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Evaluación clínica de los síntomas negativos de la esquizofrenia

Published online by Cambridge University Press:  12 May 2020

Hans-Jürgen Möller
Hans-Jürgen Möller*
Affiliation:
Departamento de Psiquiatría, Universidad Ludwig-Maximilians, Nussbaumstrasse 7, 80336Munich, Alemania
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Resumen

Frecuentemente, los síntomas positivos floridos de la esquizofrenia (alucinaciones, ideas delirantes, pensamiento muy desorganizado) son obvios. En comparación, los síntomas negativos (afecto embotado, pobreza del lenguaje, apatía, abolición y anhedonia) son más sutiles y difíciles de reconocer y diagnosticar. Sin embargo, está aumentando el reconocimiento de la importancia de los síntomas negativos en pacientes con esquizofrenia. Los síntomas negativos secundarios atribuibles a algunos factores, como falta de alivio de síntomas positivos, efectos adversos de los antipsicóticos o aislamiento social pueden disminuir con la resolución de dichos factores. Por el contrario, los síntomas negativos primarios son un aspecto intrínseco de la esquizofrenia; son persistentes y se asocian con resultados clínicos desfavorables. Aunque la falta de tratamiento eficaz para los síntomas negativos es una necesidad importante que no está cubierta todavía en esta población, el diagnóstico exacto sigue siendo importante. La evaluación de los síntomas negativos sospechados, usando escalas de puntuación validadas, puede ayudar a descartar los trastornos afectivos o cognitivos simultáneos que pueden simular síntomas negativos y distinguir los síntomas negativos primarios de los síntomas negativos secundarios potencialmente reversibles. Este artículo revisa las definiciones y la clasificación de los síntomas negativos, compara los instrumentos disponibles para su evaluación y propone algoritmos clínicos prácticos para sortear los posibles diagnósticos diferenciales.

Keywords

AlgoritmoDiagnósticoSíntomas negativos persistentesEsquizofrenia
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 14 , Issue 8 , November 2007 , pp. 375 - 382
Copyright
Copyright © European Psychiatric Association 2007

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References

Bibliografía

Alphs, LDaniel, DGVelligan, DBartko, JPanagides, JDavis, JTraining for assessment of negative symptoms of schizophrenia across languages and cultures utilizing the Negative Symptom Assessment Scale. Neuropsychopharmacology 2005;30(Suppl. 1):S113.Google Scholar
Alphs, LDSummerfelt, ALann, HMuller, RJThe negative symptom assessment: a new instrument to assess negative symptoms of schizophrenia. Psychopharmacol Bull 1989;25(2): 159–63.Google ScholarPubMed
Amador, XFKirkpatrick, BBuchanan, RWCarpenter, WTMarcinko, LYale, SAStability of the diagnosis of deficit syndrome in schizophrenia. Am J Psychiatry 1999 Apr;156(4):637–9.Google Scholar
Andreasen, NCScale for the Assessment of Negative Symptoms (SANS). Iowa City, IA: University of lowa; 1981.Google Scholar
Andreasen, NCNegative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry 1982;39(7):784–8.CrossRefGoogle ScholarPubMed
Andreasen, NCOlsen, SNegative v positive schizophrenia. Definition and validation. Arch Gen Psychiatry 1982;39(7):789–94.CrossRefGoogle Scholar
Bell, MDMishara, ALDoes negative symptom change relate to neurocognitive change in schizophrenia? Implications for targeted treatments. Schizophr Res 2006 Jan 1 ;81(1):17–27.CrossRefGoogle ScholarPubMed
Berk, MIchim, CBrook, SEfficacy of mirtazapine add on therapy to haloperidol in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled study. Int Clin Psychopharmacol 2001 Mar;16(2):87–92.CrossRefGoogle ScholarPubMed
Bottlender, RSato, TGroll, CJager, MKunze, IMoller, HJNegative symptoms in depressed and schizophrenic patients: how do they differ? J Clin Psychiatry 2003;64(8):954–8.CrossRefGoogle ScholarPubMed
Bottlender, RWegner, UWittmann, JStrauss, AMoller, HJDeficit syndromes in schizophrenic patients 15 years after their first hospitalisation: preliminary results of a follow-up study. Eur Arch Psychiatry Clin Neurosci 1999;249(Suppl. 4):27–36.CrossRefGoogle ScholarPubMed
Bow-Thomas, CCVelligan, DIMiller, ALOlsen, JPredicting quality of life from symptomatology in schizophrenia at exacerbation and stabilization. Psychiatry Res 1999;86(2): 131–42.CrossRefGoogle ScholarPubMed
Buchanan, RWPersistent negative symptoms in schizophrenia: an overview. Schizophr Bull 2006 Nov 10.Google Scholar
Carpenter, WT Jr, Heimichs, DWWagman, AMDeficit and nondeficit forms of schizophrenia: the concept. Am J Psychiatry 1988; 145(5):578–83.Google ScholarPubMed
Csemansky, JGTreatment of schizophrenia: preventing the progression of disease. Psychiatr Clin North Am 2003 Jun;26(2):367–79.CrossRefGoogle Scholar
Delamillieure, POchoa-Torres, DVasse, TBrazo, PGourevitch, RLanglois, Set al. The subjective quality of life in deficit and nondeficit schizophrenic patients. Eur Psychiatry 2005 Jun;20(4):346–8.Google ScholarPubMed
Fitzgerald, PBde Castella, ARFilia, KCollins, JBrewer, KWilliams, CLet al. A longitudinal study of patient-and observer-rated quality of life in schizophrenia. Psychiatry Res 2003;119(l-2):55–62.CrossRefGoogle Scholar
Fitzgerald, PBWilliams, CLCorteling, NFilia, SLBrewer, KAdams, Aet al. Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand 2001;103(5):387–92.CrossRefGoogle Scholar
Gorecka, JECzemikiewicz, A[The relationship between quality of life of schizophrenic patients and clinical parameters of psychosis]. Wiad Lek 2004;57(9–10):408–12.Google Scholar
Harvey, PDKoren, DReichenberg, ABowie, CRNegative symptoms and cognitive deficits: what is the nature of their relationship? Schizophr Bull 2006 Apr;32(2):250–8.CrossRefGoogle ScholarPubMed
Iancu, IPoreh, ALehman, BShamir, EKotler, MThe Positive and Negative Symptoms Questionnaire: a self-report scale in schizophrenia. Compr Psychiatry 2005;46(l):61–6.CrossRefGoogle Scholar
Kay, SRFiszbein, AOpler, LAThe positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13(2):261–76.CrossRefGoogle Scholar
Keefe, RSBilder, RMHarvey, PDDavis, SMPalmer, BWGold, JMet al. Baseline neurocognitive deficits in the CATIE schizophrenia trial. Neuropsychopharmacology 2006 Sep;31(9):2033–46.CrossRefGoogle ScholarPubMed
Kirkpatrick, BBuchanan, RWMcKenney, PDAlphs, LDCarpenter, WT Jr. The Schedule for the deficit syndrome: an instrument for research in schizophrenia. Psychiatry Res 1989 Nov;30(2):119–23.CrossRefGoogle Scholar
Kirkpatrick, BFenton, WSCarpenter, WT Jr, Marder, SRThe NIMHMATRICS consensus statement on negative symptoms. Schizophr Bull 2006 Apr;32(2):214–9.CrossRefGoogle ScholarPubMed
Lublin, HEberhard, JLevander, SCurrent therapy issues and unmet clinical needs in the treatment of schizophrenia: a review of the new generation antipsychotics. Int Clin Psychopharmacol 2005;20(4):183–98.Google ScholarPubMed
Malla, APayne, JFirst-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull 2005 Jul;31(3):650–71.Google ScholarPubMed
Moller, HJAtypical neuroleptics: a new approach in the treatment of negative symptoms. Eur Arch Psychiatry Clin Neurosci 1999;249(Suppl. 4):99–107.Google ScholarPubMed
Moller, HJManagement of the negative symptoms of schizophrenia: new treatment options. CNS Drugs 2003;17(ll):793–823.CrossRefGoogle ScholarPubMed
Moller, HJNon-neuroleptic approaches to treating negative symptoms in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2004 Apr,254(2):108–16.CrossRefGoogle Scholar
Moller, HJBottlender, RWegner, UWittmann, JStrauss, ALongterm course of schizophrenic, affective and schizoaffective psychosis: focus on negative symptoms and their impact on global indicators of outcome. Acta Psychiatr Scand Suppl 2000;407:54–7.Google Scholar
Perkins, DOGu, HBoteva, KLieberman, JARelationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 2005 Oct;162(10): 1785–804.CrossRefGoogle ScholarPubMed
Rudnick, AKravetz, SThe relation of social support-seeking to quality of life in schizophrenia. J Nerv Ment Dis 2001;189(4):258–62.CrossRefGoogle Scholar
Svirshs, TKorkeila, JHeinimaa, MHuttunen, JIlonen, TRistkari, Tet al. Quality of life and functioning ability in subjects vulnerable to psychosis. Compr Psychiatry 2007 Mar-Apr;48(2):155–60.CrossRefGoogle Scholar
Tremeau, FA review of emotion deficits in schizophrenia. Dialogues Clin Neurosci 2006;8(l):59–70.Google Scholar
Velligan, DIWang, MHaig, GLancaster, STaylor, TNAlphs, LAssociation between changes in negative symptoms and functional outcome measures in a stable schizophrenic population. American Psychiatric Association 159th Annual Meeting, 2006 May 20-25, Toronto, Ontario, Canada; 2006.Google Scholar
Winograd-Gurvich, CFitzgerald, PBGeorgiou-Karistianis, NBradshaw, JLWhite, OBNegative symptoms: a review of schizophrenia, melancholic depression and Parkinson's disease. Brain Res Bull 2006 Oct 16;70(4–6):312–21.CrossRefGoogle ScholarPubMed
Yon, VLoas, GBrien, DSubjective experiences and the psychopathological dimensions in schizophrenia. Psychiatry Res 2005 Nov 15;137(l–2):93–102.CrossRefGoogle Scholar