The effect of neuroleptics and other psychotropic drugs on negative symptoms in schizophrenia.

It has been hypothesized that the negative symptoms of schizophrenia are related to structural brain abnormalities and respond poorly to treatment with neuroleptics and other drugs since they are persistent, if not irreversible. Because this issue has important clinical and theoretical implications, the authors reviewed the relevant literature on the effect of neuroleptics, L-dopa, and other psychotropic agents on these symptoms. Contrary to the above conclusions, several large scale, controlled studies of the therapeutic effects of conventional neuroleptics have reported clinically relevant improvement in negative symptoms in a significant proportion of schizophrenics. The improvement tended to occur early in the course of treatment and was most notable in those patients with relatively shorter durations of illness. A specific class of neuroleptic drugs not studied in these earlier large scale trials, the diphenylbutylpiperidines, has been suggested to be particularly likely to ameliorate negative symptoms, possibly because of their significant calcium channel blocking action. A review of the clinical studies comparing this group of neuroleptics with those from different classes supports the suggestion that they can produce greater improvement in anergia and emotional withdrawal. Six open and four controlled trials of L-dopa treatment of negative symptoms with L-dopa alone or in combination with neuroleptics. As with neuroleptics alone, improvement tended to be greater in those with a shorter duration of illness. The available evidence suggests that negative symptoms, at least in less chronic schizophrenic patients, may be partially responsive to currently available pharmacological intervention in a significant proportion of schizophrenics.

"Negative symptoms": conceptual and methodological problems.

Research into the so-called negative symptoms of schizophrenia is plagued by often ignored problems in item identification, scale selection, quantification, clinical assessment process, and symptom (and, probably, causal) nonspecificity. Neither a negative symptom syndrome per se nor the recent rating scales designed to measure it have been validated, although some data useful in this regard have been presented for the scales. Since no criterion against which to validate these scales exists, construct validation is needed. The construct of negative symptoms, as defined by its hypothesized empirical relationships with other variables, and the procedures used to measure it must be validated simultaneously and gradually through a programmatic series of studies. In the meantime, research results pertaining to negative symptoms should be interpreted with considerable caution.

Interpersonal perception and mode of resolution in marital conflict.

The present study examined the relationship between changes in couples' perceptions of each other during a conflictual interaction and their mode of conflict resolution. Thirty-three volunteer married couples were videotaped while recreating a conflictual interaction that had occurred previously. During a subsequent replaying of the videotape, husbands' and wives' verbal descriptions of perceptions of self and spouse were elicited at three different stages of the conflict, using a method for eliciting perceptions derived from Laing. Phillipson, and Lee's multiperspective interpersonal perception technique. The interpersonal perceptions of couples who resolved the conflict by engaging the issue at hand were contrasted with those of couples who resolved the conflict via avoidance. Statistically significant differences were found between the groups, suggesting that engaging the issue was associated with an increase in spouses' access to one another's interpersonal perceptions, whereas avoidance was associated with decreases in consensually valid perceptions. Substantive and methodological implications of the study are discussed.