Sonali Sarkar, Kiley Hillner, Dawn I Velligan, Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX 78229, United States.
World J Psychiatry. 2015 Dec 22;5(4):352-61. doi: 10.5498/wjp.v5.i4.352.
Negative symptoms of schizophrenia including social withdrawal, diminished affective response, lack of interest, poor social drive, and decreased sense of purpose or goal directed activity predict poor functional outcomes for patients with schizophrenia. They may develop and be maintained as a result of structural and functional brain abnormalities, particularly associated with dopamine reward pathways and by environmental and psychosocial factors such as self-defeating cognitions and the relief from overstimulation that accompanies withdrawal from social and role functioning. Negative symptoms are more difficult to treat than the positive symptoms of schizophrenia and represent an unmet therapeutic need for large numbers of patients with schizophrenia. While antipsychotic medications to treat the symptoms of schizophrenia have been around for decades, they have done little to address the significant functional impairments in the disorder that are associated with negative symptoms. Negative symptoms and the resulting loss in productivity are responsible for much of the world-wide personal and economic burden of schizophrenia. Pharmacologic treatments may be somewhat successful in treating secondary causes of negative symptoms, such as antipsychotic side effects and depression. However, in the United States there are no currently approved treatments for severe and persistent negative symptoms (PNS) that are not responsive to treatments for secondary causes. Pharmacotherapy and psychosocial treatments are currently being developed and tested with severe and PNS as their primary targets. Academia, clinicians, the pharmaceutical industry, research funders, payers and regulators will need to work together to pursue novel treatments to address this major public health issue.
精神分裂症的阴性症状包括社交退缩、情感反应减弱、缺乏兴趣、社交动力不足以及目标导向活动减少，这些症状预示着精神分裂症患者的功能预后较差。它们可能是由于结构和功能脑异常发展和维持的，特别是与多巴胺奖励途径有关，并受到环境和心理社会因素的影响，如自我挫败的认知和从社交和角色功能中退出带来的过度刺激的缓解。阴性症状比精神分裂症的阳性症状更难治疗，是许多精神分裂症患者未满足的治疗需求。虽然抗精神病药物治疗精神分裂症的症状已经存在了几十年，但它们对与阴性症状相关的严重功能障碍几乎没有作用。阴性症状和由此导致的生产力丧失是精神分裂症在全球范围内造成个人和经济负担的主要原因。药物治疗可能对治疗阴性症状的继发性原因（如抗精神病药物的副作用和抑郁）有些效果。然而，在美国，目前还没有针对严重和持续性阴性症状（PNS）的获批治疗方法，这些症状对继发性原因的治疗没有反应。目前正在开发和测试针对严重和 PNS 的药物治疗和心理社会治疗作为其主要目标。学术界、临床医生、制药行业、研究资助者、支付方和监管机构将需要共同努力，寻求新的治疗方法来解决这一重大公共卫生问题。
