Schizophrenia: Positive and Negative Symptoms and Syndromes

Schizophrenia: Positive and Negative Symptoms and Syndromes

Modern Problems of Pharmacopsychiatry Founded 1968 by F.A. Freyhant, N. Petrilowitscht, and P. Pichot Vol. 24 Series Editors T.A. Ban, Nashville, Tenn.; Α.M. Freedman, Valhalla, N.Y.; C.G. Gottfries, Histings Backa; R. Levy, London; P. Pichot, Paris; W. Pöldinger, Basel KARG E R Basel München Paris London NewYork New Delhi Bangkok Singapore Tokyo Sydney

Schizορhrenία: Ποsίtίνe and Negative Symptoms and Syndromes Volume Editor Nancy C. Andreasen, Iowa City, Iowa 18 figures and 29 tables, 1990 KARG ER Basel München Paris London NewYork New Delhi Bangkok Singapore Tokyo Sydney

Modern Problems of Pharmacopsychíatry Library of Congress Cataloging-in-Publication Data Schizophrenia: positive and negative symptoms and syndromes /volume editor, Nancy C. Andreasen. (Modern problems of pharmacopsychiatry: vol. 24) Includes bibliographical references. 1. Schizophrenia. 2. Symptomatology. I. Andreasen, Nancy C. II. Series. [DNLM: 1. Schizophrenia. W! MO 16ßP v. 24 / WM 203 S33796] RC483.M6 vol. 24 [RC514] 616.89' 18 s - dc20 [616.89'82] DNLM / DLC ISBN 3-8055-5050-2 Bibliographic Indices This publication is listed in bibliographic services, including Current Contents and Index Medicus. Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. 1890 1990 All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, mícrocopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 1990 by S. Karger AG, P.O. Box, CH- 4009 Basel (Switzerland) Printed in Switzerland by Thür AG Offsetdruck, Pratteln ISBN 3-8055-5050-2

Contents Foreword VII Andreasen, N.C. (Iowa City, Iowa): Positive and Negative Symptoms: Historical and Conceptual Aspects 1 Barnes, T.R.E.; Liddle, P.F. (London): Evidence for the Validity of Negative Symptoms 43 Andreasen, N.C. (Iowa City, Iowa): Methods for Assessing Positive and Negative Symptoms 73 Marks, R.C.; Luchins, D.J. (Chicago, Ill.): Relationship between Brain Imaging Findings in Schizophrenia and Psychopathology. A Review of the Literature Relating to Positive and Negative Symptoms 89 Pickar, D.; Litman, R.E.; Konicki, P.E. (Bethesda, Md.); Wolkowitz, O.M. (San Francisco, Calif.); Breier, A. (Baltimore, Md.): Neurochemical and Neural Mechanisms of Positive and Negative Symptoms in Schizophrenia 124 Boyer, P.; Lecrubier, Y.; Puech, A. (Paris): Treatment of Positive and Negative Symptoms: Pharmacologic Approaches 152 McGlashan, T.H.; Heinssen, R.K.; Fenton, W.S. (Rockville, Md.): Psychosocial Treatment of Negative Symptoms in Schizophrenia 175 Subject Index 201

Foreword The past decade has been characterized by a renewal of interest in a more comprehensive and balanced approach to the definition and study of schizophrenia (or, more probably, the group of schizophrenics). The Bleulerian definitions that were widely accepted until the seventies emphasized the importance of those symptoms that we now tend to refer to as 'negatiνe' affective blunting, impoverishment of speech and thinking, avilitiοn, and asociality. During the seventies an emphasis on Schneiderfan symptoms prevailed. During the eighties, a return to an interest in negative symptoms brought the study of clinical psychopathology back to a more central, and balanced, position. Now, most clinicians and investigators recognize that, in order to comprehensively evaluate and describe their patients, they must include a discussion of negative symptoms as well as positive symptoms. This volume attempts to provide an update on this more balanced approach. It represents the first book-length discussion of the positive and negative symptoms of schizophrenia, evaluated in the context of clinical assessment, rating scales, neuroimaging studies, neurochemistry, neuropharmacology, and psychosocial treatments. In addition to balancing its coverage of symptoms, as well as its coverage of conceptual approaches, it also attempts to include a variety of international perspectives reflecting the major contributions to psychopathology provided by European colleagues, it includes chapters by British and French investigators. Although its international coverage is not complete, in that it does not reflect the substantial contributions of the Scandinavians, Germans, and southern Europeans, nevertheless it is at least not monolithically North American. No book can, of course, be totally representative.

Foreword VIII It is our hope that this book will be provide readers with a useful and up-to-date summary of the work completed, largely during the past decade, on the clinical and pathophysiological significance of positive and negative symptoms in schizophrenia. The resurgence of interest in this distinction has helped refine our thinking about the clinical picture of schizophrenia, its mechanisms, its causes, and its treatments. Iowa City, Iowa Nancy C. Andreasen, MD, PhD