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2016 ; 3
(ä): 133-150
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Treating Negative Symptoms in Schizophrenia: an Update
#MMPMID27376016
Remington G
; Foussias G
; Fervaha G
; Agid O
; Takeuchi H
; Lee J
; Hahn M
Curr Treat Options Psychiatry
2016[]; 3
(ä): 133-150
PMID27376016
show ga
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.