Assessment and treatment of negative symptoms in psychotic disorders - a national clinical guideline

Negative symptoms remain a primary driver of functional disability in schizophrenia spectrum disorders. This article presents the official Danish Multidisciplinary Psychiatry Group's (DMPG) national clinical guideline for the assessment and treatment of negative symptoms in psychotic disorders across the lifespan.

A systematic literature search for systematic reviews and meta-analyses published between 2019 and 2024 was conducted in PubMed and PsycInfo. Studies were screened and extracted by independent reviewers using Covidence. To ensure clinical utility, recommendations were formulated by synthesizing the evidence base with expert consensus, which included extrapolating adult data to formulate guidance for children and adolescents where primary evidence is scarce.

The consensus process yielded 21 specific clinical recommendations. The guideline mandates the assessment of five distinct domains (anhedonia, asociality, alogia, avolition, and blunted affect) using dedicated scales like the BNSS. It provides clear guidance on pharmacological strategies, including a conditional endorsement of modafinil augmentation and a recommendation against cannabinoids. Evidence-based psychosocial interventions, such as cognitive behavioral therapy and cognitive remediation, are also recommended.

The guideline establishes a comprehensive, clinically actionable framework for managing negative symptoms in children, adolescents, and adults. Furthermore, it emphasizes that advancing the field requires future research to utilize domain-specific tools to accurately distinguish primary from secondary negative symptoms.