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Odyssey of ‘Negative Symptoms’ of Schizophrenia: Rehabilitation vs Stigmatization

[ Vol. 4 , Issue. 1 ]

Author(s):

Saeed Shoja Shafti   Pages 40 - 51 ( 12 )

Abstract:


Background: Negative symptoms are categorized by some of the scholars into ‘primary vs secondary ‘, ‘enduring vs transitory ‘and ‘treatment-resistant vs treatmentresponsive’ groups. But it seems that such kind of grouping may not be practically supportable.

Objective: Exploring the genuineness of the abovementioned grouping and reports regarding resistance of negative symptoms against current treatments.

Method: After a primary survey regarding the frequency of negative symptoms amongst two hundreds and seventy schizophrenic patients, by means of Scale for Assessment of Negative Symptoms (SANS), in three random, double-blind, clinical trials (RCTs), and based on definite inclusion and exclusion criteria, the effectiveness of different adjunctive drugs respecting improvement of negative symptoms had been assessed.

Results: the frequency of affecting blunting, alogia, avolition-apathy, anhedonia-asociality and attention deficit was %96.28, %94.80, %99.62, %98.88 and %99.25, respectively. Citalopram, alprazolam, and clomipramine in the first tryout, nortriptyline in the second study, and maprotiline in the third trial were significantly more efficacious then placebo. In 31.2%, 28%, 26.4%, 24%and 22.4% of the patients there was about 20% reduction in the severity of attention deficit, alogia, affective blunting, anhedonia- asociality and avolition-apathy, respectively.

Conclusion: Conventional classification of negative symptoms into above-mentioned groups may not be practically supportable. Also maybe it is better to consider them solely in the Criterion B of diagnostic criteria, which considers the level of functioning.

Keywords:

Deficit syndrome, psychiatry, primary negative symptoms, schizophrenia, secondary negative symptoms, stigmatization.

Affiliation:

University of Social Welfare and Rehabilitation Sciences, (USWR), Razi Psychiatric Hospital, Postal Code: 18669-58891, P.O. Box: 18735-569, Tehran, Iran.

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