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The Symptoms of Schizophrenia

Although symptom combinations and patterns vary considerably among patients with schizophrenia and change over time in individuals, there are 3 core symptom domains: positive, negative, and cognitive1

About the Symptoms of Schizophrenia

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References

  1. Tamminga, C. A. Schizophrenia. Merck Manual Professional Version (2018). Available at: https://www.merckmanuals.com/professional/psychiatric-disorders/schizophrenia-and-related-disorders/schizophrenia#v39692526.

Negative Symptoms: Getting to the Specifics

Negative symptoms, a core symptom domain in schizophrenia, are described as a lessening or absence of normal behaviors and functions related to either motivation and interest, or emotional expression.

Negative symptom dimensions
PrimaryCause factor: schizophrenia, core symptom
SecondaryCause factor: other symptoms of schizophrenia, depression, environment
ProminentIntensity factor: more negative symptoms than positive symptoms
PredominantIntensity factor: high level of negative symptoms, low positive symptoms
PersistentTime factor: present for more than 6 months – 1 year

References

  1. Mucci, A., Merlotti, E., Üçok, A., Aleman, A. & Galderisi, S. Primary and persistent negative symptoms: Concepts, assessments and neurobiological bases. Schizophr. Res. 186, 19–28 (2017).
  2. Carpenter, W. T., Heinrichs, D. W. & Alphs, L. D. Treatment of negative symptoms. Schizophr. Bull. 11, 440–452 (1985).
  3. Hasan, A. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J. Biol. Psychiatry 13, 318–378 (2012).
  4. Rabinowitz, J. et al. Negative symptoms in schizophrenia – the remarkable impact of inclusion definitions in clinical trials and their consequences. Schizophr. Res. 150, 334–338 (2013).
  5. European Medicines Agency. Guideline on clinical investigation of medicinal products, including depot preparation in the treatment of schizophrenia. (2012).

Markers of Inflammation and Infection in Schizophrenia

Molecular Psychiatry

Cerebrospinal fluid markers of inflammation and infections in schizophrenia and affective disorders: a systematic review and meta-analysis
Orlovska-Waast S et al.
Molecular Psychiatry 2019; 24:869–887
“We aimed to systematically review the CSF immunological findings in schizophrenia spectrum and affective disorders… Current findings suggest that schizophrenia and affective disorders may have CSF abnormalities including signs of blood-brain barrier impairment and inflammation. However, the available evidence does not allow any firm conclusion since all studies showed at least some degree of bias and vastly lacked inclusion of confounding factors.”

The Challenge of Diagnosing Negative Symptoms

Primary and secondary negative symptoms may be the most important distinction in the negative symptom lexicon because of their different clinical implications.

Treatment considerations in negative symptoms of schizophreniaTreatment considerations in negative symptoms of schizophrenia

References

  1. Kirkpatrick, B., Buchanan, R. W., Ross, D. E. & Carpenter, J. A separate disease within the syndrome of schizophrenia. Arch. Gen. Psychiatry 58, 165–171 (2001).
  2. Galderisi, S., Mucci, A., Buchanan, R. W. & Arango, C. Negative symptoms of schizophrenia: new developments and unanswered research questions. The Lancet Psychiatry 5, 664–677 (2018).
  3. Kirkpatrick, B., Fenton, W. S., Carpenter, W. T. & Marder, S. R. The NIMH-MATRICS consensus statement on negative symptoms. Schizophr. Bull. 32, 214–219 (2006).
  4. Kirschner M. Schizophr Res. 2017;186:29-38.;
  5. Carpenter WT.  Schizophrenia Bulletin 1985; 11:440-452;
  6. WFBSP. The World Journal of Biological Psychiatry 2012; 13: 318–378
  7. Fervaha et al, Eur Psychiatry. 2014 Sep;29(7):449-55
  8. Bucci et al, Curr Opin Psychiatry. 2017 May;30(3):201-208

Selection of Schizophrenia Rating Scales

Rating scales help with monitoring the severity of symptoms in schizophrenia. Up until the 1980s, researchers focused on the positive symptoms, but later on they switched to both positive and negative symptoms.1

Schizophrenia ScalesSchizophrenia Scales

References

  1. Overall and Gorham. Psychological Reports. 1962;10:799-812
  2. Andreasen, University of Iowa, 1984
  3. Andreasen, University of Iowa, 1984
  4. Stanley et al. Schizophrenia Bulletin. 1987; 13(2):261–276
  5. Hopkins et al. Schizophrenia Bulletin. 2018; 44(3): 593–602
  6. Axelrod et al. Journal of Psychiatric Research. 1993; 27(3):253-258
  7. Morosini et al. Acta Psychiatr Scand. 2000;101(4):323-329
  8. Menezes et al. J Bras Psiquiatr. 2012;61(3):176-80
  9. Haro et al. Acta Psychiatr Scand Suppl. 2003;(416):16-23
  10. Kring et al. Am J Psychiatry. 2013;170:165–172
  11. Llerena et al. Compr Psychiatry. 2013;54(5): 568–574

The Burden of Schizophrenia

Despite being a disorder with relatively low prevalence, schizophrenia is ranked among the top 25 leading causes of disability1. Even with best practice treatment, outcomes are often suboptimal given the complexity of the disorder and its wide-ranging consequences.

The burden of schizophreniaThe burden of schizophrenia

References

  1. Millier, A. et al. Humanistic burden in schizophrenia: A literature review. J. Psychiatr. Res. 54, 85–93 (2014).
  2. The National Alliance on Mental Illness. Schizophrenia: Public Attitudes, Personal Needs Views from People Living with Schizophrenia, Caregivers, and the General Public. (2008).
  3. Chong, H. Y. et al. Global economic burden of schizophrenia: A systematic review. Neuropsychiatr. Dis. Treat. 12, 357–373 (2016).
  4. Whiteford HA. Et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013;9;382(9904):1575-86

DEVELOPMENT AND PSYCHOPATHOLOGY

Childhood behaviour to predict psychosis-spectrum diagnoses in adulthood
Hastings, P.D. et al.
Development and Psychopathology 2019; 1–15. doi:10.1017/S095457941900021X
“Results provided strong support for multiple domain models of psychopathology, and suggest that universal preventive interventions and social policies aimed at improving neighbourhood conditions may be particularly important for decreasing the prevalence of psychosis-spectrum diagnoses in the future.”
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NEWS IN TREATMENT OF SCHIZOPHRENIA

The goals of schizophrenia treatment differ according to the phase of illness. Early intervention is a key to more a favourable prognosis for patients since the

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TREATMENT OF NEGATIVE SYMPTOMS

Understanding the relationship between a symptom from a specific domain in schizophrenia and clinical outcomes is important because interventions that just focu

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