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Thinking and acting beyond the positive: the role of the cognitive and negative symptoms in schizophrenia

机译：思考和行动超越积极：认知和消极症状在精神分裂症中的作用

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Since currently available antipsychotic medications predominantly treat hallucinations, delusions, disorganized thoughts and behavior, and related agitation/aggression, attention has traditionally been focused on managing positive symptoms. However, prominent negative symptoms and clinically relevant cognitive impairment affect approximately 40% and 80% of people with schizophrenia, respectively. Moreover, negative and cognitive symptoms are closely related to functional outcomes, and contribute substantially to the overall illness burden. Therefore, approaches to describe, measure, and manage these symptom domains are relevant. This article summarizes the phenomenology, prevalence, assessment, and treatment of negative and cognitive symptoms in patients with schizophrenia, including pharmacologic and nonpharmacologic management strategies that can be used in clinical care now, as well as pharmacologic approaches that are being tested. Currently, no approved treatments targeting negative or cognitive symptomatology in schizophrenia are available. It is hoped that progress in the understanding of the neurobiology of these important symptom domains of schizophrenia will help develop effective treatment strategies in the future. However, until this goal is achieved, clinicians should avoid therapeutic nihilism. Rather, the severity and impact of negative and cognitive symptoms should be determined, quantified, and monitored. Further, psychosocial treatments have shown therapeutic benefits. Thus, cognitive behavioral therapy, cognitive remediation, social skills training, and computer-assisted training programs should be offered in conjunction with antipsychotic treatment. Several non-antipsychotic augmentation strategies can be tried off-label. Treatment plans that incorporate currently available management options for negative and cognitive symptomatology in patients with schizophrenia should be adapted over time and based on the individual's needs, with the aim to enhance overall outcomes.
机译：由于目前可用的抗精神病药主要治疗幻觉，妄想，犯罪思想和行为，以及相关的激动/侵略，传统上专注于管理阳性症状。然而，显着的消极症状和临床相关的认知障碍分别影响了精神分裂症的约40％和80％的人。此外，阴性和认知症状与功能结果密切相关，并对整体疾病负担大致贡献。因此，涉及描述，测量和管理这些症状域的方法是相关的。本文总结了精神分裂症患者的消极和认知症状的现象学，患病率，评估和治疗，包括可以在临床护理中使用的药理学和非武装管理策略，以及正在测试的药理学方法。目前，没有批准靶向精神分裂症的阴性或认知症状的批准治疗。希望了解对精神分裂症这些重要症状结构域的神经生物学的理解，将来有助于将来产生有效的治疗策略。但是，直到实现这一目标，临床医生应该避免治疗性虚无主义。相反，应确定，量化和监测阴性和认知症状的严重程度和影响。此外，心理社会治疗表明治疗益处。因此，应与抗精神病疗法结合提供认知行为治疗，认知修复，社交技能培训和计算机辅助培训计划。可以尝试几种非抗精神分电学增强策略。应对精神分裂症患者的阴性和认知症状学的治疗计划纳入当前可用的管理选择，应随时间调整，并根据个人的需求，旨在提高整体结果。

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