapyramidal symptoms; primary negative symptoms; schizophrenia; secondary negative symptoms.

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Conflict of interest statement

In the past 5 years, SM has received honoraria or consultation fees from Angelini, Gedeon Richter, Janssen, Lundbeck, Abbott, Grindex, and Servier. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hierarchy of negative symptoms by the level of their severity (25).
Figure 2
Figure 2
Secondary negative symptoms in schizophrenia. EPS, extrapyramidal symptom.
Figure 3
Figure 3
Trajectory of the development of primary and secondary negative symptoms in schizophrenia. EPS, extrapyramidal symptom.
See this image and copyright information in PMC

References

    1. Bobes J, Arango C, Garcia-Garcia M, Rejas J. Prevalence of negative symptoms in outpatients with schizophrenia spectrum disorders treated with antipsychotics in routine clinical practice: findings from the CLAMORS study. J Clin Psychiatry. (2010) 71:280–6. 10.4088/JCP.08m04250yel - DOI - PubMed
    1. Galderisi S, Mucci A, Bitter I. Persistent negative symptoms in first episode patients with schizophrenia: results from the european first episode schizophrenia trial. Eur Neuropsychopharmacol. (2013) 23:196–204. 10.1016/j.euroneuro.2012.04.019 - DOI - PubMed
    1. Patel R, Jayatilleke N, Broadbent M. Negative symptoms in schizophrenia: a study in a large clinical sample of patients using a novel automated method. BMJ Open. (2015) 5:7619. 10.1136/bmjopen-2015-007619 - DOI - PMC - PubMed
    1. Möller H, Jäger M, Riedel M, Obermeier M, Strauss A, Bottlrnder R. The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: assessing courses, types and time stability of diagnostic classification. Eur Psychiatry. (2011) 26:231–43. 10.1016/j.eurpsy.2010.04.012 - DOI - PubMed
    1. Strauss GP, Horan WP, Kirkpatrick B. Deconstructing negative symptoms of schizophrenia: avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome. J Psychiatr Res. (2013) 47:783–90. 10.1016/j.jpsychires.2013.01.015 - DOI - PMC - PubMed

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