A review of theories explaining negative symptoms (23 May 2022)

A review article:

Theories and models of negative symptoms in schizophrenia and clinical implications

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.

Aaron Beck, the original inventor of CBT, interviewed patients and found that
the following beliefs underpinned negative symptoms.

Beck’s beliefs that induce negative symptoms:

  • Avolition, lack of motivation:
    Beliefs are, I will be defeated anyway so why even try? it’s not going
    to work out anyway, I can’t do things until I get the energy, I need
    to conserve my energy, a little mistake is as bad as a complete
    catastrophe, i am broken.

  • Lack of socialisation:
    Beliefs are, there is no value in socialising with other people,
    nobody likes me.

  • Anhedonia:
    Beliefs are, I don’t expect doing things to be fun so why try? doing
    things is not going to be enjoyable anyway.

  • Alogia:
    Beliefs are, people don’t want to hear what I have to say anyway so why talk.

I don’t feel those beliefs drive negative symptoms for me.

I think there’s a big structural component too. It’s biochemical and it makes a huge difference. I’m not sure whether it’s a matter of choice or training.