title: Conceptualization and treatment of negative symptoms in schizophrenia.
abstract: Negative symptoms of schizophrenia including social withdrawal, diminished affective response, lack of interest, poor social drive, and decreased sense of purpose or goal directed activity predict poor functional outcomes for patients with schizophrenia. They may develop and be maintained as a result of structural and functional brain abnormalities, particularly associated with dopamine reward pathways and by environmental and psychosocial factors such as self-defeating cognitions and the relief from overstimulation that accompanies withdrawal from social and role functioning. Negative symptoms are more difficult to treat than the positive symptoms of schizophrenia and represent an unmet therapeutic need for large numbers of patients with schizophrenia. While antipsychotic medications to treat the symptoms of schizophrenia have been around for decades, they have done little to address the significant functional impairments in the disorder that are associated with negative symptoms. Negative symptoms and the resulting loss in productivity are responsible for much of the world-wide personal and economic burden of schizophrenia. Pharmacologic treatments may be somewhat successful in treating secondary causes of negative symptoms, such as antipsychotic side effects and depression. However, in the United States there are no currently approved treatments for severe and persistent negative symptoms (PNS) that are not responsive to treatments for secondary causes. Pharmacotherapy and psychosocial treatments are currently being developed and tested with severe and PNS as their primary targets. Academia, clinicians, the pharmaceutical industry, research funders, payers and regulators will need to work together to pursue novel treatments to address this major public health issue.
authors.affiliation: Sonali Sarkar, Kiley Hillner, Dawn I Velligan, Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, United States.
authors.forename: Sonali
authors.initials: S
authors.lastname: Sarkar
authors.affiliation: Sonali Sarkar, Kiley Hillner, Dawn I Velligan, Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, United States.
authors.forename: Kiley
authors.initials: K
authors.lastname: Hillner
authors.affiliation: Sonali Sarkar, Kiley Hillner, Dawn I Velligan, Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, United States.
authors.forename: Dawn I
authors.initials: DI
authors.lastname: Velligan
keywords: Functional outcomes; Motivation; Negative symptoms; Schizophrenia; Treatment