Schizophrenia and Negative Symptoms
The topic will be negative symptoms of schizophrenia, called this because they take away from or reduce functioning. Negative symptoms involve lack of motivation, social withdrawal, blunt affect, and alogia (poverty of speech or poverty of content of speech) and diminished movement.
Positive symptoms such as delusions, paranoia and hallucinations can mostly be managed and are often the focus of treatment sessions. Yet the negative symptoms are the ones that result in poor functional outcomes and worse quality of life.
Negative symptoms are harder to treat and last longer than positive symptoms. (Psychiatric Times. Negative Symptoms in Schizophrenia: The Importance of Identification and Treatment, retrieved April 3, 2012 from http:www.psychiatrictimes.com/schizophrenia/content/article/10168/)
Their improvement can result in better skills in independent living, social functioning and role functioning. The atypical medications do not treat negative symptoms.
Psychiatrists need to inquire about their patient’s daily activity and interaction with others. The goal is to determine if the individual engages in productive activity in the daytime.
According to the Psychiatric Times review, “If negative symptoms are related to depressed affect, treatments for depression could be considered. While there is no clear evidence that depression in schizophrenia responds to SSRIs, there is some evidence that SSRIs can have a positive impact on negative symptoms.”
It can sometimes be that the urgency of positive symptoms, like hearing voices, causes social withdrawal. In this instance, the Psychiatric Times review states that “increasing the dosage of antipsychotic medication or switching to a different antipsychotic may be warranted.”
The atypical drugs might not necessarily improve negative symptoms, yet individuals who take the drugs are more likely to engage in psychosocial treatment, thus the negative symptoms are minimized.
This key benefit could occur with social skills training, so a psychiatrist would do well to refer his patients there when they exhibit negative symptoms.
One good way to assess whether your loved one has negative symptoms is to compare and contrast their personality before their breakdown and how their life is after it. If your son or daughter or husband or wife had more energy and vitality pre-diagnosis, and now has no desire to go to the grocery store, that could indicate negative symptoms are present.
You need to differentiate between whether their “laziness” is a symptom, or whether they were always couch potatoes long before they got sick.
Often, negative symptoms predate the occurrence of positive symptoms and arrive in the prodromal stage of schizophrenia (Medscape, State-of-the Art Treatment for Negative Symptoms of Schizophrenia, retrieved on April 3, 2012 from http://www.medscape.org/viewarticle/560657).
Social skills training can improve competence in relationships, work, recreation and self-care. This kind of training helps individuals express their feelings and adjust their voices and facial expressions. (The Harvard Medical School Family Health Guide, the negative symptoms of schizophrenia. Retrieved on April 3, 2012 from http://www.health.harvard.edu/fhg/updates/update0706c.shtml.)
Cognitive therapy can also enhance a patient’s ability to connect with others because it can “counteract the fear of exposing limitations that make some people withdrawn or apathetic.” (Harvard Medical School Family Health Guide, ibid.)
A specific form of cognitive therapy called cognitive rehabilitation, remediation or enhancement can help individuals express their needs and show they understand the needs of others. It’s suggested that people with schizophrenia isolate because they fear other people resist their inability to express or understand feelings and desires.
I recommend certain approaches to combating negative symptoms. I agree with the benefit of social skills training and cognitive remediation. You can contact your local reputable hospital or university with a psychiatric unit or department, and find out if these services are available in your city or town. UCLA is one.
My own experience is kind of atypical: as soon as I got out of the hospital, I attended a two-day program. I only recommend a day program as a short-term option from six months to a year. A better activity would be an IPRT or Intensive Psychiatric Rehabilitation Treatment program, where you are actively engaged in setting a plan to achieve a goal.
In my personal blog, I suggested that, as hard as it can be, you get out of the house and go to a coffee shop. You don’t have to start a conversation, what counts is that you’re outside surrounded by people, so you’ll start to get comfortable living in the world.
I’m also the number-one fan of cognitive behavioral therapy or CBT (so much so that I might write another SharePost on the topic down the road).
I’ll tell you what I don’t recommend: attending a Clubhouse as your sole activity. I would much prefer volunteer work as an option for someone who can’t work at paid employment because it gets you interacting socially with others in the community.
A recent issue of SZ magazine had a feature article on getting motivation. Its message can be summed up in one example: “If you can’t work, and you like music, you could join a band.”
Too often, social skills training is not used. I have the idea that when I retire from full-time work, I would like to be a volunteer coach to people in recovery who could benefit from my experience and wisdom.
I was lucky: I had barely any negative symptoms. It was easier for me to hop on the Ferry and go into the City, which is why I make the case for going outside your room to get out in the world, even if intimate relationships are at first challenging and you just observe the activity around you.
So go to a bookstore. Go to a park. Go to a library. Observe others, see how they act and interact. Take mental notes. Think of it as a field expedition.
The more experience you get being around others, the easier it will be to take risks to get involved in relationships. A guy I interviewed for a column I wrote is quoted: “The point of recovery is to be in relationships.”
To that end, I’ll talk in the next SharePost about creating and sustaining friendships and romantic partnerships.
Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.