Persistent negative symptoms are held to account for much of the long-term morbidity and poor functional outcome of patients with schizophrenia. 8, 9 While a degree of overlap between cognitive dysfunction and negative symptoms has been identified, 10 they are generally conceptualised as separate domains. 6, 7 Cognitive dysfunction has also been repeatedly demonstrated to contribute to poor functional outcomes in schizophrenia.
Studies have consistently reported worse functional outcomes in individuals with more prominent negative symptoms, 3 – 5 demonstrating correlations between negative symptoms and impairments in occupational and social functioning in the community, as well as a reduced likelihood of living independently. But the efficacy of these drugs in alleviating the positive symptoms of this illness tended to focus attention on such symptoms as the main treatment target, and it was not until 25 years or so later that attention once again turned to the role of negative or deficit symptoms.
The introduction of antipsychotic medication in the 1950s revolutionised the treatment of schizophrenia. Bleuler 2 noted that some patients ‘appear lazy and negligent because they no longer have the urge to do anything either of their own initiative or at the bidding of another’ (p. 74), with the process resulting in ‘emotional dullness, failure of mental activity, loss of mastery over volition, of endeavour, and of ability for independent action’ (p. Kraepelin 1 described the more severe dissolution of personality seen in some people with schizophrenia, referring to ‘weakening of those emotional activities which permanently form the mainspring of volition’ (p. Such phenomena have been recognised as part of a schizophrenic illness since early in the last century.
They include deficiencies in emotional responsiveness (blunted or flat affect), poverty of speech, poor rapport, emotional and social withdrawal, anhedonia, apathy and avolition. The negative symptoms of schizophrenia represent an important dimension of psychopathology and reflect the absence or diminution of normal behaviours and functions.
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