Treating negative symptoms of schizophrenia : antipsychotics vs. antidepressants and antipsychotics

Abstract

Negative symptoms are a clinical manifestation of schizophrenia characterized by anhedonia, avolition, alogia, anergia, poor co-ordination and self-care (Rhoads & Murphy, 2015). The severity of this symptom domain is associated with low quality of life and a decline in cognitive function (Fusar-Poli et al., 2014; Kishi & Iwata, 2014). The persistent nature of negative symptoms led researchers to introduce the use of augmentation therapy with antidepressants to antipsychotics (Singh, Singh, Kar & Chan, 2010). For this reason the following PICO question was set: In adults with schizophrenia, how do antipsychotics combined with antidepressants compared to antipsychotics alone, affect the treatment of negative symptoms? Population chosen were adults with schizophrenia, whilst augmentation with antidepressants to antipsychotics was the intervention. The intervention was compared to using antipsychotic mono-therapy, while the expected outcome was the treatment of the negative symptom domain in schizophrenia. The literature search was performed through HyDi, Google Scholar and ResearchGate. Inclusion criteria consisted of peer reviewed studies in English, published during the last 10 years. Included studies focused on augmentation therapy to antipsychotics in the adult population with negative symptoms of schizophrenia. Studies focusing on depressive and cognitive symptoms were excluded. Finally, nine studies were chosen and critically appraised using the Critical Appraisal Skills Programme (CASP) and the Centre for Evidence-Based Management (CEBM). Not all results demonstrated statistically significant data in favour of augmentation therapy with antidepressants. However, all the selected studies reported an improvement in negative symptoms. In conclusion, individuals with negative symptoms of schizophrenia seem to benefit from this treatment strategy where even a minor improvement in this symptom domain may lead to better quality of life (Fusar-Poli et al., 2014). Recommendations for practice, education, research and management were addressed. This included the introduction of scales to identify individuals experiencing negative symptoms and allocating time and resources to educate health-care professionals and care-givers alike regarding this symptom domain.