Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress
in the conceptualization and assessment is not yet fully reflected by treatment research.
Nevertheless, there is a growing evidence base regarding the effects of biological
and psychosocial interventions on negative symptoms. The importance of the distinction
between primary and secondary negative symptoms for treatment selection might seem
evident, but the currently available evidence remains limited. Good clinical practice
is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment
should be optimized to avoid secondary negative symptoms due to side effects and due
to positive symptoms. For most available interventions, further evidence is needed
to formulate sound recommendations for primary, persistent, or predominant negative
symptoms.However, based on currently available evidence recommendations for the treatment
of undifferentiated negative symptoms (including both primary and secondary negative
symptoms) are provided. Although it has proven difficult to formulate an evidence-based
recommendation for the choice of an antipsychotic, a switch to a second-generation
antipsychotic should be considered for patients who are treated with a first-generation
antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social
skills training is recommended as well as cognitive remediation for patients who also
show cognitive impairment. Exercise interventions also have shown promise. Finally,
access to treatment and to psychosocial rehabilitation should be ensured for patients
with negative symptoms. Overall, there is definitive progress in the field, but further
research is clearly needed to develop specific treatments for negative symptoms.
