The NIMH-MATRICS Consensus Statement on Negative Symptoms
TLDR
A consensus development conference was held to review the data relating to the existence of separate domains within negative symptoms, as a prerequisite for choosing appropriate measures of these domains in clinical trials and to examine issues that may interfere with treatment development.Abstract:
The impairments now called negative symptoms have long been noted as common features of schizophrenia, and the concept of negative symptoms itself has a long history.1,2 Patients who exhibit significant negative symptoms have particularly poor function and quality of life,3–8 and this aspect of schizophrenia has been proposed as a separate domain with distinctive pathophysiological and therapeutic implications since at least 1974.9 Despite the attention these problems receive, no drug has received Food and Drug Administration (FDA) approval for an indication of negative symptoms, and available data indicate that second-generation antipsychotic medications have not met early hopes for a highly effective treatment for alleviation of negative symptoms.10
Because of limited progress in the development of effective treatments for negative symptoms, under the auspices of the National Institute of Mental Health (NIMH), Drs. Steve Marder, Wayne Fenton, William T. Carpenter, Jr, and Brian Kirkpatrick initiated a process to examine issues that may interfere with treatment development. The NIMH had previously focused attention on impaired cognition as a therapeutic target with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) project. The success of the MATRICS process suggested similar progress could be made in the area of negative symptoms and provided a possible model for proceeding in the area of negative symptoms.
Marder, Fenton, Carpenter, and Kirkpatrick organized a consensus development conference, which was held at the NIMH Neuroscience Center in Rockville, Maryland, on January 26–27, 2005. Those attending are listed in the appendix. The mission statement of the meeting was:
To review the data relating to the existence of separate domains within negative symptoms, as a prerequisite for choosing appropriate measures of these domains in clinical trials.
To initiate a process for developing or identifying widely acceptable, evidence-based measures and methodologies needed to establish the efficacy of treatments that target negative symptoms.
Prior to the meeting, the organizers asked experts to address a series of questions:
What are the separate components of negative symptoms?
Are they independent, or components of the same latent construct?
Which aspect of each domain belongs to the negative symptom construct?
Does this area need a separate assessment?
What is the best assessment method for clinical trials?
Since research has suggested that both negative symptoms and cognitive impairments were significant determinants of poor outcome in schizophrenia, an additional set of questions related to the relationship between these domains of psychopathology was also addressed at the conference:
Which aspects of cognition are part of the negative symptom construct?
Which are independent?
Which are uncertain?
Articles that more fully address the topics of these presentations can be found in this issue of Schizophrenia Bulletin. Those articles address regulatory issues and negative symptoms,11 negative symptoms as a therapeutic target,12 the factor structure of negative symptoms,13 restricted affect,14 anhedonia,15 and the relationship between negative symptoms and cognitive impairment.16 At the conference other presentations were also made: Wayne Fenton spoke on “Meeting Goals and Objectives: The NIMH Perspective,” Robert Buchanan on “Summary of the MATRICS Process,” William Carpenter, Jr, on “Study Design and the “Pseudospecificity' Problem,” Michael Green on “Social Cognition,” Nancy Andreasen on “Alogia,” and Jeffrey Cummings on “Apathy.”read more
Citations
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Journal ArticleDOI
Schizophrenia, “just the facts” 4. Clinical features and conceptualization
TL;DR: Heterogeneity in the etiopathology, symptomatology, and course of schizophrenia can be addressed by a dimensional approach to psychopathology, a clinical staging approach to illness course, and by elucidating endophenotypes and markers of illness progression, respectively.
Journal ArticleDOI
Social Cognition in Schizophrenia: An NIMH Workshop on Definitions, Assessment, and Research Opportunities
Michael F. Green,David L. Penn,Richard P. Bentall,William T. Carpenter,William T. Carpenter,Wolfgang Gaebel,Ruben C. Gur,Ann M. Kring,Sohee Park,Steven M. Silverstein,Robert K. Heinssen +10 more
TL;DR: A consensus-building meeting on social cognition in schizophrenia was held at the National Institute of Mental Health in March 2006, and agreement was reached on several points, including definitions of terms, the significance of social cognition for schizophrenia research, and suggestions for future research directions.
Journal ArticleDOI
From revolution to evolution: the glutamate hypothesis of schizophrenia and its implication for treatment.
Bita Moghaddam,Daniel C. Javitt +1 more
TL;DR: NMDAR has intrinsic modulatory sites that are active targets for drug development, several of which show promise in preclinical/early clinical trials targeting both symptoms and cognition, and allosteric modulators, both positive and negative, may offer superior efficacy with less danger of downregulation.
Journal ArticleDOI
Upward Spirals of Positive Emotions Counter Downward Spirals of Negativity: Insights from the Broaden-and-Build Theory and Affective Neuroscience on The Treatment of Emotion Dysfunctions and Deficits in Psychopathology
Eric L. Garland,Barbara L. Fredrickson,Ann M. Kring,David P. Johnson,Piper S. Meyer,David L. Penn +5 more
TL;DR: The proposition that positive emotions may exert a countervailing force on the dysphoric, fearful, or anhedonic states characteristic of psychopathologies typified by emotional dysfunctions is concluded.
Journal ArticleDOI
The Brief Negative Symptom Scale: Psychometric Properties
Brian Kirkpatrick,Brian Kirkpatrick,Gregory P. Strauss,Linh Nguyen,Bernard A. Fischer,Bernard A. Fischer,David G. Daniel,Angel Cienfuegos,Angel Cienfuegos,Stephen R. Marder,Stephen R. Marder +10 more
TL;DR: The Brief Negative Symptom Scale (BNSS) is a 13-item instrument designed for clinical trials and other studies that measures these 5 domains and the interrater, test-retest, and internal consistency of the instrument were strong.
References
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Journal ArticleDOI
The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia
TL;DR: Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
Journal ArticleDOI
What are the functional consequences of neurocognitive deficits in schizophrenia
TL;DR: Verbal memory and vigilance appear to be necessary for adequate functional outcome in schizophrenic patients and may prevent patients from attaining optimal adaptation and hence act as "neurocognitive rate-limiting factors."
Book
Dementia praecox and paraphrenia
TL;DR: "Dementia Praecox and Paraphrenia" (1919) was the book in which Kraepelin first presented his work on schizophrenia to the English-speaking world, and it was probably the most influential psychiatric text of the entire 20th century, and has now become rare.
Journal ArticleDOI
Negative Symptoms in Schizophrenia: Definition and Reliability
TL;DR: The developed Scale for the Assessment of Negative Symptoms has excellent interrater reliability and the five symptom complexes defined by the scale have good internal consistency, which indicates that the conceptual organization of the scale is also cohesive.
Journal ArticleDOI
Deficit and nondeficit forms of schizophrenia: the concept.
TL;DR: The authors provide a rationale for distinguishing the primary, enduring negative symptoms of schizophrenia from the more transient negative symptoms secondary to other factors and propose criteria for defining schizophrenia with the deficit syndrome.