Negative symptoms identified from the Negative Symptom Assessment and the behaviors that might be observed in each of 5 domains.
To view the 2016 article in PDF format, click here.
Lack of awareness of negative symptoms, often confused with anhedonia, is common in individuals with schizophrenia. Patients and relatives are often unaware of the extent of these symptoms and seldom communicate them to the clinician. What follows are the 5 domains of negative symptoms identified from the Negative Symptom Assessment (NSA). To view the 2016 article in PDF format, click here.
Thousands of cases in psychiatric practice involve negative symptoms in schizophrenia. Patients and relatives are often unaware of the extent of these symptoms and seldom communicate them to the clinician
The NSA describes the behaviors that might be observed in each domain. In addition to observation, it is important to ask questions regarding the person’s daily activities and engagement with others
Assessment starts with one question:
“Starting from the time you get up, could you tell me how you have spent a typical day in the past week?”
From this one question, many different levels of clinical
information can be gathered.
Clinical considerations: Is the patient noncommunicative? Do you have to pull out every detail?
The patient may produce very little speech even with prodding or limit responses to 1 or 2 words; may exhibit long pauses before responding to questions; may produce speech that is vague and have trouble clarifying further; may mumble as if it is too difficult to articulate.
Clinical consideration: Is the individual enthusiastic about any specific activities?
The patient may have a limited range of emotional experiences such as anger, happiness, sadness, surprise, fear or pride, reduced affective expressiveness as evidenced by monotone speech and blunting, reduced ability to display common affective states upon request.
Clinical consideration: Is the patient actively engaged with hobbies and productive activity during the day?
The patient may have few friends, limited desire for or interactions with others, poor rapport with the interviewer, and very little desire for contact.
Clinical consideration: Does the patient generate a multifaceted answer without prompting?
May engage in little productive activity, spend much of the day sitting or lying around, may not take care of basic grooming and hygiene, has little interest in world events or hobbies, may have limited life goals or sense of purpose.
Clinical consideration: How does this individual compare with a person without schizophrenia?
Patient seems to be "sluggish," may appear that moving requires considerable effort, expressive gestures such as using hands and nodding that normally facilitate communication may be reduced or absent.
For more information, see Negative Symptoms in Schizophrenia: An Update on Identification and Treatment, on which this slideshow is based.
(This slideshow article was originally posted on 2/16/2016 and has since been updated.)