Recognizing Primary Vs Secondary Negative Symptoms and Apathy Vs Expression Domains

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Negative symptoms of schizophrenia include blunted affect, alogia, asociality, anhedonia, and avolition. Rating scales are helpful for recognizing and monitoring these symptoms, but clinicians must determine whether the symptoms are primary or secondary. Secondary negative symptoms can be caused by depression, psychotic symptoms, medication side effects, and substance abuse, and they usually improve with treatment of the underlying cause. On most rating scales, negative symptoms have been found to load onto 1 of 2 domains—apathy or diminished expression. This distinction may facilitate the development of new treatments.