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Treatments for negative symptoms

What are negative symptoms? 

Negative symptoms are referring to an absence of normal functions. This may include (but is not limited to) blunted affect, which is a scarcity of facial expressions of emotion, reduced frequency and range of gestures and voice modulation, and restricted eye contact; alogia (poverty of speech); asociality (reduced social interaction); avolition (reduced motivation and often poor hygiene) and anhedonia, which is reduced experience of pleasure.

What is the evidence on treatments for negative symptoms?

Overall, moderate quality evidence suggests a medium-sized effect of improved negative symptoms with second generation antipsychotics compared to placebo, although the improvements may not be clinically significant. No effect was found for negative symptoms with first generation antipsychotics compared to placebo.

For individual antipsychotics, moderate to high quality evidence suggests improved overall and negative symptoms with adjunctive fluvoxamine. Moderate to low quality evidence suggests olanzapine and quetiapine may be more efficacious for negative symptoms than haloperidol, and clozapine may be more efficacious than chlorpromazine.

For children and adolescents with schizophrenia, moderate to low quality evidence suggests aripiprazole, asenapine, molindone, olanzapine and risperidone may all have small to medium-sized benefits over placebo for the treatment of negative symptoms. Only quetiapine improved depression symptoms in children and adolescents. Moderate to high quality evidence suggests more weight gain in children and adolescents with all antipsychotics apart from ziprasidone, with olanzapine and quetiapine resulting in the most weight gain. Moderate to low quality evidence found large effects of more extrapyramidal side effects with paliperidione, ziprasidone, risperidone, and aripiprazole; olanzapine and quetiapine resulted in increases in triglycerides (medium-sized effects); and there was a small effect of decreased prolactin with aripiprazole, medium-sized effects of increased prolactin with olanzapine and paliperidione, and a large effect of increased prolactin with risperidone in children and adolescents.

Moderate to high quality evidence suggests a medium-sized effect of improved negative symptoms with selective serotonin re-uptake inhibitor antidepressants in people with chronic schizophrenia, however moderate quality evidence suggests these effects may not be clinically significant. Moderate to low quality evidence suggests particular improvement was noted in affective flattening and avolition.

Also see the Signs and Symptoms negative symptoms topic.

July 2017

 

 

Page last updated: 2:34  7 September 2017

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