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Negative Symptoms of Schizophrenia Treatment: Medication, Therapy

Effective treatment of schizophrenia, such as the negative symptoms, includes a combination of drugs, behavior therapy, and support therapy.

There are three types of symptoms in schizophrenia—positive, negative, and cognitive. 

Although it is easier to recognize positive symptoms and cognitive symptoms, treating negative symptoms is a challenging task because these symptoms, such as lack of motivation, make it harder for the affected people to seek early treatment.

Medications such as antipsychotic medications have many studies backing up their use in the treatment of positive symptoms. However, when it comes to treating negative symptoms, scientists are yet to figure out which medication is really effective.

Moreover, drugs used to treat positive symptoms of schizophrenia can potentially increase negative symptoms. Hence, effective treatment of schizophrenia includes a combination of drugs, behavior therapy, and support therapy.

What are the negative symptoms of schizophrenia?

Unlike positive symptoms, negative symptoms may take time to identify because they are not prominent enough to be as noticed as positive symptoms.

Negative symptoms of schizophrenia include:

  • Anhedonia: This is the medical term for lack of pleasure. The person loses interest in the things that were once enjoyable to them.
  • Alogia: A medical term for trouble with speech. People with alogia might not talk or express themselves much, sometimes for days in the end.
  • Affective flattening: Affective flattening refers to the flattening of voice and facial emotions. Affected people may not smile normally or show usual facial emotions in response to events or conversations around them.
  • Social withdrawal: Affected people avoid going out with friends or attending social gatherings. This may occur as a symptom of depression that accompanies schizophrenia or as a secondary symptom to the wrong belief that people are trying to harm them.
  • Lack of self-care: Affected people may stop bathing, following hygiene, or taking care of themselves.

What medications are used in the treatment of schizophrenia?

  • Atypical antipsychotics:
    • Doctors generally start with medications known as atypical antipsychotics in the treatment of schizophrenia, which include:
      • Aripiprazole
      • Clozapine
      • Ziprasidone
      • Risperidone
      • Olanzapine
      • Olanzapine/fluoxetine
  • Typical antipsychotics:
    • Typical antipsychotic medications, also known as neuroleptics or major tranquilizers, include haloperidol and chlorpromazine. These may be prescribed for targeting positive symptoms of schizophrenia such as hallucinations, but these are not effective in treating negative symptoms.
    • These drugs can help treat negative symptoms that are a result of positive symptoms. For example, if a person has a wrong belief that a demon tries to attack them when they leave home and therefore avoids social gatherings, typical antipsychotics can alleviate this fear so that they can leave their home and connect socially.
  • Antidepressants:
    • Antidepressants are generally used in combination with antipsychotics in patients with schizophrenia. Many people who have schizophrenia also have depression. 
    • These antidepressants work on the brain chemicals that are linked to emotions such as serotonin, dopamine, and norepinephrine. Among them, selective serotonin reuptake inhibitors are the most commonly prescribed ones.

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Schizophrenia is the most disabling mental illness.
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What is the role of behavior therapy and support therapy in schizophrenia?

Psychosocial therapy including behavioral therapy, support therapy, and family psychoeducation equip affected people with the necessary social skills that allow them to interact amicably with friends and new connections.

These therapies not only involve helping people with persistent negative systems but also teach their families to identify the deficits in their loved ones and the techniques to cope with them.

  • Supportive therapy:
    • Patients with negative symptoms can relearn social skills through supportive psychosocial therapy. This type of therapy helps boosts their self-esteem and motivates them to engage with family, friends, and social circles.
    • Affected patients can find a companion in their therapist who can provide reassurance and offer common-sense advice. Moreover, they may see their therapist to help bridge the communication gap between them and their family.
  • Behavioral therapy:
    • Behavioral therapy can teach people with schizophrenia to engage in activities that result in a better quality of life and improvement in handling day-to-day tasks. 
    • The therapy can teach them to:
      • Express feelings and needs
      • Ask questions
      • Control gestures and facial expressions
      • Identify and change the thinking patterns that have a negative influence on behavior and emotions
  • Family psychoeducation (family therapy):
    • Family therapy involves sessions of family members with the therapist who will teach them to recognize the effect that schizophrenia symptoms have on their close ones affected with the illness.
    • It teaches them how to handle the affected patients in a better way without angry confrontations.
    • Family therapy helps the family learn the right techniques to adjust to their patient’s needs.

Do dietary supplements work in treating the negative symptoms of schizophrenia?

Several theories have been proposed to support the use of dietary supplements in treating negative symptoms of schizophrenia. Some studies have efficacy data that support the use of folate and vitamin B12 supplements to be beneficial.

Although it looks enticing to use dietary supplements as a natural way to combat the negative symptoms of schizophrenia, there is not enough evidence for experts to recommend them for long-term use.

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Medically Reviewed on 3/31/2022

References

Image Source: iStock Images

Schizophrenia. https://emedicine.medscape.com/article/288259-overview

Correll CU, Schooler NR. Negative symptoms in schizophrenia: A review and clinical guide for recognition, assessment, and treatment. Neuropsychiatr Dis Treat. 2020;16:519-534.

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