Assessment of Negative Symptoms

Recognition        

• After we address urgent symptoms, take time to focus only on the negative symptoms and signs.
• Pay attention to the patient’s level of interaction, interest, and engagement.
• Evaluate body language, facial expressions, gestures, and eye contact.
• Ask questions about the patient’s daily activities and interactions, social activities inside and outside the family, work or school involvement, and pleasurable activities or hobbies.
• Ask informants about the patient’s normal daily behavior relevant to negative symptoms.
• Consider administering NSA-4 or another negative symptom assessment tool.

Assessment        

• Assess affect and behavior that may suggest negative symptoms
• Assess psychiatric and medical comorbidities that may present as negative symptoms or aggravate negative symptom complaints.
• Assess medication side effects that may present as negative symptoms or aggravate negative symptom complaints.
• Gauge the level of impairment by comparing the patient to what we would expect from healthy age- and sex-matched individuals.

Management      

• Optimize current medications to treat/maintain the stability of psychotic (positive) symptoms.
• Minimize medication side effects that may aggravate negative symptoms.
• Consider medication adjustment or switch to a medication with efficacy in treating negative symptoms.
• Treat comorbid medical and psychiatric conditions if possible.
• Refer to a specialist for treatment of a comorbid medical condition if necessary.
• Refer to a psychologist for psychosocial intervention.
• Encourage self-care, social interaction, and environmental stimulation.

References

1. Correll CU, Schooler NR. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatr Dis Treat. 2020;16:519–534. Published 2020 Feb 21. doi:10.2147/NDT.S225643