Background: Negative symptoms (NSs) are a major contributor to the
poor quality of life people with schizophrenia and are the most important
cause of long- term disability. Recent evidence has shown that
15-25% of people with schizophrenia experience NSs which warrant
treatment. The purpose of this paper is to address issues of diagnostic
and treatment challenges of NSs.
Method: NSs are multifactorial in origin and it is diffi cult to differentiate
between primary and secondary NSs. The primary NSs or ‘ defi cit
symptoms ’ are due to underlying disorder whereas secondary NSs are
secondary to positive psychotic symptoms, extra-pyramidal side effects
of anti psychotic medication, depression and catatonia. Andreasen
includes NSs of affective fl attening, alogia, avolition, anhedonia, and
attention, which in turn are defi ned by a number of symptoms as
refl ected by the Scale for the Assessment of Negative Symptoms
(SANS). It is diffi cult to differentiate between NSs and that of depression.
Amongst all atypical antipsychotics clozapine has a good effect
on the secondary NSs but not on primary. Other specifi c psychosocial
interventions have some benefi cial effects on NSs include cognitive
remediation, CBT, social skills training and group therapies involving
Conclusion: NSs are hard to defi ne as they are more subjective than the
presence of positive symptoms. They are nonspecifi c and may mimic
depression. Accurate assessment of NSs requires robust standard rating
scales. More research is required to understand the psychopathology of
NSs and to fi nd out more effi cacious interventions of their management.