Theories and models of negative symptoms in schizophrenia and clinical implications

Abstract

Negative symptoms in schizophrenia include avolition, anhedonia, asociality, alogia and affective blunting. These symptoms correlate strongly with clinical and functional outcomes, but respond poorly to conventional treatments. Research on the origins and mechanisms of negative symptoms can potentially advance the development of interventions. In this Review, we outline important points of convergence for phenomenological and neurobiological evidence. First, we summarize how negative symptoms are conceptualized and how these psychopathologies manifest in clinical and subclinical populations. Next, we critically review theoretical and empirical models of negative symptoms. We propose that the ‘trait with state-elevation’ properties of negative symptoms make them particularly useful for identifying individuals who may be at risk of developing psychosis and for predicting the onset of psychosis. Finally, we suggest that future research should use sophisticated technology and longitudinal designs to capture both inter-individual and intra-individual variability in negative symptoms and to improve diagnosis and treatments.