Möller Hans-Jürgen
Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany.
Eur Psychiatry. 2007 Sep;22(6):380-6. doi: 10.1016/j.eurpsy.2007.03.010. Epub 2007 May 23.
The florid positive symptoms of schizophrenia (hallucinations, delusions, grossly disordered thinking) are often obvious. By comparison, negative symptoms (flattened affect, impoverished speech, apathy, avolition, anhedonia) are subtler and more difficult to recognize and diagnose. However, there is increasing recognition of the importance of negative symptoms in patients with schizophrenia. Secondary negative symptoms attributable to such factors as unrelieved positive symptoms, the adverse effects of antipsychotic pharmacotherapy, or social isolation may subside with resolution of such factors. In contrast, primary negative symptoms are an intrinsic aspect of schizophrenia; they are persistent and have been associated with poorer clinical outcomes. Although the lack of a reliably effective treatment for negative symptoms is a serious unmet need in this patient population, accurate diagnosis is still important. Assessment of suspected negative symptoms, using validated rating scales, can help to rule out comorbid affective or cognitive disorders that may mimic negative symptoms and to distinguish primary negative symptoms from potentially reversible secondary negative symptoms. This article reviews the definitions and classification of negative symptoms, compares the tools available for their assessment, and offers practical clinical algorithms for sorting through the differential diagnosis.
精神分裂症的明显阳性症状（幻觉、妄想、严重思维紊乱）往往很突出。相比之下，阴性症状（情感平淡、言语贫乏、冷漠、意志缺乏、快感缺失）则较为隐匿，更难识别和诊断。然而，人们越来越认识到阴性症状在精神分裂症患者中的重要性。由未缓解的阳性症状、抗精神病药物治疗的不良反应或社会隔离等因素导致的继发性阴性症状，可能会随着这些因素的解决而消退。相比之下，原发性阴性症状是精神分裂症固有的一个方面；它们持续存在，且与较差的临床预后相关。尽管缺乏可靠有效的阴性症状治疗方法是这类患者群体中一个严重未得到满足的需求，但准确诊断仍然很重要。使用经过验证的评定量表评估疑似阴性症状，有助于排除可能模拟阴性症状的共病情感或认知障碍，并区分原发性阴性症状和潜在可逆转的继发性阴性症状。本文综述了阴性症状的定义和分类，比较了用于评估阴性症状的工具，并提供了用于梳理鉴别诊断的实用临床算法。
