Relationship between neuroleptic dose and positive and negative symptoms

Secondary negative symptoms - A review of mechanisms, assessment and treatment

Negative symptoms in schizophrenia may be classified as primary or secondary. Primary negative symptoms are thought to be intrinsic to schizophrenia, while secondary negative symptoms are caused by positive symptoms, depression, medication side-effects, social deprivation or substance abuse. Most of the research on secondary negative symptoms has aimed at ruling them out in order to isolate primary negative symptoms. However, secondary negative symptoms are common and can have a major impact on patient-relevant outcomes. Therefore, the assessment and treatment of secondary negative symptoms are clinically relevant. Furthermore, understanding the mechanisms underlying secondary negative symptoms can contribute to an integrated model of negative symptoms. In this review we provide an overview of concepts, evidence, assessment and treatment for the major causes of secondary negative symptoms. We also summarize neuroimaging research relevant to secondary negative symptoms. We emphasize the relevance of recent developments in psychopathological assessment of negative symptoms, such as the distinction between amotivation and diminished expression, which have only rarely been applied in research on secondary negative symptoms.

Rethinking medication prescribing practices in an inner-city Hispanic mental health clinic

Improved compliance with pharmacotherapy was achieved in treating Hispanic outpatients with psychotic disorders when recognition of culturally based differences between patients and psychiatrists led to modifications in prescribing practices. Unacculturated Hispanic outpatients experienced akathisia as an increase in "nerviosismo." Addressing this issue, as well as using anxiolytics and low doses of antipsychotics when beginning treatment, led to an improvement in compliance. Increased discussion of other antipsychotic side effects, which forced us to confront our false assumption that unacculturated Hispanics would be prone to suggestibility and, therefore, that discussions of side effects would lead to an increase in somatization, similarly improved medication compliance and therapeutic alliance. Practicing psychiatrists need to become aware of cultural factors to better treat patients with different backgrounds.