Conceptualizationandtreatmentofnegativesymptomsinschizophrenia

摘要： Negativesymptomsofschizophreniaincludingsocialwithdrawal,diminishedaffectiveresponse,lackofinterest,poorsocialdrive,anddecreasedsenseofpurposeorgoaldirectedactivitypredictpoorfunctionaloutcomesforpatientswithschizophrenia.Theymaydevelopandbemaintainedasaresultofstructuralandfunctionalbrainabnormalities,particularlyassociatedwithdopaminerewardpathwaysandbyenvironmentalandpsychosocialfactorssuchasself-defeatingcognitionsandtherelieffromoverstimulationthataccompanieswithdrawalfromsocialandrolefunctioning.Negativesymptomsaremoredifficulttotreatthanthepositivesymptomsofschizophreniaandrepresentanunmettherapeuticneedforlargenumbersofpatientswithschizophrenia.Whileantipsychoticmedicationstotreatthesymptomsofschizophreniahavebeenaroundfordecades,theyhavedonelittletoaddressthesignificantfunctionalimpairmentsinthedisorderthatareassociatedwithnegativesymptoms.Negativesymptomsandtheresultinglossinproductivityareresponsibleformuchoftheworld-widepersonalandeconomicburdenofschizophrenia.Pharmacologictreatmentsmaybesomewhatsuccessfulintreatingsecondarycausesofnegativesymptoms,suchasantipsychoticsideeffectsanddepression.However,intheUnitedStatestherearenocurrentlyapprovedtreatmentsforsevereandpersistentnegativesymptoms(PNS)thatarenotresponsivetotreatmentsforsecondarycauses.PharmacotherapyandpsychosocialtreatmentsarecurrentlybeingdevelopedandtestedwithsevereandPNSastheirprimarytargets.Academia,clinicians,thepharmaceuticalindustry,researchfunders,payersandregulatorswillneedtoworktogethertopursuenoveltreatmentstoaddressthismajorpublichealthissue. ... （共10页）