Managing negative symptoms in psychoses including schizophrenia
Negative symptoms are a significant cause of long-term disability in schizophrenia because they respond poorly to treatment with most antipsychotics.
Ensure antipsychotic therapy is optimised and take the following steps to address negative symptoms:
- assess if negative symptoms are an antipsychotic adverse effect (eg sedation); follow the advice here on mitigating the adverse effect
- assess for and treat comorbidities that can cause negative symptoms (eg depression, anxiety, obstructive sleep apnoea)
- optimise the patient’s engagement with their family and community—see Support for families, carers and significant others of people with psychoses including schizophrenia and Psychosocial interventions for psychoses including schizophrenia
- encourage physical activity1—exercise can improve negative symptoms
- use psychosocial interventions guided by a detailed cognitive assessment; behavioural therapy and social skills training can be particularly beneficial.
If negative symptoms persist despite these interventions, contact the patient’s psychiatrist for advice. The choice of therapy depends on the patient’s comorbidities and treatment history; for example, if depressive symptoms are prominent, combining an antipsychotic with an antidepressant (particularly a selective noradrenaline reuptake inhibitor [SNRI]) may improve secondary negative symptomsCorrell 2017. If monotherapy is used, amisulpride and cariprazine have the best evidence of efficacy for negative symptomsKrause 2018.
1 For advice on physical activity, see Australia’s Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines.Return