Negative symptoms of schizophrenia are a core symptom cluster that determines, together with cognition, real-world function in the community. This chapter reviews the comprehensive assessment of the five modern negative symptom domains: alogia, blunted affect, anhedonia, avolition, and asociality. Of those, “failure of the will” (avolition) may be most critical for function. The distinction between primary and secondary negative symptoms as well as persistent negative symptoms for treatment planning is emphasized. Finally, treatments including non-pharmacological approaches are discussed.
KeywordsNegative symptoms Eugen Bleuler Deficit syndrome Alogia Blunted affect Anhedonia Avolition Asociality Assessment Primary negative symptoms Persistent negative symptoms Secondary negative symptoms Treatments Cariprazine
- 33.Zisook S, Kasckow JW, Golshan S, Fellows I, Solorzano E, Lehman D, et al. Citalopram augmentation for subsyndromal symptoms of depression in middle-aged and older outpatients with schizophrenia and schizoaffective disorder: a randomized controlled trial. J Clin Psychiatry. 2009;70:562–71.CrossRefGoogle Scholar
- 35.Sweet V. Slow medicine: the way to healing. New York: Riverhead Books; 2017.Google Scholar
- Baumeister RT, Tierney J. Willpower: rediscovering the greatest human strength. New York, NY: The Penguin Press; 2011. – A revisiting of the idea of the will that applies to patients with negative symptoms.Google Scholar
- Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. World Psychiatry. 2017;16:14–24. – A recent summary and update that provides more detail about the five negative symptoms domains and how these five constructs are actually measured (provides helpful examples from the established negative symptom rating scales).CrossRefGoogle Scholar
- McNally K. Eugene Bleuler’s four As. Hist Psychol. 2009;12:43–59. – As noted in the chapter, Bleuler never articulated his four As. Using Bleuler’s four As as an example, the author argues that progressive research agendas ignore historical context at their own peril. The article is a passionate plea to avoid intellectual laziness and read the primary literature.CrossRefGoogle Scholar