Journal
CLINICAL PSYCHOLOGY REVIEW
Volume 31, Issue 1, Pages 161-168Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.cpr.2010.09.002
Keywords
Schizophrenia; Negative symptoms; Emotional expression; Asociality; Avolition; Diagnosis
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Funding
- NIMH NIH HHS [K24 MH001699-01A2, K24 MH001699, K23 MH076976-01A1, RC1 MH088843-01, K23 MH076976, K24 MH01699, R01 MH066428, R01 MH066428-01A2, RC1 MH088843] Funding Source: Medline
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The DSM-5 formulation presents an opportunity to refine the negative symptom assessments that are crucial for a schizophrenia diagnosis. This review traces the history of negative symptom constructs in neuropsychiatry from their earliest conceptualizations in the 19th century. It presents the relevant literature for distinguishing between different types of negative symptoms. Although a National Institute of Mental Health consensus initiative proposed that there are five separate negative symptom domains, our review of the individual items demonstrates no more than three negative symptom domains. Indeed, numerous factor analyses of separate negative symptom scales routinely identify only two domains: 1) expressive deficits, which include affective, linguistic and paralinguistic expressions, and 2) avolition for daily life and social activities. We propose that a focus on expressive deficits and avolition will be of optimum utility for diagnosis, treatment-considerations, and research purposes compared to other negative symptom constructs. We recommend that these two domains should be assessed as separate dimensions in the DSM-5 criteria. (C) 2010 Elsevier Ltd. All rights reserved.
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