Study of negative symptoms in schizophrenia

Abstract

Introduction: Schizophrenia is a major mental illness that can afflict and corrupt the normal functions of powerful mind. Schizophrenia is a chronic relapsing disorder with incomplete remissions. It is characterized by a diverse set of signs and symptoms which include positive, negative, cognitive, disorganization, mood and motor symptom dimensions. Aims: The current study was aimed to study the negative symptoms in schizophrenia in patients attending a rural teaching hospital and its relation to demographic parameters, severity of illness and follow up changes. Setting and Design: This is a cross-sectional study done in a rural medical college of Telangana state. The sample size consisted of 50 Schizophrenia subjects. Materials and Methods: The socio-demographic data was recorded on intake proforma and psychiatric morbidity was assessed using Brief Psychiatric Rating Scale (BPRS). Negative symptoms were assessed on Scale for Assessment of Negative Symptoms(SANS). Results: In the study sample of 50 schizophrenia subjects, 35(70%) subjects were having gradual onset of symptoms, 13(26%) subjects were having illness from past 24 months, 26(52%) subjects were treatment naïve, 8 (16%) relapse subjects and 16(32%) were on regular maintenance treatment. The pattern of negative symptoms 34(68%) were having flat affect, 32 (64%) alogia, 40 (80%) avolition, 38 (76%) anhedonia, 36 (72%) were having inattention. On SANS, most marked negative symptom is impersistence at work. In the present study negative symptoms were more often seen in unmarried subjects, literate subjects, unemployed subjects, joint families, gradual onset of illness, duration of illness between 13-24 months and in relapse cases. BPRS and SANS scores improved on follow up evaluations after initiation of treatment (p value <0.05). Conclusion: In the present study negative symptoms had a significant association with demographic parameters like education and occupation. In majority of the subjects, duration of illness is less than one year and the negative symptoms started quite early in the course of the disease contrary to the popular evidence. In the present study there is an equal distribution of symptoms in all five domains of negative symptoms with ‘avolition’ at the top. Clinically negative symptoms were missed in few subjects, as is the case in general. So, it is advisable to employ standard rating scales in all clinical evaluations, lest one should overlook the negative symptoms. Follow up evaluations in all showed the negative symptoms responding effectively to treatment, contrary to the existing evidence regarding their refractoriness.

Keywords

• schizophrenia
• negative symptoms
• sans.