Aleman André, Lincoln Tania M, Bruggeman Richard, Melle Ingrid, Arends Johan, Arango Celso, Knegtering Henderikus
University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands.
Clinical Psychology and Psychotherapy, Department of Psychology, University of Hamburg, Germany.
Schizophr Res. 2017 Aug;186:55-62. doi: 10.1016/j.schres.2016.05.015. Epub 2016 Jun 9.
Negative symptoms, e.g. social withdrawal, reduced initiative, anhedonia and affective flattening, are notoriously difficult to treat. In this review, we take stock of recent research into treatment of negative symptoms by summarizing psychosocial as well as pharmacological and other biological treatment strategies. Major psychosocial approaches concern social skills training, cognitive behavior therapy for psychosis, cognitive remediation and family intervention. Some positive findings have been reported, with the most robust improvements observed for social skills training. Although cognitive behavior therapy shows significant effects for negative symptoms as a secondary outcome measure, there is a lack of data to allow for definite conclusions of its effectiveness for patients with predominant negative symptoms. With regard to pharmacological interventions, antipsychotics have been shown to improve negative symptoms, but this seems to be limited to secondary negative symptoms in acute patients. It has also been suggested that antipsychotics may aggravate negative symptoms. Recent studies have investigated glutamatergic compounds, e.g. glycine receptor inhibitors and drugs that target the NMDA receptor or metabotropic glutamate 2/3 (mGlu2/3) receptor, but no consistent evidence of improvement of negative symptoms was found. Finally, some small studies have suggested improvement of negative symptoms after non-invasive electromagnetic neurostimulation, but this has only been partly replicated and it is still unclear whether these are robust improvements. We address methodological issues, in particular the heterogeneity of negative symptoms and treatment response, and suggest avenues for future research. There is a need for more detailed studies that focus on different dimensions of negative symptoms.
阴性症状，如社交退缩、主动性降低、快感缺失和情感平淡， notoriously difficult to treat。在本综述中，我们通过总结心理社会以及药物和其他生物治疗策略，对阴性症状治疗的最新研究进行了评估。主要的心理社会方法包括社交技能训练、针对精神病的认知行为疗法、认知矫正和家庭干预。已经报道了一些积极的研究结果，社交技能训练的改善最为显著。虽然认知行为疗法作为次要结果指标对阴性症状显示出显著效果，但缺乏数据来确定其对以阴性症状为主的患者的有效性。关于药物干预，抗精神病药物已被证明可改善阴性症状，但这似乎仅限于急性患者的继发性阴性症状。也有人认为抗精神病药物可能会加重阴性症状。最近的研究调查了谷氨酸能化合物，如甘氨酸受体抑制剂以及靶向N-甲基-D-天冬氨酸受体或代谢型谷氨酸2/3（mGlu2/3）受体的药物，但未发现改善阴性症状的一致证据。最后，一些小型研究表明，非侵入性电磁神经刺激后阴性症状有所改善，但这只得到了部分重复验证，而且这些改善是否显著仍不清楚。我们讨论了方法学问题，特别是阴性症状和治疗反应的异质性，并提出了未来研究的方向。需要进行更详细的研究，关注阴性症状的不同维度。
