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

[ Vol. 4 , Issue. 1 ]


Saeed Shoja Shafti   Pages 40 - 51 ( 12 )


<i>Background:</i> 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. </p> <p> <i>Objective:</i> Exploring the genuineness of the abovementioned grouping and reports regarding resistance of negative symptoms against current treatments. </p> <p> <i>Method:</i> 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. </p> <p> <i>Results:</i> 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. </p> <p> <i>Conclusion:</i> 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.


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


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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