RT Journal
A1 Turkington D, Morrison AP
T1 COgnitive therapy for negative symptoms of schizophrenia
JF Archives of General Psychiatry
JO Archives of General Psychiatry
YR 2012
FD February 1
VO 69
IS 2
SP 119
OP 120
DO 10.1001/archgenpsychiatry.2011.141
UL http://dx.doi.org/10.1001/archgenpsychiatry.2011.141
AB 
Society in general has historically been most concerned about positive symptoms of schizophrenia such as hallucinations and delusions. Indeed, scientific research has focused almost exclusively on this particular dimension of the illness. On the other hand, service users and caregivers report most concern about debilitating negative symptoms, particularly reduced motivation and alogia, and cognitive deficits such as reduced attention and poor short-term memory. Antipsychotic medication operating through the mechanism of dopamine blockade shows optimal benefit for positive symptoms and for some secondary negative symptoms but may actually worsen primary negative symptoms such as alogia and affective blunting. It was hoped that partial agonists might deliver benefit in relation to this symptom cluster, but meta-analyses have not yet confirmed this. Similarly, clozapine shows its optimal benefit against positive symptoms in treatment-resistant schizophrenia but only a modest benefit on primary negative symptoms. Persistent negative symptoms have also been shown to exhibit minimal responsiveness to standard psychosocial treatments such as cognitive remediation, family therapy, and social skills training. On the other hand, cognitive deficits have shown benefit with cognitive remediation but without durability of effect or generalizability. The National Institute of Mental Health–Measurement and Treatment Research to Improve Cognition in Schizophrenia consensus statement on negative symptoms2 calls for research initiatives for new treatments for negative symptoms and linked cognitive deficits. There is limited evidence from the published literature of benefit with cognitive therapy for negative symptoms from secondary analyses.3- 5 However, the only 5-year follow-up of cognitive therapy vs befriending showed that the more durable effect of cognitive therapy was on negative rather than positive or overall symptoms.6 Cognitive therapy may therefore be a promising intervention for these very disabling symptoms. However, inclusion criteria for these studies have not specified that persistent core negative symptoms, eg, alogia and affective blunting, should be present, so the response of negative symptoms in the deficit state to cognitive therapy has not been systematically tested. It is predicted that such symptoms may be less responsive, and strategies for individualized specific cognitive therapy interventions with core negative symptoms have been devised.7