title: Avolition and expressive deficits capture negative symptom phenomenology: implications for DSM-5 and schizophrenia research.
abstract: The DSM-5 formulation presents an opportunity to refine the negative symptom assessments that are crucial for a schizophrenia diagnosis. This review traces the history of negative symptom constructs in neuropsychiatry from their earliest conceptualizations in the 19th century. It presents the relevant literature for distinguishing between different types of negative symptoms. Although a National Institute of Mental Health consensus initiative proposed that there are five separate negative symptom domains, our review of the individual items demonstrates no more than three negative symptom domains. Indeed, numerous factor analyses of separate negative symptom scales routinely identify only two domains: 1) expressive deficits, which include affective, linguistic and paralinguistic expressions, and 2) avolition for daily life and social activities. We propose that a focus on expressive deficits and avolition will be of optimum utility for diagnosis, treatment-considerations, and research purposes compared to other negative symptom constructs. We recommend that these two domains should be assessed as separate dimensions in the DSM-5 criteria.
authors.affiliation: Institute for Social and Psychiatric Initiatives (InSPIRES), Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA. messij01@nyumc.org
authors.forename: Julie W
authors.initials: JW
authors.lastname: Messinger
authors.forename: Fabien
authors.initials: F
authors.lastname: Trémeau
authors.forename: Daniel
authors.initials: D
authors.lastname: Antonius
authors.forename: Erika
authors.initials: E
authors.lastname: Mendelsohn
authors.forename: Vasthie
authors.initials: V
authors.lastname: Prudent
authors.forename: Arielle D
authors.initials: AD
authors.lastname: Stanford
authors.forename: Dolores
authors.initials: D
authors.lastname: Malaspina
mesh_terms: D039721:Diagnostic and Statistical Manual of Mental Disorders; D004644:Emotions; D006801:Humans; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology