Tuesday, November 29, 2022

Is Flat Affect A Negative Symptom Of Schizophrenia

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Efficacy Of Pst For Schizophrenia

Im Experiencing Flat Affect | Schizophrenia

Schizophrenia is a chronic psychiatric disorder that results in cognitive, social, and emotional impairment. In addition to blunted affect, schizophrenic patients experience a tremendous amount of cognitive and behavioral impairment. With the progression of illness, impairment takes place in the general functioning of the individual. The impairment in the functioning is mostly felt in the cognitive domain. As a result, some schizophrenic patients display poor insight or awareness about the neurocognitive deficits the illness caused .

Standard psychoeducation programs designed for schizophrenic patients need to be formulated to make up for the impairment in the functioning resultant of the illness. Psychoeducation programs are being used to compensate for the impairments and to teach new skills. The goal of the psychoeducation programs is to help both the patients and their significant others accept the illness and to increase their coping resources. Problem solving, assertiveness, communication, and related cognitivebehavioral skills form the backbone of such programs. For instance, a multicenter randomized study in Germany showed that psychoeducation reduced the rehospitalization rates of the schizophrenic patients from 58% to 41% and the time spent at the hospital from 78 to 39 days .

Sharon L. Johnson, in, 2009

Biochemical And Genetic Studies

Recent works on the neurogenesis and neuroplasticity pathways have generated special interest in their role in negative symptomatology. That neuroinflammation in adulthood might lead to the development of negative symptoms subsequently has been proposed on the basis of the finding of elevated C-reactive protein in these patients and evidence of herpes simplex virus infection. A study by Yoshimura et al. found a reduced serum brain-derived neurotrophic factor -like immunoreactivity in chronic schizophrenics, probably as a result of long-standing neurodegeneration and simultaneous reparative process in the brain. As BDNF is involved in various stages of nervous system development and functioning, its involvement in various manifestations of the disorder is imperative. However, convincing results are lacking and further exploration is needed. Similarly, a hypofunctioning N-methyl-D-aspartate system which plays a role in the long-term potentiation and promoting neuroplasticity has been implicated in the genesis of the negative symptoms. It is hypothesized that reduced NMDA transmission, possibly in face of neuroinflammation, might be detrimental at the functional level, and supporting evidence in form of a demonstrated improvement in symptoms with NMDA agonists such as D-cycloserine are encouraging.

Avolition And Drug Development

After two decades of psychotropic drug development with moderately superior tolerability profile over the previous drugs, the 2000s have been characterized by stagnation of productivity in psychiatric drug development,. The stagnation has been attributed to a lack of pathophysiological understanding of the mental disorders, difficulties in defining targets, poor translation from animal models to human, and the absence of biological markers. Adherence to diagnostic systems that were not specifically designed for drug development, such as the DSM, and the use of overinclusive outcome measures and scales has also been suggested as a major reason for the failure to develop novel psychotropics,,.

Indeed, it is accepted by academicians, clinicians, and regulators that the behavioral syndromes defined by DSM classifications and the assessment scales attempting to define the severity of these impairments do not correspond to specific, putative biological processes and brain abnormalities. Nevertheless, meeting criteria for the DSM classifications and manifesting a threshold level of severity still constitute the criteria for patients inclusion in trials and the basis for independent investigator-initiated studies and new drug applications.

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Mean Change From Baseline At Week 26 In Panss

On factors assessing changes in domains relevant to negative symptoms, differences in mean change from baseline at week 26 were statistically significant in favor of cariprazine versus risperidone on the Marder factor for Disorganized Thoughts , the Prosocial Functioning factor , and the Meltzer Cognitive subscale .

3.1.4 Demonstrating that negative symptom change is genuine: pseudospecificity analyses

In prospective analysis of the PANSS-FSPS, mean change from baseline at week 26 was the same for cariprazine and risperidone , providing primary evidence for the lack of pseudospecific change in negative symptoms related to positive symptom improvement. In post hoc analyses, these results were supported by small and similar between-group mean changes on the individual positive items included in the PANSS-FSPS mean change in unusual thought content, a general item included in the PANSS-FSPS , was -0.24 for cariprazine and -0.26 for risperidone, with no significant between-group difference noted.

What Are Positive And Negative Symptoms

Psychotic Disorders

Positive and negative symptoms are medical terms for two groups of symptoms in schizophrenia.

Positive symptoms add. Positive symptoms include hallucinations , delusions , and repetitive movements that are hard to control.

Negative symptoms take away. Negative symptoms include the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships.

There is also a third group of symptoms, usually called cognitive symptoms. This includes anything related to thinking, such as disorganized thoughts, memory problems, and difficulties with focus and attention.

Where can I learn more?

About the author

The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.

Q& A is for readers who want to take charge of their well-being, support a friend or loved one, find good help, or just learn more about mental health and substance use. Here, the information and resource experts at HeretoHelp will answer the questions that were asked most often. Weâll offer tips and information, and weâll connect you with help in BC, Canada. If you have a question youd like to ask, email us at , tweet , or log in to HeretoHelp and post a comment on this page.

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The Neurobiology Of Negative Symptoms In Schizophrenia

The heterogeneity in etiology and clinical manifestation of the negative symptoms in schizophrenia led to the exploration of several structural abnormalities, pathways, and mechanisms which may underlie this complex of symptoms. The attempt to reduce these symptoms heterogeneity leads to concepts of deficit and non-deficit schizophrenia and diminished expression and avolition/apathy domains. Different hypotheses have been constructed for these models pathophysiological mechanisms, but unfortunately without fully satisfying results .

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Best Practices For Managing Negative Symptoms In The Clinic

Negative symptoms are common in schizophrenia and over half of patients will experience clinically relevant negative symptoms that need treatment at some point., In addition to the limited efficacy of most available pharmacological treatments, negative symptom characteristics are a challenge in the clinic since some patients may lack insight into the extent and impact of their symptoms. Patients rarely present with negative symptom complaints and more immediately pressing positive symptoms may distract clinicians from the negative symptom burden. Given the difficulty in differentiating negative symptoms that are intrinsic to schizophrenia from negative symptoms resulting from another underlying cause, clinicians should carefully monitor and actively manage all clinically relevant negative symptoms .

How Can You Treat Schizophrenia

Positive and Negative Symptoms of Schizophrenia

Schizophrenia treatment, as of now, usually continues for lifelong, right from the time of diagnosis. Treatment for schizophrenia needs to be continued even when the schizophrenia symptoms seem to have subsided or faded. Schizophrenia treatment is generally a combination of medication, coordinated specialty care services and psychotherapy. A team that comprises of a psychiatrist, psychiatric nurse, social worker and psychologist should guide the schizophrenia treatment.

Medications acts as a foundation in schizophrenia treatment. Antipsychotic medication and anti-tremor medications are commonly prescribed to schizophrenic patients. The combinations of various neuro-psychotic medications as well as doses are decided based on the severity of the schizophrenia symptoms.

Along with medications, schizophrenic patients also need strong social support. This is also referred to as psychological intervention and following are some of these therapies:

Family Therapy in Schizophrenia: This therapy educates the family on how to support and deal with the family member suffering from schizophrenia.

Individual Therapy for Treating Schizophrenia: Regular psychotherapy can normalize thought patterns in a schizophrenic patient to a great extent. Individual therapy also includes teaching the patients on how to identify warning signs of a schizophrenia relapse, cope up with stress. It also helps the individuals to be able to manage their illness overall.

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Negative Symptoms Of Schizophrenia

Schizophrenia is a severe mental illness that is characterized by hallucinations, delusions, and paranoia. Although most people think of hearing voices and associate them with schizophrenia, those are just some of the symptoms. The symptoms experienced are divided into two subtypes including negative symptoms and positive symptoms.

Negative symptoms usually involve subtracting something from the persons life such as emotion or happiness. In other words negative means absence of normal behavior or should be considered something the person lacks. Positive symptoms involve adding something to the persons experience such as hallucinations, delusions, etc.

Even though most people know about positive symptoms that can be experienced, most experts agree that the negative symptoms have a greater impact on overall functioning and wellbeing. In other words its not the voices that necessarily cause the most difficulties for people with schizophrenia. Its the social withdrawal, anhedonia, blunted emotion, and major depression that are most difficult to cope with.

The Current Measurement Of Negative Symptoms: Instruments And Their Properties

Simply viewed, negative symptoms encompass all that is missing from the normal range of emotions and behaviors. The definitions of negative symptoms and the related measurement scales are broad aggregates of examiner observations and examinee reports. Central to this challenge is the lack of a clear definition of what is the normal range of these behaviors. While the extremes of normality and abnormality in this domain can be identified with ease, the extent to which more moderate behaviors are quantified, defining incremental levels of impairment and a clear threshold for separation from normal, is challenging. Further, despite active research in the field, no objective bio-markers to diagnose or quantify negative symptoms are currently available. Therefore, what is observed and reported is unavoidably affected by subjective interpretations, raising questions about validity and reliability of the assessments of this construct,,.

The first attempts to quantify negative symptoms were the Brief Psychiatric Rating Scale Scale for the Assessment of Negative Symptoms , Positive and Negative Syndrome Scale , and Negative Symptom Assessment. However, these first-generation scales have been criticized in recent years due to outdated item content, conceptual limitations, overreliance on behavioral indicators at the expense of experiential factors, and psychometric issues.

  • Alogia: a reduction in the quantity of speech or amount of spontaneous elaboration.

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    What Treatments Are There For Relieving The Negative Symptoms Of Schizophrenia

    When it comes to schizophrenia, treatment options may include a combination of psychotherapy and medication. Medications may include antidepressants, antipsychotics, and mood stabilizers, depending on the nature of ones condition.

    Psychotherapy for schizophrenia may help patients work on emotional regulation strategies, recognize psychotic thinking patterns, and help them develop effective coping strategies when they face obstacles from having schizophrenia. Patients may see a psychologist or social worker one-on-one or engage in group therapy to learn from others about their experiences having schizophrenia. When done right, psychotherapy can be very beneficial and help those living with schizophrenia live healthy and satisfying lives.

    Lastly, some people with schizophrenia may seek cognitive remediation therapy to work on cognitive problems resulting from experiencing psychosis. This kind of therapy involves the practice and translation of cognitive skills to everyday life. Sometimes, people may use digital cognitive therapy tools or good cognitive therapy worksheets to work on these skills and then perform bridging activities or use a bridging worksheet to help them generalize their cognitive practice. This form of therapy is very popular, as it helps clients build the cognitive capacities needed for emotional regulation.

    Negative Symptoms Domains: Avolition/apathy And Diminished Expression


    Factor analysis studies have suggested that negative symptoms include two domains: apathy/avolition and diminished expression, which led to building separate hypotheses for these domains . In current conceptualizations, the avolition/apathy domain is defined as deficits in different motivation areas. Two possible mechanisms and circuits are considered to be involved: the reward circuit and the salience circuit . Functional MRI studies tried to elucidate the substrate of the motivational deficit using tasks involving reward anticipation, and it was found that there is an association between the activation of the ventral striatum and the apathy/avolition domain. This relationship has not been confirmed for the diminished expression domain. Only a limited number of studies have investigated the correlations between neural structures and the apathy/avolition domain, and the following results were reported: a low volume of the frontal lobes, thinning of the anterior cingulate cortex and orbitofrontal cortex, and structural abnormalities of connectivity between the medial orbitofrontal cortex and the anterior rostral cingulate cortex .

    Transcranial direct current stimulation has been mainly studied for positive symptoms, auditory hallucinations, but an improvement of negative symptoms as a subsidiary result, especially motivational deficits, has been reported. The modulation of corticalsubcortical networks can explain the benefits for negative symptoms .

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    Genetic Basis Of Negative Symptoms

    The progress in the genetics of schizophrenia in the last years has been noticeable. Heritability represents a statistical estimate to quantitate the relative genetic contribution to a trait relative to its environmental contributors. Heritability is the amount or proportion of phenotypic variance of the disease of interest in the population that is inherited through genetic factors. The heritability of schizophrenia has been established at 81% , making the genetic factor the most significant for the disease.

    According to evidence from previous family and association studies, it has been suggested that genetic factors are involved in the development of schizophrenia and also in its clinical presentation. Studies that investigated genes potentially involved in negative symptoms pathogenesis highlighted that classifying patients with schizophrenia into specific subtypes based on predominant symptoms is useful for selecting the specific treatment. The findings, and references for these studies are summarized on Table 3.

    Why Do I Feel Worse After Physical Therapy

    While its not uncommon to feel sore after physical therapy, you should never experience severe pain. Its important not to confuse soreness with pain. Muscles that have become tight and weak over time require stretching and exercise which results in a lactic acid build-up that can cause irritation.

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    Coping And Support For Caregivers

    Caring for a loved one who is suffering from flat affect is challenging. It’s much more than dealing with a loved one who tends to be “cold.” It’s not a personality trait. This symptom of schizophrenia makes it impossible for your loved one to translate emotion into a verbal or physical expression. The brain and body are not connecting.

    While they may be unable to express their emotions, your emotions are likely in overdrive as you struggle to come to terms with this symptom of schizophrenia. Continuing to educate yourself on the condition and the experiences your loved one will face is one of the most important ways to cope.

    Gathering information can help you better understand what to expect and what you can do to help.

    Although your primary focus is on supporting your loved one, it’s also important to remember to help yourself. This means seeking support from local or online groups, a mental health provider, or a trusted friend or family member.

    Sharing your experiences and challenges can help you process your emotions and give you encouragement and hope. You may also gain helpful information about new or progressive treatment methods as well as other resources to help your loved one.

    How Is A Flat Affect Different From Emotional Blunting

    Novel Strategies Addressing Negative Symptoms of Schizophrenia

    While a flat affect and emotional blunting may sound like the same thing, they are indeed different .

    Like a flat affect, emotional blunting is a symptom of a condition. Its a diminished emotional response, like suddenly not laughing at a movie you once found funny.

    If youre not feeling much of an emotional response to a stimulus, you may not show an emotional response either, which is how its linked with a flat affect. But in flat affect, you do have an emotional response, although you dont show it in your face or body.

    Emotional blunting is present in many of the same conditions as a flat affect, including:

    • depression

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    What Features Are Characteristic Of Pseudodementia Associated With Depression

    Patients with pseudodementia may or may not have a history of depressive or vegetative symptoms. They tend to have flat affect, to give up easily when mental status is examined, or to say that they cannot perform a task without even trying it. They often respond surprisingly well when given extra time and encouragement, but they may deny their success. Results of mental status examination are inconsistent for example, they may fail a simple task but perform a similar, more difficult one correctly. Or they may have variable strengths and weaknesses over repeated testing sessions.

    Tatsuro Kumada, Atsuo Fukuda, in, 2020

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