From the Guidelines
Positive symptoms of schizophrenia include hallucinations, delusions, and disorganized behavior, while negative symptoms include apathy, avolition, and anhedonia, which can lead to isolation or self-neglect. These symptoms are often assessed with the Positive and Negative Syndrome Scale, where lower numbers indicate fewer symptoms 1.
Key Characteristics of Symptoms
- Positive symptoms are characterized by an excess or distortion of normal functions, including hallucinations, delusions, and disorganized thinking.
- Negative symptoms reflect a diminishment or absence of normal functions, including flat affect, reduced speech, anhedonia, social withdrawal, and lack of motivation.
Treatment Approaches
- Antipsychotics, such as dopamine D-receptor antagonists or partial agonists, are the primary pharmacological treatment for schizophrenia and can help reduce positive symptoms 1.
- However, negative symptoms and cognitive defects may not respond as well to antipsychotics, and alternative approaches, such as cognitive behavioral therapy, social skills training, and occupational therapy, may be necessary.
Importance of Early Treatment
- Early effective treatment of schizophrenia is vital in preserving patients' cognition and ability to function, with evidence suggesting that time is crucial in treating the disorder 1.
- Social support, therapy, psychoeducation, and overall case management are essential aspects of treatment, in addition to pharmacotherapies.
From the FDA Drug Label
Of these 9803 patients, 2687 were patients who received RISPERIDONE while participating in doubleblind, placebo-controlled trials Table 8 lists the adverse reactions reported in 2% or more of RISPERIDONE-treated adult patients with schizophrenia in three 4 to 8 week, doubleblind, placebo-controlled trials Parkinsonism includes extrapyramidal disorder, musculoskeletal stiffness, parkinsonism, cogwheel rigidity, akinesia, bradykinesia, hypokinesia, masked facies, muscle rigidity, and Parkinson’s disease Akathisia includes akathisia and restlessness. Dystonia includes dystonia, muscle spasms, muscle contractions involuntary, muscle contracture, oculogyration, tongue paralysis. Tremor includes tremor and parkinsonian rest tremor Nervous System Disorders Parkinsonism 14178 Akathisia* 10103 Sedation 1052 Dizziness 742 Dystonia* 3 4 2 Tremor*231 Dizziness postural 2 0 0
The positive neurological symptoms are not explicitly mentioned in the provided text, but the negative neurological symptoms include:
- Parkinsonism (e.g. extrapyramidal disorder, musculoskeletal stiffness, parkinsonism)
- Akathisia (e.g. akathisia, restlessness)
- Dystonia (e.g. dystonia, muscle spasms)
- Tremor
- Sedation
- Dizziness
- Dizziness postural 2
From the Research
Neurological Symptoms
The studies provide evidence of both positive and negative neurological symptoms, particularly in the context of schizophrenia and other psychiatric disorders.
- Positive symptoms are characterized by the presence of abnormal behaviors or experiences, such as delusions and hallucinations 3, 4.
- Negative symptoms, on the other hand, are marked by the absence or reduction of normal behaviors or experiences, including social withdrawal, apathy, and blunted emotional response 3, 4, 5.
Diagnostic Value of Symptoms
Research suggests that positive symptoms have higher diagnostic value than negative symptoms in schizophrenia 3.
- However, negative symptoms can have a significant impact on psychosocial functioning and disease outcome, making it essential to investigate their pathophysiology and develop effective treatments 5.
Functional Neurological Symptoms
Functional neurological symptoms, which are not explained by a defined disease, are common in neurology and general medical practice 6.
- These symptoms can include functional weakness and non-epileptic seizures, and may be related to psychiatric models or other underlying factors.
Treatment of Symptoms
Studies have explored various treatment options for positive and negative symptoms, including the use of antipsychotic medications and selective serotonin reuptake inhibitors 4, 7.
- Co-administration of risperidone and escitalopram may be effective in treating both positive and negative symptoms of schizophrenia, while minimizing side effects 4.
- Repetitive transcranial magnetic stimulation (rTMS) has also shown promise in reducing depressive symptoms in individuals with schizophrenia spectrum disorders 7.