Clinical evaluation of negative symptoms in schizophrenia

2007 ◽  
Vol 22 (6) ◽  
pp. 380-386 ◽  
Author(s):  
Hans-Jürgen Möller
Keyword(s):  
Differential Diagnosis ◽  
Negative Symptoms ◽  
Rating Scales ◽  
Unmet Need ◽  
Cognitive Disorders ◽  
Accurate Diagnosis ◽  
Positive Symptoms ◽  
Clinical Algorithms ◽  
Rule Out

AbstractThe florid positive symptoms of schizophrenia (hallucinations, delusions, grossly disordered thinking) are often obvious. By comparison, negative symptoms (flattened affect, impoverished speech, apathy, avolition, anhedonia) are subtler and more difficult to recognize and diagnose. However, there is increasing recognition of the importance of negative symptoms in patients with schizophrenia. Secondary negative symptoms attributable to such factors as unrelieved positive symptoms, the adverse effects of antipsychotic pharmacotherapy, or social isolation may subside with resolution of such factors. In contrast, primary negative symptoms are an intrinsic aspect of schizophrenia; they are persistent and have been associated with poorer clinical outcomes. Although the lack of a reliably effective treatment for negative symptoms is a serious unmet need in this patient population, accurate diagnosis is still important. Assessment of suspected negative symptoms, using validated rating scales, can help to rule out comorbid affective or cognitive disorders that may mimic negative symptoms and to distinguish primary negative symptoms from potentially reversible secondary negative symptoms. This article reviews the definitions and classification of negative symptoms, compares the tools available for their assessment, and offers practical clinical algorithms for sorting through the differential diagnosis.

Definitions and measurement of negative symptoms in schizophrenia

2020 ◽  
pp. 1-18
Author(s):  
István Bitter
Keyword(s):  
Substance Abuse ◽  
Mental Disorders ◽  
Negative Symptoms ◽  
Rating Scales ◽  
Social Deprivation ◽  
Unmet Need ◽  
Disease Process ◽  
Extrapyramidal Symptoms ◽  
Positive Symptoms ◽  
Need For Treatment

Negative symptoms of schizophrenia represent deficits in different domains, e.g. loss or diminution in emotions, thinking and movement. Persistent primary negative symptoms are considered to be part of the schizophrenia disease process and represent an unmet need for treatment, while secondary negative symptoms are associated with positive symptoms of schizophrenia, other mental disorders (e.g. depression, substance abuse), extrapyramidal symptoms, social deprivation, etc. Validated rating scales are helpful in the evaluation and measurement of negative symptoms. Current consensus supports the focus on the following five domains (five ‘As’): blunted affect, alogia, anhedonia, asociality, and avolition.

Cognitive disorders and negative symptoms as correlates of motivational deficits in psychotic patients

1994 ◽  
Vol 24 (4) ◽  
pp. 869-884 ◽  
Author(s):  
B. Schmand ◽  
T. Kuipers ◽  
M. Van Der Gaag ◽  
J. Bosveld ◽  
F. Bulthuis ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Negative Symptoms ◽  
Cognitive Disorders ◽  
Control Group ◽  
Positive Symptoms ◽  
Time On Task ◽  
Reaction Test ◽  
Motivational Deficit ◽  
Energetic Model ◽  
Positive Symptoms Of Psychosis

SynopsisThe problem of a possible lack of motivation to perform cognitive tasks, which is often encountered in psychotic patients, has been approached from the perspective of the ‘energetics’ of cognition (Hockey et al. 1986) and from the broader clinical context of psychosis as an ‘amotivational syndrome’ and its related negative symptoms.The presence of motivational deficits was investigated in a group of psychotic in-patients (N = 73, and 40 had schizophrenia) compared with a control group of non-psychotic psychiatric in-patients (N = 23). The motivational deficit was operationalized in terms of Sanders's (1983) cognitive–energetic model as a large effect of ‘time-on-task’ during a simple, monotonous reaction test. Significantly more psychotic patients than control patients showed evidence of this type of motivational deficit. The deficit appeared to be related with negative but not with positive symptoms of psychosis. Furthermore, the deficit was shown to be related to the cognitive disorders of psychosis, which have been amply documented in the literature, i.e. disorders of vigilance, verbal memory and distractibility. These results suggest that the cognitive disorders of psychosis are not of a ‘computational’ but of an ‘energetical’, i.e. motivational nature.

scholarly journals Differential X-ray diagnosis of pseudotuberculous scenario of pulmonary abscess with tuberculous cavities

2021 ◽  
Vol 29 (1) ◽  
pp. 9-20
Author(s):  
R. Yu. Churylin ◽  
I. O. Voronzhev ◽  
Yu. A. Kolomiichenko ◽  
О. О. Коvalova ◽  
V. V. Syrota
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Thoracic Surgery ◽  
Lung Abscess ◽  
Accurate Diagnosis ◽  
Tuberculosis Patients ◽  
X Ray ◽  
Pulmonary Abscess ◽  
Over Time

Background. Recent decades in Ukraine have been characterized by a significant increase in the number of tuberculosis patients, often with forming cavities of destruction. X-ray diagnosis of lung cavitary lesions is one of the current issues of modern pulmonology and thoracic surgery. Pulmonary abscesses resemble other diseases with destruction and cavities substantiating the need for differential diagnosis with tuberculosis. Purpose – specifying particular scenarios of X-ray presentation of lung abscess and determining the capability of differential diagnosis of pseudotuberculosis with cavities of tuberculosis etiology. Materials and methods. The paper deals with the analysis of X-ray examination of thoracic viscera provided for 252 patients with lung abscess, aged 18 and up to 78. X-ray radiography in two projections, linear and computed tomography (56 patients involved) were performed. All patients underwent a study over time. Results. Almost in most lung abscess cases, there is a need for differential diagnosis with a range of medical entities. The obtained data have made it possible to suggest a classification of X-ray scenarios of lung abscess. The scenarios of X-ray presentation of acute pulmonary abscess are typical and atypical, among those: cystoid, pseudotuberculous, affected 38 patients (15 %), and pulmonary-pleural. The peculiarities of X-ray presentation of pseudotuberculous scenario along with the differences and signs allowing to make an accurate diagnosis have been specified. Conclusions. X-ray study remains an essential in diagnosing purulent-destructive diseases. Being familiar with the scenarios mentioned above and pseudotuberculous one, in particular, will make it possible to significantly improve diagnosis as well as differential diagnosis of pulmonary abscess.

The Differential Diagnosis of Negative Symptoms in Chronic Schizophrenia

1989 ◽  
Vol 23 (4) ◽  
pp. 491-496 ◽  
Author(s):  
Harvey A. Whiteford ◽  
Cecilia A. Peabody
Keyword(s):  
Differential Diagnosis ◽  
Negative Symptoms ◽  
Chronic Schizophrenia ◽  
Accurate Diagnosis ◽  
Paper Briefly ◽  
Schizophrenic Patients

Negative symptoms in schizophrenic patients can have many causes. This paper briefly reviews some of those factors which may contribute to negative symptoms apart from the schizophrenic illness itself. Making these distinctions is crucial for accurate diagnosis, management and prognosis.

Toxic role in schizophrenia: A review by a clinical case

2016 ◽  
Vol 33 (S1) ◽  
pp. S292-S292
Author(s):  
M. Canseco Navarro ◽  
A. Peña Serrano ◽  
J.M. Hernández Sánchez ◽  
M. Canccino Botello ◽  
F. Molina López ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Negative Symptoms ◽  
Clinical Case ◽  
Paranoid Schizophrenia ◽  
Clinical History ◽  
Positive Symptoms ◽  
History Of ◽  
Competing Interest ◽  
Hospital General

IntroductionOften find it difficult diagnostic approach to patients with symptoms that could correspond to several clinical entities. This requires making a correct differential diagnosis to enable a better understanding and addressing the disease in an individualized way.ObjectiveDescribe pathogenetic factors of paranoid schizophrenia highlighting their relationship with drug consumption.MethodsReview of the clinical history of a patient admitted to acute ward of the Hospital General Universitario of Valencia.ResultsA case of a 30-year-old man, whose income is motivated by persistent and structured autolytic ideation occurs. It presents positive symptoms for several years and amotivational syndrome ago. It has a history of cannabis, cocaine and alcohol since he was thirteen and remains abstinent for more than six months ago. Differential diagnosis arises between amotivational toxic syndrome, reactive depressive symptoms to the disease and negative symptoms for chronic psychotic process. Finally diagnosed with paranoid schizophrenia and is included in the program of first psychotic episodes.Today the productive symptoms disappeared and remain negative though with less intensity achieving an improvement in overall activity.ConclusionsConsumption of toxic influences the development of a chronic psychotic process that may appear years later, becoming a etiological and maintainer factor, not only if its consumption continue, but other effects that occur long term amotivational syndrome and worsening prognosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Classification of neuroleptic drugs - lack of relationship to effect on negative symptoms in schizophrenia

1987 ◽  
Vol 2 (4) ◽  
pp. 289-294
Author(s):  
Svein G. Dahl
Keyword(s):  
Drug Treatment ◽  
Negative Symptoms ◽  
Chemical Properties ◽  
Drug Level ◽  
Neuroleptic Drug ◽  
Positive Symptoms ◽  
Neuroleptic Drugs ◽  
Dependent Relationship ◽  
The Individual

SummaryThere is both pharmacological and clinical support for a classification of the schizophrenic syndrome into negative and positive subtypes. For neuroleptics that act upon both types of symptoms, it appears that lower doses are required for treatment of negative than for positive symptoms. Successful drug treatment of negative symptoms may therefore depend upon the choice of a correct dosage for the individual patient. Due to variation in pharamacokinetic parameters, similar doses of a neuroleptic drug may result in different plasma levels in individual patients, especially after oral medication. Pharmacokinetic variations, if not under proper control, may easily disguise a concentration-dependent relationship, such as the effects of a neuroleptic drug upon negative and positive symptoms. In drug treatment of negative symptoms it may therefore be an advantage to individualize the doses as a function of plasma drug level measurements, when available. No general relationship has been demonstrated between the chemical properties or pharmacodynamics of neuroleptic drugs and their potential to act upon negative symptoms. Also, the drugs which have been demonstrated to have an “energizing” effect have widely different pharmacokinetic properties. A chemical or pharmacological classification of neuroleptics therefore does not seem to give any information about their possible efficacy in treating negative symptoms in schizophrenia.

The Scale for the Assessment of Negative Symptoms (SANS): Conceptual and Theoretical Foundations

1989 ◽  
Vol 155 (S7) ◽  
pp. 49-52 ◽  
Author(s):  
Nancy C. Andreasen
Keyword(s):  
Negative Symptoms ◽  
Rating Scales ◽  
Thought Disorder ◽  
Positive Symptoms ◽  
Global Rating ◽  
Formal Thought Disorder ◽  
Detailed Evaluation ◽  
Global Ratings ◽  
Theoretical Foundations ◽  
Made In

The Scale for the Assessment of Negative Symptoms (SANS) was the first instrument developed in order to provide for comprehensive assessment of negative symptoms in schizophrenia (Andreasen, 1982, 1983). It consists of five scales that evaluate five different aspects of negative symptoms: alogia, affective blunting, avolition-apathy, anhedonia-asociality, and attentional impairment. Each of these negative symptoms can be rated globally, but in addition detailed observations are made in order to achieve the global rating. It is complemented by a Scale for the Assessment of Positive Symptoms (SAPS), which permits detailed evaluation and global ratings of hallucinations, delusions, positive formal thought disorder and bizarre behaviour (Andreasen, 1984). Taken together, the two scales provide a comprehensive set of rating scales in order to measure the symptoms of schizophrenia and to assess their change over time.

Objective and parametric methods used in functional classification disabled swimmers

Physiotherapy ◽  
2013 ◽  
Vol 21 (3) ◽  
Author(s):  
Natalia Uścinowicz ◽  
Wojciech Seidel ◽  
Paweł Zostawa ◽  
Sebastian Klich
Keyword(s):  
Medical Diagnosis ◽  
Olympic Games ◽  
Objective Evaluation ◽  
Subjective Assessment ◽  
Fair Play ◽  
Functional Classification ◽  
Kinematic Parameters ◽  
Athletes With Disabilities ◽  
Rule Out

AbstractThe recent Olympic Games in London incited much interest in the competition of disabled athletes. Various people connected with swimming, including coaches and athletes, have speculated about the fairness of competitions of disabled athletes. A constant problem are the subjective methods of classification in disabled sport. Originally, athletes with disabilities were classified according to medical diagnosis. Due to the injustice which still affects the competitors, functional classification was created shortly after. In the present review, the authors show the anomalies in the structure of the classification. The presented discovery led to the suggestion to introduce objective methods, thanks to which it would be no longer necessary to rely on the subjective assessment of the classifier. According to the authors, while using objective methods does not completely rule out the possibility of fraud by disabled athletes in the classification process, it would certainly reduce their incidence. Some of the objective methods useful for the classification of disabled athletes are: posturography, evaluation of the muscle parameters, electrogoniometric assessment, surface electromyography, and analysis of kinematic parameters. These methods have provide objective evaluation in the diagnostic sense but only if they are used in tandem. The authors demonstrate the undeniable benefits of using objective methods. Unfortunately, there are not only advantages of such solution, there also several drawbacks to be found. The conclusion of the article is the statement by the authors that it is right to use objective methods which allow to further the most important rule in sport: fair-play.

Performance of patients with different schizophrenia subtypes on the Synthetic House–Tree–Person Test

2019 ◽  
Vol 47 (11) ◽  
pp. 1-8 ◽  
Author(s):  
AiBao Zhou ◽  
Pei Xie ◽  
ChaoChao Pan ◽  
Zhe Tian ◽  
Junwei Xie
Keyword(s):  
Negative Symptoms ◽  
Positive Symptoms ◽  
Study Results ◽  
Symptom Type ◽  
Positive And Negative Symptoms

We explored differences in performance on the Synthetic House–Tree–Person Test between people with mainly positive symptoms and those with mainly negative symptoms of schizophrenia and, further, aimed to provide a basis for the diagnosis of schizophrenia symptom type. Participants were 58 people receiving treatment for schizophrenia, and we asked them to complete the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Synthetic House–Tree–Person Test. There were significant differences in results on the Synthetic House–Tree–Person Test between the group with positive symptoms, the group with a mix of positive and negative symptoms, and the group with negative symptoms. There were 12 features of participants' drawings, such as big hands, which were correlated with hallucinations and delusions in positive symptoms, and 9 features, such as trees in a landscape, which were correlated with avolition and anhedonia in negative symptoms. Our study results suggest differences in performance on the Synthetic House–Tree–Person Test between these different symptom subtypes of schizophrenia; hence, the features that appear in drawings made during the test may contribute to the diagnosis of symptoms of people with schizophrenia.

Evaluation of positive and negative symptoms in schizophrenia

1986 ◽  
Vol 1 (2) ◽  
pp. 108-122 ◽  
Author(s):  
Nancy C. Andreasen ◽  
William M. Grove
Keyword(s):  
Negative Symptoms ◽  
The United States ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
University Of Iowa ◽  
Normal Functions ◽  
Subsequent Investigation ◽  
The University ◽  
The Relationship ◽  
Positive And Negative Symptoms

SummaryMost investigators concur that schizophrenia is probably a heterogeneous group of disorders that share the common features of psychotic symptoms, partial response to neuroleptics, and a relatively poor outcome. The subdivision of schizophrenia into two subtypes, positive versus negative, has achieved wide acceptance throughout the world during recent years. This distinction has heuristic and theoretical appeal because it unites phenomenology, pathophysiology, and etiology into a single comprehensive hypothesis.In spite of its wide appeal, the distinction has a number of problems. These include the failure to distinguish between symptom syndromes and diseases; failure to deal with the mixed patient; failure to take longitudinal course into account; and failure to address conceptually and methodologically the distinction between positive and negative symptoms.This paper focuses primarily on the conceptual basis for two instruments designed to measure positive and negative symptoms, the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS), originally described in 1982. Since their description, these scales have been used in a variety of other centers. These scales are based on the hypothesis that negative symptoms represent a deficit or diminution in normal psychological functions wliile positive symptoms represent an excess or distortion of normal functions. Reliability data are now available from Italy, Spain, and Japan which suggest that these scales can be used reliably in cultural settings outside the United States. The results of these studies are summarized in this paper. In addition, a replication study involving a new sample of 117 schizophrenics collected at the University of Iowa is described. In this second study of the SANS and SAPS, internal consistency is found to be quite high in the SANS. Thus negative symptoms appear to be more internally correlated with one another than are positive symptoms. The implications of this result are discussed. A principal components analysis is used to explore the relationship between positive and negative symptoms. While the study reported in 1982 suggested that positive and negative symptoms are negatively correlated, in the present study they appear to be uncorrelated. Overall, the results suggest that the SANS and SAPS are useful comprehensive instruments for the evaluation of positive and negative symptoms. The relationship between these symptoms and external validators such as cognitive functioning or CT scan abnormalities will be reported in a subsequent investigation.

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