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Thinking and acting beyond the positive: the role of the cognitive and negative symptoms in schizophrenia

Published online by Cambridge University Press:  18 November 2014

Maren Carbon  and
Christoph U. Correll
Maren Carbon
Affiliation:
Psychiatry Research, The Zucker Hillside Hospital, North Shore—Long Island Jewish Health System, Glen Oaks, New York, USA
Christoph U. Correll*
Affiliation:
Psychiatry Research, The Zucker Hillside Hospital, North Shore—Long Island Jewish Health System, Glen Oaks, New York, USA Psychiatry and Molecular Medinine, Hofstra North Shore LIJ School of Medicine, Hempstead, New York, USA Psychiatric Neuroscience Center of Excellence, The Feinstein Institute for Medical Research, Manhasset, New York, USA Psychiatry, Albert Einstein College of Medicine, Bronx, New York, USA
*
*Address for correspondence: Christoph U. Correll, MD, The Zucker Hillside Hospital, Psychiatry, 75-59 263rd Street, Glen Oaks, NY 11004, USA. (Email: ccorrell@lij.edu)
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Abstract

Since currently available antipsychotic medications predominantly treat hallucinations, delusions, disorganized thoughts and behavior, and related agitation/aggression, attention has traditionally been focused on managing positive symptoms. However, prominent negative symptoms and clinically relevant cognitive impairment affect approximately 40% and 80% of people with schizophrenia, respectively. Moreover, negative and cognitive symptoms are closely related to functional outcomes, and contribute substantially to the overall illness burden. Therefore, approaches to describe, measure, and manage these symptom domains are relevant. This article summarizes the phenomenology, prevalence, assessment, and treatment of negative and cognitive symptoms in patients with schizophrenia, including pharmacologic and nonpharmacologic management strategies that can be used in clinical care now, as well as pharmacologic approaches that are being tested. Currently, no approved treatments targeting negative or cognitive symptomatology in schizophrenia are available. It is hoped that progress in the understanding of the neurobiology of these important symptom domains of schizophrenia will help develop effective treatment strategies in the future. However, until this goal is achieved, clinicians should avoid therapeutic nihilism. Rather, the severity and impact of negative and cognitive symptoms should be determined, quantified, and monitored. Further, psychosocial treatments have shown therapeutic benefits. Thus, cognitive behavioral therapy, cognitive remediation, social skills training, and computer-assisted training programs should be offered in conjunction with antipsychotic treatment. Several non-antipsychotic augmentation strategies can be tried off-label. Treatment plans that incorporate currently available management options for negative and cognitive symptomatology in patients with schizophrenia should be adapted over time and based on the individual’s needs, with the aim to enhance overall outcomes.

Keywords

Assessmentcognitionnegative symptomsschizophreniatreatment
Type
CME Review Article
Information
CNS Spectrums , Volume 19 , Issue S1: CME SUPPLEMENT , December 2014 , pp. 35 - 53
Copyright
© Cambridge University Press 2014 

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Footnotes

This activity is supported by an educational grant from Envivo Pharmaceuticals, LLC (a.k.a. FORUM Pharmaceuticals, Inc)

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