Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-26T15:02:10.369Z Has data issue: false hasContentIssue false
  • English
  • Français

The deficit syndrome in schizophrenia: implications for the treatment of negative symptoms

Published online by Cambridge University Press:  16 April 2020

Celso Arango ,
Robert W. Buchanan ,
Brian Kirkpatrick  and
William T. Carpenter
Celso Arango*
Affiliation:
Servicio de Psiquiatría, Hospital General “Gregorio Marañón”, C/ Ibiza 43, 280079Madrid, Spain
Robert W. Buchanan
Affiliation:
Servicio de Psiquiatría, Hospital General “Gregorio Marañón”, C/ Ibiza 43, 280079Madrid, Spain
Brian Kirkpatrick
Affiliation:
Servicio de Psiquiatría, Hospital General “Gregorio Marañón”, C/ Ibiza 43, 280079Madrid, Spain
William T. Carpenter
Affiliation:
Servicio de Psiquiatría, Hospital General “Gregorio Marañón”, C/ Ibiza 43, 280079Madrid, Spain
*
*Corresponding author. E-mail address:carango@mce.hggm.es (C. Arango).
Get access

Abstract

Schizophrenia psychopathology clusters around several symptom domains. One of these domains is negative symptomatology. We have defined the deficit syndrome as a disease entity characterized by the presence of primary enduring negative symptoms. A focus on primary negative symptoms demonstrates that deficit and nondeficit schizophrenia subgroups differ on clinical features, associated neuroimaging findings, neuropsychological and neurological measures, pattern of risk factors, and pharmacological response profiles. In the present article we focus on the importance of the distinction between primary and secondary negative symptoms for pathophysiology research. The development and mechanistic understanding of anti-negative symptom drugs may be informative regarding pathophysiology of primary negative symptoms. Although new antipsychotics are effective for secondary negative symptoms they have shown no efficacy for the deficit syndrome and new mechanisms of drug action appear to be required to address this aspect of the disease syndrome. The loss of precious human experiences and the association with poor long-term functional outcome justifies a focused and dedicated effort to discover the causes and treatments of this distinctive aspect of schizophrenia.

Type
Original article
Information
European Psychiatry , Volume 19 , Issue 1 , January 2004 , pp. 21 - 26
Copyright
Copyright © 2003 European Psychiatric Association

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Dementia praecox or the Group of Schizophrenias. New York, NY: International Universities Press; 1950.Google Scholar
Carpenter, WT JrArango, CKirkpatrick, BBuchanan, RW. Deficit psychopathology and a paradigm shift in schizophrenia research. Biol Psychiatry 1999;46:352–60.CrossRefGoogle Scholar
Carpenter, WT JrBuchanan, RWKirkpatrick, BTamminga, CWood, F. Strong inference, theory testing, and the neuroanatomy of schizophrenia. Arch Gen Psychiatry 1993;50:825–31.CrossRefGoogle ScholarPubMed
Kirkpatrick, BBuchanan, RWRoss, DECarpenter, WT Jr. A separate disease within the syndrome of schizophrenia. Arch Gen Psychiatry 2001;58:165–71.10.1001/archpsyc.58.2.165CrossRefGoogle ScholarPubMed
Kraepelin, E. Dementia praecox and paraphrenia. New York: Krieger; 1971 [Original work published 1919].Google Scholar
Rado, S. Psychoanalysis of behavior: collected papers. New York; Grune & Stratton; 1956.Google Scholar
Meehl, PE. Schizotaxia, schizotypy, and schizophrenia. Am Psychol 1962;17:827–38.CrossRefGoogle Scholar
Jaspers, K. General psychopathology. 7th ed. Manchester: Manchester University Press; 1963 [Hoenig J, Hamilton MW, Trans.].Google Scholar
Carpenter, WT JrBartko, JJCarpenter, CLStrauss, JS. Another view of schizophrenia subtypes. A report from the international pilot study of schizophrenia. Arch Gen Psychiatry 1976;33:508–16.10.1001/archpsyc.1976.01770040068012CrossRefGoogle ScholarPubMed
Carpenter, WT JrStrauss, JS. The prediction of outcome in schizophrenia. IV: eleven-year follow-up of the Washington IPSS cohort. J Nerv Ment Dis 1991;179:517–25.CrossRefGoogle ScholarPubMed
Buchanan, RWCarpenter, WT. Domains of psychopathology: an approach to the reduction of heterogeneity in schizophrenia. J Nerv Ment Dis 1994;182:193–204.CrossRefGoogle Scholar
Andreasen, NCOlsen, S. Negative v positive schizophrenia. Definition and validation. Arch Gen Psychiatry 1982;39:789–94.CrossRefGoogle Scholar
Crow, TJ. Molecular pathology of schizophrenia: more than one disease process?. Br Med J 1980;280:66–8.CrossRefGoogle ScholarPubMed
Carpenter, WT JrHeinrichs, DWWagman, AMI. Deficit and nondeficit forms of schizophrenia: the concept. Am J Psychiatry 1988;145:578–83.Google ScholarPubMed
Kirkpatrick, BBuchanan, RWMcKenney, PDAlphs, LDCarpenter, WT Jr. The schedule for the deficit syndrome: an instrument for research in schizophrenia. Psychiatry Res 1989;30(2):119–23.CrossRefGoogle Scholar
Overall, JEGorham, DR. The Brief Psychiatric Rating Scale. Psychol Rep 1962;10:799–812.10.2466/pr0.1962.10.3.799CrossRefGoogle Scholar
Andreasen, NC. The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. Br J Psychiatry 1989;7(Suppl):49–58.CrossRefGoogle Scholar
Kay, SRFiszbein, AOpler, LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–76.10.1093/schbul/13.2.261CrossRefGoogle Scholar
Blyler, CRGold, JM. Cognitive effects of typical antipsychotic treatment: another look. In: Sharma, THarvey, PD editors. Cognition in schizophrenia: impairments, importance, and treatment strategies. New York: Oxford University Press; 2000. p. 241–65.Google Scholar
Tek, CKirkpatrick, BBuchanan, RW. A five-year followup study of deficit and nondeficit schizophrenia. Schizophr Res 2001(49):253–60.CrossRefGoogle ScholarPubMed
Tamminga, CAThaker, GKBuchanan, RKirkpatrick, BAlphs, LDChase, TNet al. Limbic system abnormalities identified in schizophrenia using positron emission tomography with fluorodeoxyglucose and neocortical alterations with deficit syndrome. Arch Gen Psychiatry 1992;49(7):522–30.CrossRefGoogle ScholarPubMed
Buchanan, RWBreier, AKirkpatrick, BElkashef, AMunson, RCGellad, Fet al. Structural abnormalities in deficit and nondeficit schizophrenia. Am J Psychiatry 1993;150(1):59–65.Google ScholarPubMed
Quarantelli, MLarobina, MVolpe, UAmati, GTedeschi, ECiarmiello, Aet al. Stereotaxy-based regional brain volumetry applied to segmented MRI: validation and results in deficit and nondeficit schizophrenia. Neuroimage 2002;17(1):373–84.CrossRefGoogle ScholarPubMed
Kane, JHonigfeld, GSinger, JMeltzer, H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45:789–96.CrossRefGoogle ScholarPubMed
Conley, RRichardson, CKent, DGounaris, CZaremba, S. Clozapine response varies in deficit vs. non-deficit schizophrenic subjects. Biol Psychiatry 1994;35:746.CrossRefGoogle Scholar
Buchanan, RWBreier, AKirkpatrick, BBall, PCarpenter, WT Jr. Positive and negative symptom response to clozapine in schizophrenic patients with and without the deficit syndrome. Am J Psychiatry 1998;155:751–60.Google ScholarPubMed
Kane, JMMarder, SRSchooler, NRWirshing, WCUmbricht, DBaker, RWet al. Clozapine and haloperidol in moderately refractory schizophrenia: a six-month randomized and double-blind comparison. Arch Gen Psychiatry 2001;58:965–72.CrossRefGoogle Scholar
Rosenheck, RDunn, LPeszke, MCramer, JXu, WThomas, Jet al. Impact of clozapine on negative symptoms and on the deficit syndrome in refractory schizophrenia. Am J Psychiatry 1999;156:88–93 Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia.10.1176/ajp.156.1.88CrossRefGoogle ScholarPubMed
Tamminga, C. Glutamatergic aspects of schizophrenia. Br J Psychiatry 1999;37(Suppl):12–5.CrossRefGoogle Scholar
Goff, DCTsai, GLevitt, JAmico, EManoach, DSchoenfeld, DAet al. A placebo-controlled trial of D-cycloserine added to conventional neuroleptics in patients with schizophrenia. Arch Gen Psychiatry 1999;56(1):21–7.CrossRefGoogle ScholarPubMed
Heresco-Levy, UJavitt, DCErmilov, MMordel, CSilipo, GLichtenstein, M. Efficacy of high-dose glycine in the treatment of enduring negative symptoms of schizophrenia. Arch Gen Psychiatry 1999;56(1):29–36.CrossRefGoogle ScholarPubMed
Tsai, GYang, PChung, L.CLange, NCoyle, JT. D-serine added to antipsychotics for the treatment of schizophrenia. Biol Psychiatry 1998;44:1081–9.CrossRefGoogle ScholarPubMed
Tsai, GEYang, PChung, LCTsai, ICTsai, CWCoyle, JT. D-serine added to clozapine for the treatment of schizophrenia. Am J Psychiatry 1999;156(11):1822–5.Google ScholarPubMed
Boyer, PLecrubier, YPuech, AJDewailly, JAubin, F. Treatment of negative symptoms in schizophrenia with amisulpride. Br J Psychiatry 1995;166:68–72.CrossRefGoogle ScholarPubMed
Paillere-Martinot, MLLecrubier, YMartinot, JLAubin, F. Improvement of some schizophrenic deficit symptoms with low doses of amisulpride. Am J Psychiatry 1995;152:130–4.Google ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.