[Pharmacologic and cognitive therapy treatment strategies in in persistent negative schizophrenic symptoms]

Negative symptoms are a cofeature of schizophrenia which constitute a severe burden on relatives as well as on the patient himself. Novel (atypical) antipsychotic drugs unlike conventional antipsychotics cause substantial progress in the treatment of negative symptoms. Methodological flaws in recent studies which evaluate the effectiveness of neuroleptics in negative symptoms are being discussed critically. Especially the needs for differentiation of primary and secondary negative symptoms are underlined. Cognitive behavioural rehabilitation strategies are also reviewed. A newly developed cognitive behavioural approach in the treatment of negative symptoms developed by the "Research Group for Rehabilitation in Schizophrenia" of the Department of Psychiatry at the Freiburg University is proposed. A framework is discussed in which neuroleptic treatment optimalization and enhancement of coping strategies by psychosocial approaches are integrated. The need for integrating the patient in rehabilitation and treatment planning is underlined. Despite the limitations of methodology of most studies the findings of research reviewed here could be able to stimulate the optimalization of rehabilitation with these patients. It is necessary to ensure that all patients--especially those with high risk for deteriorating outcome--receive optimal treatment at the earliest possible stage in the course of their schizophrenic disorder. Progress in early intervention strategies [42] are therefore of outstanding interest. Main barriers to effective treatment have to be considered: noncompliance (and side-effects) of medication, repeated relapse, "treatment resistance", negative symptoms, and neurocognitive deficits. These factors indicate the need to favour integrated treatment approaches in which drugs and psychosocial strategies can be combined in a manner that maximizes the potential synergism.