Treating Negative Symptoms in Schizophrenia: an Update

Gary Remington, George Foussias, Gagan Fervaha, Ofer Agid, Hiroyoshi Takeuchi, Jimmy Lee, Margaret Hahn

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

Interest in the negative symptoms of schizophrenia has increased rapidly over the last several decades, paralleling a growing interest in functional, in addition to clinical, recovery, and evidence underscoring the importance negative symptoms play in the former. Efforts continue to better define and measure negative symptoms, distinguish their impact from that of other symptom domains, and establish effective treatments as well as trials to assess these. Multiple interventions have been the subject of investigation, to date, including numerous pharmacological strategies, brain stimulation, and non-somatic approaches. Level and quality of evidence vary considerably, but to this point, no specific treatment can be recommended. This is particularly problematic for individuals burdened with negative symptoms in the face of mild or absent positive symptoms. Presently, clinicians will sometimes turn to interventions that are seen as more “benign” and in line with routine clinical practice. Strategies include use of atypical antipsychotics, ensuring the lowest possible antipsychotic dose that maintains control of positive symptoms (this can involve a shift from antipsychotic polypharmacy to monotherapy), possibly an antidepressant trial (given diagnostic uncertainty and the frequent use of these drugs in schizophrenia), and non-somatic interventions (e.g., cognitive behavioral therapy, CBT). The array and diversity of strategies currently under investigation highlight the lack of evidence-based treatments and our limited understanding regarding negative symptoms underlying etiology and pathophysiology. Their onset, which can precede the first psychotic break, also means that treatments are delayed. From this perspective, identification of biomarkers and/or endophenotypes permitting earlier diagnosis and intervention may serve to improve treatment efficacy as well as outcomes.

Original languageEnglish
Pages (from-to)133-150
Number of pages18
JournalCurrent Treatment Options in Psychiatry
Volume3
Issue number2
DOIs
Publication statusPublished - 2016 Jun 1

Fingerprint

Schizophrenia
Antipsychotic Agents
Endophenotypes
Polypharmacy
Cognitive Therapy
Therapeutics
Antidepressive Agents
Uncertainty
Early Diagnosis
Biomarkers
Pharmacology
Brain
Pharmaceutical Preparations

Keywords

  • Brain stimulation
  • Negative symptoms
  • Pharmacotherapy
  • Schizophrenia
  • Treatment

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Remington, G., Foussias, G., Fervaha, G., Agid, O., Takeuchi, H., Lee, J., & Hahn, M. (2016). Treating Negative Symptoms in Schizophrenia: an Update. Current Treatment Options in Psychiatry, 3(2), 133-150. https://doi.org/10.1007/s40501-016-0075-8

Treating Negative Symptoms in Schizophrenia : an Update. / Remington, Gary; Foussias, George; Fervaha, Gagan; Agid, Ofer; Takeuchi, Hiroyoshi; Lee, Jimmy; Hahn, Margaret.

In: Current Treatment Options in Psychiatry, Vol. 3, No. 2, 01.06.2016, p. 133-150.

Research output: Contribution to journalReview article

Remington, G, Foussias, G, Fervaha, G, Agid, O, Takeuchi, H, Lee, J & Hahn, M 2016, 'Treating Negative Symptoms in Schizophrenia: an Update', Current Treatment Options in Psychiatry, vol. 3, no. 2, pp. 133-150. https://doi.org/10.1007/s40501-016-0075-8
Remington, Gary ; Foussias, George ; Fervaha, Gagan ; Agid, Ofer ; Takeuchi, Hiroyoshi ; Lee, Jimmy ; Hahn, Margaret. / Treating Negative Symptoms in Schizophrenia : an Update. In: Current Treatment Options in Psychiatry. 2016 ; Vol. 3, No. 2. pp. 133-150.
@article{4685d2b75adc4d6096283ff04868561a,
title = "Treating Negative Symptoms in Schizophrenia: an Update",
abstract = "Interest in the negative symptoms of schizophrenia has increased rapidly over the last several decades, paralleling a growing interest in functional, in addition to clinical, recovery, and evidence underscoring the importance negative symptoms play in the former. Efforts continue to better define and measure negative symptoms, distinguish their impact from that of other symptom domains, and establish effective treatments as well as trials to assess these. Multiple interventions have been the subject of investigation, to date, including numerous pharmacological strategies, brain stimulation, and non-somatic approaches. Level and quality of evidence vary considerably, but to this point, no specific treatment can be recommended. This is particularly problematic for individuals burdened with negative symptoms in the face of mild or absent positive symptoms. Presently, clinicians will sometimes turn to interventions that are seen as more “benign” and in line with routine clinical practice. Strategies include use of atypical antipsychotics, ensuring the lowest possible antipsychotic dose that maintains control of positive symptoms (this can involve a shift from antipsychotic polypharmacy to monotherapy), possibly an antidepressant trial (given diagnostic uncertainty and the frequent use of these drugs in schizophrenia), and non-somatic interventions (e.g., cognitive behavioral therapy, CBT). The array and diversity of strategies currently under investigation highlight the lack of evidence-based treatments and our limited understanding regarding negative symptoms underlying etiology and pathophysiology. Their onset, which can precede the first psychotic break, also means that treatments are delayed. From this perspective, identification of biomarkers and/or endophenotypes permitting earlier diagnosis and intervention may serve to improve treatment efficacy as well as outcomes.",
keywords = "Brain stimulation, Negative symptoms, Pharmacotherapy, Schizophrenia, Treatment",
author = "Gary Remington and George Foussias and Gagan Fervaha and Ofer Agid and Hiroyoshi Takeuchi and Jimmy Lee and Margaret Hahn",
year = "2016",
month = "6",
day = "1",
doi = "10.1007/s40501-016-0075-8",
language = "English",
volume = "3",
pages = "133--150",
journal = "Current Treatment Options in Psychiatry",
issn = "2196-3061",
publisher = "Springer International Publishing AG",
number = "2",

}

TY - JOUR

T1 - Treating Negative Symptoms in Schizophrenia

T2 - an Update

AU - Remington, Gary

AU - Foussias, George

AU - Fervaha, Gagan

AU - Agid, Ofer

AU - Takeuchi, Hiroyoshi

AU - Lee, Jimmy

AU - Hahn, Margaret

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Interest in the negative symptoms of schizophrenia has increased rapidly over the last several decades, paralleling a growing interest in functional, in addition to clinical, recovery, and evidence underscoring the importance negative symptoms play in the former. Efforts continue to better define and measure negative symptoms, distinguish their impact from that of other symptom domains, and establish effective treatments as well as trials to assess these. Multiple interventions have been the subject of investigation, to date, including numerous pharmacological strategies, brain stimulation, and non-somatic approaches. Level and quality of evidence vary considerably, but to this point, no specific treatment can be recommended. This is particularly problematic for individuals burdened with negative symptoms in the face of mild or absent positive symptoms. Presently, clinicians will sometimes turn to interventions that are seen as more “benign” and in line with routine clinical practice. Strategies include use of atypical antipsychotics, ensuring the lowest possible antipsychotic dose that maintains control of positive symptoms (this can involve a shift from antipsychotic polypharmacy to monotherapy), possibly an antidepressant trial (given diagnostic uncertainty and the frequent use of these drugs in schizophrenia), and non-somatic interventions (e.g., cognitive behavioral therapy, CBT). The array and diversity of strategies currently under investigation highlight the lack of evidence-based treatments and our limited understanding regarding negative symptoms underlying etiology and pathophysiology. Their onset, which can precede the first psychotic break, also means that treatments are delayed. From this perspective, identification of biomarkers and/or endophenotypes permitting earlier diagnosis and intervention may serve to improve treatment efficacy as well as outcomes.

AB - Interest in the negative symptoms of schizophrenia has increased rapidly over the last several decades, paralleling a growing interest in functional, in addition to clinical, recovery, and evidence underscoring the importance negative symptoms play in the former. Efforts continue to better define and measure negative symptoms, distinguish their impact from that of other symptom domains, and establish effective treatments as well as trials to assess these. Multiple interventions have been the subject of investigation, to date, including numerous pharmacological strategies, brain stimulation, and non-somatic approaches. Level and quality of evidence vary considerably, but to this point, no specific treatment can be recommended. This is particularly problematic for individuals burdened with negative symptoms in the face of mild or absent positive symptoms. Presently, clinicians will sometimes turn to interventions that are seen as more “benign” and in line with routine clinical practice. Strategies include use of atypical antipsychotics, ensuring the lowest possible antipsychotic dose that maintains control of positive symptoms (this can involve a shift from antipsychotic polypharmacy to monotherapy), possibly an antidepressant trial (given diagnostic uncertainty and the frequent use of these drugs in schizophrenia), and non-somatic interventions (e.g., cognitive behavioral therapy, CBT). The array and diversity of strategies currently under investigation highlight the lack of evidence-based treatments and our limited understanding regarding negative symptoms underlying etiology and pathophysiology. Their onset, which can precede the first psychotic break, also means that treatments are delayed. From this perspective, identification of biomarkers and/or endophenotypes permitting earlier diagnosis and intervention may serve to improve treatment efficacy as well as outcomes.

KW - Brain stimulation

KW - Negative symptoms

KW - Pharmacotherapy

KW - Schizophrenia

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=85009743523&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85009743523&partnerID=8YFLogxK

U2 - 10.1007/s40501-016-0075-8

DO - 10.1007/s40501-016-0075-8

M3 - Review article

AN - SCOPUS:85009743523

VL - 3

SP - 133

EP - 150

JO - Current Treatment Options in Psychiatry

JF - Current Treatment Options in Psychiatry

SN - 2196-3061

IS - 2

ER -