EPA guidance on treatment of negative symptoms in schizophrenia

Abstract

Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there is a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. The importance of the distinction between primary and secondary negative symptoms for treatment selection might seem evident, but the currently available evidence remains limited. Good clinical practice is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment should be optimized to avoid secondary negative symptoms due to side effects and due to positive symptoms. For most available interventions, further evidence is needed to formulate sound recommendations for primary, persistent, or predominant negative symptoms. However, based on currently available evidence recommendations for the treatment of undifferentiated negative symptoms (including both primary and secondary negative symptoms) are provided. Although it has proven difficult to formulate an evidence-based recommendation for the choice of an antipsychotic, a switch to a second-generation antipsychotic should be considered for patients who are treated with a first-generation antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social skills training is recommended as well as cognitive remediation for patients who also show cognitive impairment. Exercise interventions also have shown promise. Finally, access to treatment and to psychosocial rehabilitation should be ensured for patients with negative symptoms. Overall, there is definitive progress in the field, but further research is clearly needed to develop specific treatments for negative symptoms.

Additional perspective on cariprazine and negative symptoms

“…In my editorial [2], I specifically reviewed, singled out and recommended a trial of cariprazine as a treatment for negative symptoms in schizophrenia. This recommendation is consistent with other expert guidance [4]. Nemeth et al appear to feel that a stronger recommendation is warranted but unfortunately offers limited additional support beyond several case reports, an open-label study, and a post hoc analysis of two acute phase clinical trials [5].…”

How do we address treating the negative symptoms of schizophrenia pharmacologically?

“…The present report focuses on the treatment landscape of negative symptoms in schizophrenia, including both Federal Drug Authority (FDA) or other regulatory bodies approved and investigational treatments. The reader is referred to two recent reviews for further details [4,5].…”

Investigating the Relationships of P3b with Negative Symptoms and Neurocognition in Subjects with Chronic Schizophrenia

“…Neurocognitive deficits and negative symptoms have a pivotal role in schizophrenia due to their severe impact on patients’ functioning in daily life and the absence of effective pharmacological treatments targeting them [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”