Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy.
CHU de Caen, Service de Psychiatrie, 14000Caen, France.
Eur Psychiatry. 2021 Feb 18;64(1):e23. doi: 10.1192/j.eurpsy.2021.11.
During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent.
In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice.
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.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. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones.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. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment.Several recommendations are provided for the identification of secondary negative symptoms in clinical settings.
The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
在过去的几十年中，人们越来越意识到阴性症状（NS）严重干扰了现实生活的功能，尤其是当它们是原发性和持续性的时，因此对阴性症状的兴趣重新燃起。
在本指导文件中，我们对证据进行了系统回顾，并详细阐述了在临床试验和实践中对阴性症状进行概念化和评估的若干建议。
专家共识和系统评价为原发性和持续性阴性症状的最佳评估提供了指导；现已有可更好评估体验领域的第二代评定量表；然而，阴性症状在研究和临床环境中的评估仍然很差。本欧洲精神病学协会（EPA）指南建议在临床试验中使用持续性阴性症状（PNS）的概念，并强调需要进一步努力使 PNS 的定义在研究中保持一致，以尽可能排除继发性阴性症状。我们还鼓励临床医生使用第二代量表，至少可以补充第一代量表。EPA 指南还进一步建议，从任何阴性症状的综合或因子评分中，根据循证排除第一代量表中包含的几个项目，以改善研究和临床环境中的阴性症状测量。建议使用自评工具来进一步补充在阴性症状评估中使用观察量表。为了在临床环境中识别继发性阴性症状，还提供了一些建议。
本指导文件的传播可能会促进关于阴性症状评估的国家指南的制定，并最终改善精神分裂症患者的护理。
