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Negative Symptoms Across the Schizophrenia Spectrum: Phenomenological and Neurobiological Perspectives

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Handbook of Schizophrenia Spectrum Disorders, Volume II

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Abstract

Recognition of the negative symptoms of schizophrenia dates back to the earliest descriptions of Kraepelin and Bleuler. Since, there has been increasing interest in this domain of psychopathology, in large part driven by the recognition of its importance in determining functional outcomes. This is highlighted by the recent formation of a National Institute of Mental Health (NIMH) initiative focused on negative symptoms. In the present chapter we explore the historical and current conceptualization of the negative symptoms of schizophrenia, including the recent formulation of two core subdomains of negative symptoms: (1) Diminished expression; and (2) Amotivation. We then expand this current conceptualization through an exploration of these negative symptoms across the schizophrenia spectrum, including schizoaffective disorder, high-risk and prodromal non-affective psychosis populations, as well as the schizophrenia spectrum personality disorders. The phenomenology of negative symptoms in schizophrenia and schizoaffective disorder, derived from studies examining one or both of these illnesses, are compared and contrasted. We then explore the prominence of such negative symptoms in the clinical presentation of high-risk and prodromal populations. Moreover, with the expanding genetic boundaries of the schizophrenia spectrum that now includes schizotypal, schizoid, paranoid, and avoidant personality disorders, we discuss the presence of negative symptoms in these populations. A growing body of evidence for the neurobiological underpinnings of these symptoms from across the schizophrenia spectrum is explored. We subsequently conclude with a synthesis of the negative symptom construct across the schizophrenia spectrum, based on available scientific evidence, and highlight fundamental questions that remain to be addressed as we move towards a more comprehensive understanding of negative symptoms and ultimately strive to improve functional outcomes for individuals with schizophrenia.

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Abbreviations

AES:

Apathy evaluation scale

BPRS:

Brief psychiatric rating scale

CT:

Computed tomography

DLPFC:

Dorsolateral prefrontal cortex

DTI:

Diffusion tensor imaging

fMRI:

functional magnetic resonance imaging

GABA:

Gamma amino butyric acid

MRI:

Magnetic resonance imaging

NAA:

N-acetylaspartate

NIMH:

National institute of mental health

NOS:

Not otherwise specified

OFC:

Orbitofrontal cortex

PANSS:

Positive and negative syndrome scale

PAS:

Physical anhedonia scale

PET:

Positron emission tomography

PFC:

Prefrontal cortex

rCBF:

regional cerebral blood flow

SANS:

Scale for the assessment of negative symptoms

SAPS:

Scale for the assessment of positive symptoms

SAS:

Social anhedonia scale

SDS:

Schedule for the deficit syndrome

SPD:

Schizotypal personality disorder

SPECT:

Single photon emission computed tomography

VTA:

Ventral tegmental area

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Authors and Affiliations

  1. Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada, M5T 1R8

    George Foussias, Ofer Agid & Gary Remington

  2. Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada, M5S 1A8

    George Foussias & Gary Remington

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  1. George Foussias
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Correspondence to George Foussias .

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  1. , Rappaport Faculty of Medicine, Technion - Israel Institute of Technolog, Haifa, Israel

    Michael Ritsner

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Foussias, G., Agid, O., Remington, G. (2011). Negative Symptoms Across the Schizophrenia Spectrum: Phenomenological and Neurobiological Perspectives. In: Ritsner, M. (eds) Handbook of Schizophrenia Spectrum Disorders, Volume II. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0831-0_1

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