Negative symptoms of schizophrenia: About and treatment - Medical News Today

Schizophrenia is a chronic, complex mental disorder that interferes with the ability to feel, think, and behave. It presents with both positive and negative symptoms.

Negative symptoms of schizophrenia refer to "abnormally absent" feelings or motivations rather than additional, new experiences or behaviors. These lost or decreased feelings and motivations are those that people without schizophrenia would typically have.

Most of these negative symptoms stem from motivational, or volitional, impairment and problems feeling or expressing emotions.

Keep reading to learn more about the negative symptoms of schizophrenia, including common examples, the differences between positive and negative symptoms, and the treatment options.

The negative symptoms associated with schizophrenia mostly relate to motivational and emotional impairments. Many mimic the symptoms of depression. More than 50% of people with chronic schizophrenia experience at least one negative symptom associated with the disease.

Motivation issues specifically may be a real point of concern, as they can also prevent people from engaging in self-care and seeking or following a treatment plan.

Common negative symptoms of schizophrenia include:

• lack of motivation, such as a decrease in or loss of the ability to make plans and to start and sustain them
• inability to express or feel pleasure, known as anhedonia
• being socially withdrawn
• speaking less than usual or having trouble speaking
• trouble expressing emotions, which may present as a flat, blank, or unchanging facial expression
• a monotone voice
• poor eye contact
• reduced or little interest in life
• trouble sustaining relationships
• reduced personal hygiene
• attention problems

Negative schizophrenia symptoms can be primary or secondary. Symptoms that are related to the actual pathophysiology of the condition are primary negative symptoms. Those associated with environmental factors, medical treatment, or conditions occurring alongside schizophrenia are secondary negative symptoms.

It is worth noting that it is sometimes difficult to discern what is primary and what is secondary in terms of symptoms. Nevertheless, negative symptoms require clinical help in either case.

Unlike the negative symptoms of schizophrenia, which involve a lack of feelings or behaviors, the positive symptoms of schizophrenia are additional symptoms that people with schizophrenia experience.

In other words, positive symptoms of schizophrenia are "abnormally present" in people with the condition.

Some positive symptoms associated with schizophrenia include:

• delusions, which are false beliefs not based in reality that do not change even when someone has evidence that they are not true
• hallucinations, which involve seeing, feeling, hearing, or smelling things that are not real or not apparent to others
• paranoia, due to reasons that are not realistic or based in reality
• exaggerated or distorted perceptions of reality
• severe problems concentrating or thinking clearly
• feeling as though there is a "blocking" of the thoughts

Learn more about the positive symptoms of schizophrenia.

There is no cure for schizophrenia, but most people can manage their symptoms using a combination of medication, psychotherapy, psychosocial support, and support from family or loved ones.

Common treatment and management options for schizophrenia include:

• Antipsychotic medications: These affect or influence brain chemicals that regulate thought patterns or emotions. Medications are typically less effective in addressing the negative symptoms of schizophrenia, but second-generation antipsychotics may offer more relief than first-generation antipsychotics.
• Psychotherapy: In particular, cognitive behavioral therapy and group or community therapy may be helpful.
• Psychosocial support: This helps teach people how to manage symptoms, identify early warning signs associated with a relapse of symptoms, and learn social skills. The aim is to promote someone's ability to take care of themselves and engage in society.
• Self-care strategies: These include getting enough sleep, eating a nutritious diet, managing stress, exercising, engaging in enjoyable activities, maintaining healthy relationships, and quitting smoking, if applicable.
• Education, support, and awareness: Programs and services are available that help educate and support the family and other loved ones of people with schizophrenia.

These treatment options are for schizophrenia in general, not just the negative symptoms. However, people should note that some ongoing clinical trials are focusing on the treatment of negative symptoms specifically.

Natural remedies

Some natural remedies may help treat schizophrenia or its symptoms — both positive and negative. However, most still require additional research to ensure their effectiveness and safety.

Natural remedies with some evidence to support their use in people with schizophrenia include:

• Omega-3 fatty acids: Research shows that for young people experiencing their first psychotic episode, treatment with omega-3 supplements may reduce their risk of developing serious or chronic forms of schizophrenia.
• Folate: The Food and Drug Administration (FDA) endorses the use of one type of folate, which is also called vitamin B9 or folic acid. The organization has approved l-methylfolate (Deplin) for the treatment of depression and schizophrenia in addition to conventional treatments.
• Mind-and-body approaches: The National Alliance on Mental Illness claims that all mind-and-body treatments tend to improve anxiety, mood, and other symptoms of mental health conditions. In addition, they provide physical activity that can reduce fatigue, weight gain, and the side effects of mental health medications. Some common forms of mind-and-body approaches include:
  • meditation
  • aerobic or anaerobic exercise

No single lab or physical test can diagnose schizophrenia.

Instead, a healthcare professional, ideally a psychiatrist, will diagnose schizophrenia by closely evaluating and observing someone's symptoms. They will usually look at the course of these symptoms over at least 6 months. A doctor will only diagnose someone with schizophrenia if at least two of the following symptoms are persistent and reduce the ability to function:

• hallucinations
• delusions
• very disorganized or catatonic behavior, which involves muscular rigidity or other severe motor behavior disturbances
• disorganized or confused speech
• negative symptoms

To diagnose someone with schizophrenia, a doctor must also rule out other possible causes of the person's symptoms. Conditions and factors that can cause similar symptoms include:

There is not enough reliable evidence to explain exactly why some people experience schizophrenia and its associated symptoms.

However, some factors do seem to contribute to the development and, in some cases, progression of schizophrenia. These include:

• Genetic factors: No single gene variation causes schizophrenia, but people with a close, genetically related relative with schizophrenia are at least six times more likely to develop it.
• Abnormalities in brain chemistry, structure, and function: In particular, this could mean abnormal levels or activity of neurotransmitters that allow brain cells to communicate, such as glutamate and dopamine. It could also refer to differences in how brain regions connect or work together.
• Environmental factors: These may include exposure to malnutrition or viruses before birth, autoimmune disorders, and living in stressful conditions or poverty.
• Substance use or misuse: This could include, in particular, the use of mind-altering drugs during teenage years and young adulthood.

As with most medical conditions, identifying and properly treating schizophrenia as early as possible increases the likelihood of being able to manage the condition successfully and reduces the risk of psychotic episodes occurring.

Receiving proper care during a first psychotic episode also tends to reduce how often someone requires hospitalization and allow them to control their symptoms sooner.

People with well-managed schizophrenia can often live very productive, rewarding lives.

People with schizophrenia can experience symptoms known as negative symptoms, which mostly stem from:

• problems expressing or feeling emotions
• difficulty getting motivated to start and complete activities
• cognitive issues, such as attention problems or trouble speaking

Although traditional medications for schizophrenia may not improve negative symptoms significantly, some supportive therapies might be effective.

People should contact a healthcare professional if they experience changes in their mood or their emotional or cognitive abilities.