Symptoms known as “negative symptoms” are some of the first signs of schizophrenia but will often be present throughout treatment. In many cases, they come on slowly. These symptoms often are mild at first and can be hard to spot. They may overlap with symptoms of other mental health issues, like depression, too. All of these factors can make diagnosing schizophrenia hard.1-3
Schizophrenia has 3 main phases: prodromal, active, and residual. They typically first occur in that order. Negative symptoms first appear during the prodromal stage. However, they also can be present during the active and residual stages. How many negative symptoms someone has and how severe they are can help predict a person’s long-term outcomes.1,2,4
What are negative symptoms?
Negative symptoms are called “negative” because they involve a loss of behaviors or reactions that are typical for the person. A loss of desire to socialize is an example of a negative symptom. Someone might normally be excited about talking to others. But if they have schizophrenia, they may lose that desire and isolate themselves.1-5
On the other hand, positive symptoms involve the addition of a new behavior or reaction. Positive symptoms of schizophrenia include hallucinations, delusions, and disorganized thinking.1-5
Common examples of negative symptoms include:1-6
- Feeling less emotion or reduced expression of emotions
- Lacking facial expressions (flat affect)
- Speaking less than normal or not at all (alogia)
- Not being able to enjoy activities or feel pleasure (anhedonia)
- Having lower levels of motivation and desire to reach goals (avolition)
- Not wanting to interact and socialize with others (asociality)
- Ignoring personal hygiene or appearance
- Loss of movement or ability to respond in conversation (catatonia)
Negative symptoms sometimes can result from positive symptoms. For example, if a person has a delusion that they are being followed, they may choose to stay in their house. This can lead to social isolation.2
Why do negative symptoms happen with schizophrenia?
The exact cause of schizophrenia is not known. It is thought to be a combination of many different factors. Some of these factors change the way the brain functions.1,7,8
Neurotransmitters are chemicals that send messages in the brain. They tell your body how to respond to things. They also affect how you feel emotions. Common neurotransmitters are glutamate, serotonin, and dopamine. When these chemicals are out of balance, some of the symptoms of schizophrenia may occur.1,7,8
Negative symptoms likely stem from the way neurotransmitters interact with different parts of the brain. One theory is that negative symptoms result from low levels of dopamine in a certain area of the brain.7,8
People with schizophrenia symptoms also may have symptoms of depression or other mood disorders. For example, a person who has psychosis along with periods of depression may have schizoaffective disorder. Schizoaffective disorder is one of the schizophrenia spectrum disorders. These disorders are similar to but different from schizophrenia.2,6
How are negative symptoms treated?
Negative symptoms can be harder to treat than positive symptoms. The original antipsychotic drugs used for schizophrenia did not work well. These drugs are called typical antipsychotics. They mostly helped with positive symptoms. They also had a lot of side effects.1,7,9
But there is a newer group of antipsychotics called atypical antipsychotics. They are also called second-generation antipsychotics. Atypical antipsychotics boost neurotransmitters in some areas of the brain. They also decrease activity in other areas. This may help improve both positive and negative symptoms. Atypical antipsychotics also have fewer side effects than typical ones.1,7,9
Medical researchers are always developing new medicines. Currently there are medicines being researched that are trying to address negative symptoms. When they become available, your doctor may recommend they be added to your treatment plan.
Antidepressant drugs may be helpful, too, if a person has depression alongside their schizophrenia. Other treatments being studied for use along with antipsychotics are anti-dementia drugs and lifestyle changes such as exercise.1,7,9,10
Therapy is also a treatment option. People often try cognitive behavioral therapy (CBT) or family therapy to help manage symptoms. These options teach coping skills and help to change behaviors around negative symptoms.1
Sometimes, negative symptoms can affect daily life or functioning. In these cases, social skills training or other rehabilitation programs may be an option.1