Primary and persistent negative symptoms: Concepts, assessments and neurobiological bases
Section snippets
Primary and persistent negative symptoms: evolution of concepts and assessment
Negative symptoms of schizophrenia represent a heterogeneous clinical construct and different strategies have been proposed to reduce their heterogeneity in the context of clinical trials and neurobiological research. The distinction between primary negative symptoms, a core aspect of the illness (Carpenter et al., 1988) and negative symptoms secondary to other factors (e.g. positive symptoms, extrapyramidal side effects, depression or isolation) bears important therapeutic implications. In
Definition
DS is defined by the diagnostic criteria outlined in the Box 1. The categorization of patients into DS and NDS by means of the Schedule for the Deficit Syndrome (SDS, Kirkpatrick et al., 1989) has been shown to have good inter-rater reliability (Kirkpatrick et al., 1989, Fenton and McGlashan, 1994, Amador et al., 1999, Galderisi et al., 2002, Peralta and Cuesta, 2004) and a high degree of stability with good test-retest reliability (Kirkpatrick et al., 1993, Fenton and McGlashan, 1994, Amador
Definition
The concept of PNS is broader than that of DS (Buchanan, 2007) and, according to the NIMH-MATRICS consensus report, includes symptoms that have not responded to the usual treatments, interfere with patient’s ability to perform normal role functions, persist during periods of clinical stability, and represent an unmet therapeutic need (Kirkpatrick et al., 2006). PNS criteria according to Buchanan (2007) are listed in Box 2.
Conclusions
In the last decades, the attempt to reduce heterogeneity of negative symptoms of schizophrenia led to the identification of two psychopathological constructs: DS and PNS.
Since the introduction of the criteria for diagnosing DS a large body of research has been carried out, trying to distinguish DS from NDS. An important research question is whether DS represents a more severe form of the same illness with respects to NDS or a separate disease entity. Brain imaging (Gonul et al., 2003, Heckers
Authors' contributions
All authors were involved in the manuscript development and review and have approved the final draft of the manuscript for publication.
Conflicts of interest
Armida Mucci has received a partial coverage of the expenses to participate in the 2015 EPA congress from Janssen-Cilag (unrelated to this paper).
Alp Üçok has received honoraria from Abdi Ibrahim, Otsuka, AstraZeneca and Janssen-Cilag (unrelated to this paper).
Silvana Galderisi participated in advisory boards for Hoffmann-La Roche, Janssen-Cilag, Lundbeck, Angelini-Acraf, Amgen and Pierre Fabre (unrelated to this paper).
André Aleman was supported by an ERC consolidator grant (project no.
Acknowledgments
The authors wish to thank the European negative symptoms research network (EuroNES) group and the ECNP Schizophrenia Network for the fruitful discussion of the reviewed topics.
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