![]() ![]() After 15 years from the consensus statement, negative symptoms are still poorly assessed and even when they are caused by known and treatable factors, such as extrapyramidal side effects, they are rarely recognized and properly treated. ![]() In 2005, the National Institute of Mental Health (NIMH) developed the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative, which promoted a consensus conference aimed to review data on the existence of separate domains within negative symptoms and initiated a process for the development of evidence-based measures to improve their assessment. However, so far, progress in the development of innovative treatments has been slow and negative symptoms often represent an unmet need in the care of subjects with schizophrenia. In the light of the strong impact on functional outcome and of the burden on patients, relatives, and health care systems, negative symptoms have become a key target of the search for new therapeutic tools. Furthermore, 50–90% of subjects with schizophrenia-spectrum disorders show negative symptoms during their first episode of the illness. Large cross-sectional studies demonstrated that 50–60% of patients with schizophrenia have at least one negative symptom of moderate severity and approximately 10–30% of them experienced two or more, often enduring negative symptoms. Main driver of the growing interest for negative symptoms in subjects with schizophrenia has been the evidence of their frequent occurrence and strong relationship with low remission rates, poor real-life functioning, and quality of life. The last decades witnessed a huge increase in the attention on negative symptom conceptualization. In spite of the predominant trend, the focus on negative symptoms kept alive by few research groups enabled further progress in the field. The introduction of classification systems and operational criteria for diagnosis in psychiatry contributed to de-emphasizing the role of negative symptoms as a core aspect of schizophrenia, most likely due to a poorer inter-rater reliability in their assessment, as compared to positive symptoms. ![]() The conceptualization and descriptions of negative symptoms proposed by the 20th-century classic scholars included two aspects: loss of motivation and reduction of emotional expression. Negative symptoms have been recognized as a key component of schizophrenia since its first descriptions. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms second-generation rating scales, which provide a better assessment of the experiential domains, are available however, NS are still poorly assessed both in research and clinical settings.
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