Hallucinations and delusions are the most obvious symptoms of schizophrenia. But such psychotic or “positive” symptoms are not necessarily the most important or disabling ones. Another set of symptoms, called “negative” symptoms, are much more pervasive and persistent - and they have a much greater effect on a patient’s quality of life, reports the July issue of the Harvard Mental Health Letter.

Negative symptoms are marked by absence as much as presence: inexpressive faces, monotone speech, few gestures, seeming lack of interest in the world, and inability to feel pleasure. “Positive symptoms make treatment seem more urgent. But negative symptoms are the main reason patients with schizophrenia cannot live independently, hold jobs, establish personal relationships, and manage everyday social situations. These symptoms are also the ones that trouble them most,” says Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter.

Negative symptoms are closely related to limitations in cognitive abilities, such as mental flexibility and the capacity to pay attention and shift focus when necessary. Such mental limitations also affect real-world functioning and the outcome of the illness.

A form of therapy called cognitive rehabilitation is being used to teach people with schizophrenia how to safely communicate their needs and show that they understand the needs of others. Also called cognitive remediation or cognitive enhancement, this therapy involves exercises that require patients to pay attention and to read social situations. The Harvard Mental Health Letter suggests that caregivers and doctors can also help combat negative symptoms by providing education, psychotherapy, and behavioral training, as well as help with employment, housing, and family relations.

Also in this issue:

• Treating borderline personality disorder
• Genetic counseling in psychiatry
• Mental health insurance
• When is an experience traumatic?
• A doctor discusses: Who will be happy in retirement?

Harvard Mental Health Letter