Negative schizophrenia is not a commonly talked about disease. And it is this form of the disease that significantly contributes to the deterioration of the social and economic status of the patient. This is because prevailing and persistent negative symptoms constitute a greater barrier to employing the patient.

Contents:

  1. What are negative symptoms in schizophrenia?
  2. Negative symptoms - he alth consequences
  3. Negative symptoms - social and systemic situation
  4. Negative symptoms - patients' behavior
  5. Negative symptoms - treatment
  6. Negative symptoms - family situation

Schizophrenia with negative symptoms causesthat almost 70 percent of patients with schizophrenia and predominant persistent negative symptoms are on disability pensions. In addition, there are also a number of comorbidities that patients have to deal with, which additionally increases the costs of this disorder.

What are negative symptoms in schizophrenia?

Negative symptoms in schizophrenia (or defective) are symptoms that result in the loss of the ability to experience and express emotions. With a significant intensification of such symptoms, the sick person may withdraw from life or be isolated from other people.

Patients withdraw completely from social life and their roles, they are able to stay in their apartment for weeks, they are also reluctant to undertake any preventive measures, such as medical visits. They often require round-the-clock care, also needing support with basic, everyday activities.

Negative symptoms can be divided into primary and secondary:

Primary negative symptomsare an integral part of the idiopathic schizophrenic process, have a stable and chronic clinical course, and may be resistant to treatment. They occur in 10-30% of patients.

Secondary negative symptomsresult from additional symptoms and factors related to schizophrenia, such as:

  • positive (psychotic) symptoms
  • anxiety
  • depression
  • side effects of drugs
  • addictions
  • deprivation (i.e. continuous failure to meet some physical or more often psychological need) social

These symptoms do not result directly from the disease process itself, but are the result of coexistence. They are present more frequently than primary negative symptoms and are easier to treat.

In clinical practice, the differentiation of negative primary and secondary symptoms can be difficult. Therefore, patients are divided into two groups:

  • patients with predominant negative symptoms (predominant) , i.e. patients in whom other symptoms (mainly psychotic) might also be present, but their occurrence was controlled and mild.
  • patients with significant negative (prominent) symptoms , i.e. people with significant negative symptoms.

According to the research, unlike other patients with schizophrenia, the group of patients with predominant and also persistent negative symptoms have a worse prognosis, and these patients are more often refractory to treatment.

Negative symptoms - he alth consequences

According to the report "Schizophrenia with negative symptoms. The burden of the disease in patients and their relatives", 31% of patients suffer from obesity and arterial hypertension, and 21% of people struggle with lipid metabolism disorders.

More than 40% of women suffering from schizophrenia with negative symptoms have never had a Pap smear, and only 17% of women have ever had an ultrasound scan of the reproductive organs.

The data on diabetes are also disturbing - it is estimated that it may affect up to 15% of patients with schizophrenia. This is over 1.5 times more often than the national average for our society, estimated by the WHO at 9.5%.

Patients suffering from schizophrenia with negative symptoms also struggle with addictions more often. In this population, nicotine addiction is three times more common than in the general population (88% and 25-30%, respectively).

The most frightening, however, is the data on the risk of death among people suffering from schizophrenia with negative symptoms.

Compared to the population of he althy people, it is more than 2.5 times higher, and the average life expectancy of a schizophrenic patient is even 10-20 years shorter. It is mainly associated with an over eightfold increased risk of suicide among patients diagnosed with schizophrenia.

People with schizophrenia with predominant negative symptoms require special care, because it is very difficult to establish contact with patients and their behavior is unpredictable.

Due to the low level of activity and the stable picture of the disease, this group of patients seems to doctors to be less at risk of suicide attempts.

Currently it isit is suicide that is considered to be the main cause of death of patients with schizophrenia, and these patients may be at greater risk of suffering from it than people treated, for example, for depression.

Negative symptoms - patients' behavior

People suffering from schizophrenia with predominant negative symptoms may have problems with expressing emotions and perceiving other people's emotions, they have no motivation to act, and their life energy is significantly reduced.

The severity of such symptoms may lead to the patient withdrawing from his social roles or isolation from other people.

The specificity of negative symptoms causes such people to quit education, do not start work, and do not establish close relationships with another person. They also often avoid contact with other people at all.

Schizophrenia with negative symptoms is often accompanied by emotional indifference ("I don't care", "Do what you want"), or the so-called pale affect ("flattened experience", decreased expression of emotions or even lack of expression) and impairment of the ability to communicate with the environment through facial expressions, gestures and body posture. Other negative symptoms include:

  • abulia (i.e. "inaction" as a result of the inability or limited ability to plan and take actions with a specific, complex goal)
  • anhedonia (decreased ability or inability to feel pleasure)
  • aspontane (decrease, loss of spontaneity of behavior and feelings)
  • passivity, apathy, impoverishment of speech (speaking in single words of poor content, little differentiation of speech)
  • avolition (lack of own will or limitation)
  • slow movement, less self-care

Progressing negative symptoms may lead to the so-called breaks in the life line, i.e. changes in the patient's previous plans, intentions and life goals. Therefore, it is very important to diagnose and start treatment as early as possible.

Negative symptoms - social and systemic situation

The social and systemic costs of schizophrenia are high, and the disease itself is often associated with the deterioration of the social and professional status of the patient. Unemployment among patients with schizophrenia is very high and remains at the level of 80-90%.

Almost 70% of patients with schizophrenia with predominant and persistent negative symptoms are on a disability pension.

Over 40% of patients dropped out of education, including 19% still in high school.

As many as 83% of patients are unable to liveindependently and often requires round-the-clock care of the family, so its members often have to resign from their own professional work for this purpose.

All these factors generate high systemic costs related to both treatment and the patient's lost productivity.

According to the data from the report "Schizophrenia with negative symptoms. The burden of disease in patients and their relatives", the average annual value of costs incurred by society in 2022 per one patient with schizophrenia with predominantly negative symptoms, due to its loss productivity, amounted to PLN 48 841.

Negative symptoms - treatment

To improve the situation of patients with negative symptoms, a holistic approach to the patient is crucial - providing modern pharmacotherapy, community care, education and help in bringing people back to life.

However, due to the patient's he alth condition and the characteristics of negative symptoms, undertaking such forms of treatment and activation requires a lot of mobilization from the patient himself, and most often their implementation and continuation depends on the determination of their relatives. Hence, the patients themselves are rather reluctant to use the available help.

That is why it is so important to initiate volitional processes so that patients can benefit from various forms of therapy. Currently, patients with schizophrenia with negative symptoms are treated suboptimally.

There is a drug on the market proven effective in reducing negative symptoms and improving everyday functioning, containing an active substance called cariprazine. However, this drug is not reimbursed, so it is not available to most patients.

According to an expert Prof. dr hab. n. med. Agata Szulc, Department of Psychiatry, Faculty of He alth Sciences, Medical University of Warsaw

Schizophrenia is one of the most stigmatizing and severe chronic diseases in the field of mental he alth. It is characterized by the presence of two types of symptoms - positive and negative. Positive symptoms include experiencing by the patient stimuli contrary to reality (delusions, hallucinations), while negative symptoms are associated with, among others, With the patient's withdrawal from social life, loss of interest, emotional pallor or apathy, and as a consequence may lead to complete isolation from the world. Schizophrenia is called a disease of young people for a reason.

The disease usually falls on the period of early adulthood. Up to 40% of patients experience the first symptoms of the disease before the age of 20. It is worth mentioning that in men agethe incidence is lower (15-24 years) than in women (25-34 years). Earlier onset of the disease is usually associated with a worse prognosis. Thus, it means that the disease affects people entering adulthood and those potentially the most professionally active.

Despite the complexity of the picture of the disease, the situation of patients diagnosed with schizophrenia has changed significantly in recent years - not only in the methods of treating the disease, but most of all in the approach to it, also dependent on the observed treatment effects. In both dimensions, the introduction of second-generation antipsychotic drugs was of great importance. Currently, Polish patients have access to modern pharmacological treatment, i.e. long-acting antipsychotic drugs administered once a month. However, they still do not have access to drugs administered every 3 months. However, not all patients receive proper care and treatment. The emphasis is placed not only on appropriate medications, but also on non-pharmacological therapy and comprehensive environmental support, especially from the family. These are directions that should be constantly developed. They protect the patient against falling out of social and professional roles. Due to the change in the perception of schizophrenia, one of the biggest challenges is the diagnosis and treatment of negative symptoms. Because remaining in the shadow of positive symptoms, it is the negative symptoms that leave a stronger stigma on the patient, and consequently have a negative impact on the he alth care system.

Negative symptoms occur in 90% of patients experiencing the first episode of the disease and in 40% of chronically ill patients. The most common ones are social and emotional withdrawal. These symptoms are often underestimated, explained by laziness or the nature of the patient. However, potentially "harmless" withdrawn patients require more attention and care. Due to the fact that these symptoms are difficult to recognize, they require the attention of physicians and the public, in particular because they may be persistent. To a large extent, this means that patients burdened with them may never become independent persons again. Negative symptoms are dangerous because their occurrence and intensity is often associated with the deterioration of the social and professional status of the patient.

These symptoms also affect the patient's ability to function independently. Patients often require round-the-clock care, usually provided by the family. Negative symptoms are an obstacle to employment. Almost 70% of patients with schizophrenia and predominant negative symptoms are on a disability pension. Only 21% of patients remain economically active, of which 9% aresheltered employment. Negative symptoms cannot be ignored, especially due to the patients' early age onset and the risk of transition to a persistent form.

Negative symptoms - family situation

People suffering from schizophrenia with predominant and persistent negative symptoms need support with basic, everyday tasks and often require round-the-clock care, usually provided by the family. For this reason, not only the patients themselves face the disease, but also their relatives and carers.

According to the study conducted for the report "Schizophrenia with negative symptoms. The burden of the disease in patients and their relatives", the majority (59%) of primary caregivers of patients declare that due to the disease of a close relative, the financial status of their household decreased.

It was related to, inter alia, with the necessity to reduce the working time (13%), resignation - despite the possibility of further work - from work or retirement (7%), change of the nature of work, which resulted in lower earnings (7%).

At the same time, 6% of people declared that they could not retire - despite their will and reaching the appropriate age - because they are burdened with the need to support a sick family member.

Despite the deterioration of the family's financial situation, 87% of caregivers did not receive any benefits due to the patient's schizophrenia, while 9% received the allowance for the carer of a disabled person. The average monthly amount of the benefit was PLN 208 net.

The families of patients feel burned out, overburdened with care, misunderstanding by the environment.

Due to the difficulty and time-consuming nature of care, they often do not have space to pursue their interests (48%) or holidays (50%).

Due to the high concentration on the sick person, the caregivers loosen their ties with extended family and friends.

Because it happens that some family members do not accept the disease and treat its symptoms - such as withdrawal from life, reluctance to perform everyday activities at home, such as maintaining order - as a symptom of patients' laziness, caring for a patient with schizophrenia with overwhelming negative symptoms become a recurring theme of conflicts within the family.

In order for the daily functioning of patients with schizophrenia with predominant and persistent negative symptoms to improve, comprehensive assistance is necessary, including the systematic intake of well-chosen drugs, psychotherapy, psychoeducation of the patient and his family, and training in social skills.

It should be remembered, however, that in the case of schizophrenic patients with predominant and persistent negative symptoms, encouraging participation in therapeutic activities is particularly difficult.

This is because patients can stay in their room for weeks and are deprived of energy and will.

However, thanks to modern pharmacotherapy, patients with schizophrenia can become more independent, thus relieve their caregivers and return to activity.

Read also:

  • Types of schizophrenia
  • Inheriting schizophrenia
  • Treatment of schizophrenia
  • Paranoid Schizophrenia
  • Catatonic Schizophrenia
  • How to recognize paranoia?
About the authorAnna Jarosz A journalist who has been involved in popularizing he alth education for over 40 years. Winner of many competitions for journalists dealing with medicine and he alth. She received, among others The "Golden OTIS" Trust Award in the "Media and He alth" category, St. Kamil awarded on the occasion of the World Day of the Sick, twice the "Crystal Pen" in the national competition for journalists promoting he alth, and many awards and distinctions in competitions for the "Medical Journalist of the Year" organized by the Polish Association of Journalists for He alth.

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Category:

Psychiatry