Negative Symptoms in Schizophrenia: Relationship to Positive Symptoms and Outcome

Abstract

The diagnostic criteria for schizophrenia have historically been based predominantly on the so-called positive symptoms, i.e., delusions, hallucinations, thought disorganization. This is not to say that the significance of negative symptom psychopathology, i.e., deficits of affect, drive, interest, speech, and thought, has been minimized, but rather less well characterized and understood. Reported differences between positive and negative symptoms in their pharmacologic response (Csernansky et al. 1986; Huber et al. 1980; Johnstone et al. 1983; Kay and Opler 1987) and pathobiologic correlates have been interpreted as evidence that these symptom clusters reflect different pathophysiologic processes or substrates (Andreasen 1982; Andreasen and Olsen 1982; Andreasen et al. 1982; Crow 1980a, b). In addition, follow-up studies indicating that negative symptoms are associated with a more chronic course of illness and poorer outcomes have been taken as evidence that negative symptom psychopathology may reflect a specific subtype of schizophrenia (Carpenter et al. 1988; Crow 1985; Kay et al. 1986; Pogue-Geile and Harrow 1984).