Negative symptoms across developmental stages in psychosis spectrum

Negative symptoms are a core feature of schizophrenia and other psychoses that contribute substantially to functional disability but benefit little from standard treatment, thus representing an unmet therapeutic need. In fact, mechanisms underlying negative symptoms emerge in the early years of development and progress across various developmental stages of psychosis course. In premorbid period, subtle social withdrawal as well as deficits in emotion expression and social communication may represent early signals indicating vulnerability for a variety of disorders including schizophrenia. Attenuated negative symptoms, which manifest in the 5 consensus domains of anhedonia, avolition, asociality, alogia and blunted affect, are prevalent in prodromal period, predictive of conversion to full-blown psychosis, and associated with role and social dysfunction. Negative symptoms in both early psychosis and chronic schizophrenia are best conceptualized by the 5 consensus symptom domains. Greater severity of negative symptoms in first-episode psychosis is associated with more functional impairment, poorer premorbid adjustment and longer duration of untreated psychosis. There is progressive accrual of negative symptoms along the course of illness, in particular primary persistent negative symptoms which are more prevalent in the chronic illness stage, contributing to pronounced functional impairment and worse prognosis. In this article, we review the manifestations of negative symptoms in the context of developmental framework, highlighting the trajectory of negative symptoms across and the unique relevance for different stages of psychotic illness, as well as its relationships with functional disability, other illness-related factors, and treatment implications.