Negative Symptoms in Schizophrenia: Depressive or Deficit Syndrome

  • Jacqueline A. Samson
  • Alexander Young
  • Ming T. Tsuang
Conference paper


The development of a comprehensive understanding of the etiology, treatment, and prevention of psychiatric disorders has been slow and hampered by uncertainties about the existence of etiologically distinct illnesses within the larger domain of psychiatric illness. Early attempts at subtyping psychiatric disorders relied heavily on clinical observation and the abilities of clinicians to recognize patterns of recurring symptoms and outcome within their clinics and practices. From this approach emerged the seminal descriptions of Kraepelin and Bleuler, and the foundation of current clinical nosology. Key to the early systems (and to our current DSM III-R system) (1) was the distinction between affective illnesses conceptualized as disorders of mood disturbance (such as manic-depressive psychosis), and schizophrenic illnesses conceptualized as being associated with a fundamental defect in the emotions or volition [according to Kraepelin (2)] or capacity for appropriate affective response or goal-directed activity [(according to Bleuler (3)]. Schizophrenic illnesses were seen as more permanent in nature, with a progressively deteriorating course, and often characterized by disordered thinking, delusional beliefs, or impairments in perceptual processes (hallucinations).


Negative Symptom Schizophrenic Patient Schizoaffective Disorder Depressive Syndrome Affective Illness 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Washington, DC, American Psychiatric Association, 1987.Google Scholar
  2. 2.
    Kraepelin E: Dementia Praecox and Paraphrenia. Translated by Barclay RM, edited by Robertson GM. Huntington, New York, Robert E. Krieger Publishing Co. Inc, 1971.Google Scholar
  3. 3.
    Bleuler E: Dementia Praecox or The Group of Schizophrenias. Translated by Zinkin J. New York, International Universities Press, 1950.Google Scholar
  4. 4.
    Kety SS: The concept of schizophrenia, in Controversies in Schizophrenia. Edited by Alpert M. New York, Guilford Press, 1985.Google Scholar
  5. 5.
    Crow TJ: The molecular pathology of schizophrenia: More than one disease process? Br Med J 280: 66–68, 1980.Google Scholar
  6. 6.
    Crow TJ: The two-syndrome concept: Origins and current status. Schizophr Bull 11: 471–485, 1985.Google Scholar
  7. 7.
    Goldberg S: Negative and deficit symptoms in Schizophrenia do respond to neuroleptics. Schizophr Bull 11: 453–456, 1985.Google Scholar
  8. 8.
    Strauss JS, Carpenter WT, Bartko JJ: The diagnosis and understanding of Schizophrenia: III. Speculations on the processes that underlie Schizophrrenic symptoms and signs. Schizophr Bull (Experimental issue No. 11 ): 6169, 1974.Google Scholar
  9. 9.
    Gift TE, Strauss JS, Kokes RF et al: Schizophrenia: affect and outcome. Am J Psychiatry 137: 580–585, 1980.Google Scholar
  10. 10.
    Strauss JS: Negative symptoms: future developments of the concept. Schizophr Bull 11: 457–460, 1985.CrossRefGoogle Scholar
  11. 11.
    Carpenter WT, Heinrichs DW, Alphs LD: Treatment of negative symptoms. Schizophr Bull 11: 440–452, 1985.PubMedCrossRefGoogle Scholar
  12. 12.
    Carpenter WT, Heinrichs DW, Wagman AMI: Deficit and nondeficit forms of Schizophrenia: the concept. Am J Psychiatry 145: 578–582, 1988.PubMedGoogle Scholar
  13. 13.
    Andreasen NC: Affective flattening and the criteria for Schizophrenia. Am J Psychiatry 136: 944–947, 1979.Google Scholar
  14. 14.
    Andreasen NC: Negative symptoms in Schizophrenia, definition and reliability. Arch Gen Psychiatry 39: 784788, 1982.Google Scholar
  15. 15.
    Andreasen NC: Positive vs negative Schizophrenia: a critical evaluation. Schizophr Bull 11: 380–389, 1985.Google Scholar
  16. 16.
    Lewine RJ, Sommers AA: Clinical definition of negative symptoms as a reflection of theory and methodology in Controversies in Schizophrenia. Edited by Alpert M. New York, Guilford Press, 1985.Google Scholar
  17. 17.
    Sommers AA: “Negative symptoms”: conceptual and methodological problems. Schizophr Bull 11: 364–378, 1985.Google Scholar
  18. 18.
    Grinker RR: Anhedonia and depression in Schizophrrenia, in Depression and Human Existence. Edited by Anthony EJ, Benedek T, Boston, Little, Brown and Co, 1975.Google Scholar
  19. 19.
    Cooper JE: Diagnostic change in a longitudinal study of psychiatric patients. Br J Psychiatry 113: 129–142, 1967.Google Scholar
  20. 20.
    Bowers MB, Astrachan BA: Depression in acute schizophrenic psychoses. Am J Psychiatry 123: 976–979, 1967.Google Scholar
  21. 21.
    Shanfield S, Tucker GJ, Harrow M et al: The schizophrenic patient and depressive symptomatology. J Nery Men Dis 151: 203–210, 1970.CrossRefGoogle Scholar
  22. 22.
    McGlashan TH, Carpenter WT: Affective symptoms and the diagnosis of schizophrenia. Schizophr Bull 5: 547–553, 1979.CrossRefGoogle Scholar
  23. 23.
    Brockington IF, Kendell RE, Wainwright S: Depressed patients with schizophrenic or paranoid symptoms. Psychological Medicine 10: 665–675, 1980.PubMedCrossRefGoogle Scholar
  24. 24.
    Moller H, vonZerssen D: Depressive states occurring during the neuroleptic treatment of schizophrenia. Schizophr Bull 8: 109–117, 1982.Google Scholar
  25. 25.
    Vaillant GE: The natural history of the remitting schizophrenias. Am J Psychiatry 120: 367–376, 1963.Google Scholar
  26. 26.
    McGlashan T, Carpenter WT: Post-psychotic depression in schizophrenia. Arch Gen Psychiatry 33: 231–239, 1976.CrossRefGoogle Scholar
  27. 27.
    Johnson DAW: The significance of depression in the prediction of relapse in chronic schizophrenia. Br J Psychiatry 152: 320–323, 1988.Google Scholar
  28. 28.
    Tsuang MT, Simpson JC: Schizoaffective disorder: concept and reality. Schizophr Bull 10: 14–25, 1984.CrossRefGoogle Scholar
  29. 29.
    Harrow M, Grossman L: Outcome in schizoaffective disorders: a critical review and re-evaluation of the literature. Schizophr Bull 10: 87–108, 1984.Google Scholar
  30. 30.
    Samson JA, Simpson JC, Tsuang MT: Outcome studies of schizoaffective disorders. Schizophr Bull, in press.Google Scholar
  31. 31.
    Vaillant GE: A historical review of the remitting schizophrenics. J Nery Ment Dis 138: 48–56, 1964.CrossRefGoogle Scholar
  32. 32.
    Stephens JH, Astrup C, Mangrum JC: Prognostic factors in recovered and deteriorating schizophrenics. Am J Psychiatry 122: 116–121, 1966.Google Scholar
  33. 33.
    McCabe MS, Fowler RC, Cadoret RJ et al: Symptom differences in schizophrenia with good and poor prognosis. Am J Psychiatry 128: 1239–1243, 1972.Google Scholar
  34. 34.
    Taylor MA, Abrams R: Manic-depressive illness and good prognosis schizophrenia. Am J Psychiatry 132: 741–742, 1975.Google Scholar
  35. 35.
    Knight RA, Roff JD, Barnett J, Moss JL: Concurrent and predictive validity of thought disorder and affectivity: a 22-year follow-up of acute schizophrenics. J Abn Psychol 88: 1–12, 1979.CrossRefGoogle Scholar
  36. 36.
    Tsuang MT, Dempsey GM: Long-term outcome of major psychoses II. Schizoaffective disorders compared with schizophrenia, affective disorders and a surgical control group. Arch Gen Psychiatry 36: 1302–1304, 1979.PubMedCrossRefGoogle Scholar
  37. 37.
    Abrams R, Taylor MA: A rating scale for emotional blunting. Am J Psychiatry 135: 226–229, 1978.Google Scholar
  38. 38.
    Iager AC, Kirch DG, Wyatt RG: A negative symptom rating scale. Psychiatry Res 16: 27–36, 1985.PubMedCrossRefGoogle Scholar
  39. 39.
    Kay SR, Fishzbein A, Opler LA: The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13: 261–275, 1987.PubMedCrossRefGoogle Scholar
  40. 40.
    Lindenmayer JP, Kay SR, Friedman C: Negative and positive schizophrenic syndromes after the acute phase: a prospective follow-up. Comp Psychiatry 27: 276–286, 1986.CrossRefGoogle Scholar
  41. 41.
    Kay SR, Fiszbein A, Lindenmayer JP et al: Positive and negative syndromes in schizophrenia as a function of chronicity. Acta Psychiatr Scand 74: 507–518, 1986.Google Scholar
  42. 42.
    Pogue-Geile MF, Harrow M: Negative and positive symptoms in schizophrenia and depression: a follow-up. Schizophr Bull 10: 371–387, 1984.Google Scholar
  43. 43.
    Samson JA, Young A, Tsuang M et al: Negative symptoms in schizophrenia and depression. In New Research Abstracts, American Psychiatric Association Annual Meetings. American Psychiatric Association, 1988.Google Scholar
  44. 44.
    Andreasen NC: Scale for the assessment of negative symptoms. Department of Psychiatry, College of Medicine, The University of Iowa, Iowa City, Iowa, 1984.Google Scholar
  45. 45.
    Endicott J, Spitzer RL: A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia (SADS). Arch Gen Psychiatry 35: 837–844, 1978.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Jacqueline A. Samson
    • 1
  • Alexander Young
    • 1
  • Ming T. Tsuang
    • 1
  1. 1.Harvard Medical School Boston Massachusetts and BrocktonWest Roxbury VA Medical CenterBrocktonUSA

Personalised recommendations