Ruah Mental Health Longitudinal Community Living Research
Bulletin No 10 Negative Symptoms
What is the Ruah Community Living In the Community Living Study, negative symptoms
Research? were assessed by the interviewers at each
interview. Six items were rated on a 7-point scale
From 2005 to 2009, more than 200 people aged from Absent to Extreme (Lindenmeyer et al,
between 18-40 years with a mental illness diagnosis 1994). These items were:
participated in a series of 6 interviews over a 3 year
period. They were asked a wide range of questions § Poor rapport: Interpersonal distancing and
reduced verbal and nonverbal communication
about their life in order to answer the question:
§ Lack of spontaneity: Reduced flow of
What are the factors that predict obtaining,
conversation associated with apathy, avolition,
sustaining and regaining successful independent
defensiveness or cognitive deficit
community living by young adults with a severe and
persistent mental illness? § Emotional withdrawal: Lack of interest in or
involvement with life s events
An overview of the study, its methodology and
instruments used is given in Bulletin 1. The findings § Blunted affect: Reduction in facial expression,
of the study what factors in participants lives modulation of feelings, and communicative
were shown to be predictors of successful gestures
independent community living are summarised in § Active social avoidance : Diminished social
Bulletin 2. One of the strong predictors was involvement associated with unwarranted fear,
Negative Symptoms the more evident a person s hostility or distrust
negative symptoms, the worse their quality of life
could be predicted to be. It is this concept and its § Passive/apathetic social withdrawal:
contribution to quality of life in the community that Diminished interest and initiative in social
will be discussed here. interactions due to passivity, apathy, avolition
or lack of energy.
Negative symptoms
Implications
In schizophrenia, a distinction is made between
negative and positive symptoms. Negative Many of the activities that can lead to
symptoms are those behaviours that would be improvements in quality of life are impaired by
expected to be present but are absent (such as negative symptoms.
volition or rapport) while positive symptoms are Developing self-confidence or self-efficacy
those which would usually be absent but are
present (such as hallucinations or delusions). Activities such as attending information groups at
Recent literature suggests that the incidence of the local clinic, or peer programs such as WRAP or
negative symptoms may extend beyond the Hearing Voices, can provide information and
schizophrenia diagnostic category (Toomey et al, examples that increase a person s confidence in
1997; Erhart et al, 2006). their ability to respond to stressors. Lack of
motivation may make it difficult to even attend the
More severe negative symptoms predict worse activities, and some of the other negative
outcomes (Whitty et al, 2008, Narvaez et al, 2008) symptoms (social avoidance or withdrawal, and
and are linked with impaired cognitive functioning emotional withdrawal) may mean that it is difficult
(for example memory, verbal fluency and for the person to engage even if they do attend.
processing deficits) which in turn is a predictor of They may be unable to absorb the information
poor quality of life (Sarilla et al, 2008). provided, or be unable to strike up conversations
Pharmacological treatments, while often very with peers or service providers.
effective with positive symptoms, have had limited
success in mitigating the impact of negative Obtaining, keeping and performing well in
symptoms (Erhart et al, 2008). People experiencing employment can be another source of self-efficacy
negative symptoms often do not recognise how Negative symptoms, though, can pose difficulties
much they interfere with functioning, nor do they
seek help from clinicians to manage them. Family
members are more likely to notice and even
complain about the disruption of their emotional
connection with their relative, but again are
unlikely to seek treatment to manage the negative
symptoms (Velligan & Alphs, 2008).
The Ruah Mental Health Longitudinal Communi ty Li ving Research was funded by Lotte rywest and supported by the WA Health Depa rtment
with reliable, punctual attendance, with § Investigate what pharmacological options are
communicating effectively with colleagues, and available to alleviate some or all of the
with deriving any pleasure from the work or negative symptoms the person is experiencing.
interactions.
§ Speak with family members, involve them in
Family satisfaction psycho-education groups, or provide written
information, if it seems they are
A sense that one is a fully accepted member of the
misinterpreting negative symptoms as
family, and that the interactions within the family
character flaws in the individual.
are satisfactory, is another predictor of good quality
of life. Again, negative symptoms can become a § Offer support to attend activities. This may
barrier to full inclusion within the family. Lack of involve taking the person to the activity
motivation can be read as laziness and lead to initially, to counteract the apathy and lack of
arguments. The lack of spontaneity, blunted affect, motivation. Repeated attendance and
poor rapport and emotional withdrawal may not successful interactions may increase their
worry the person experiencing the negative engagement over time.
symptoms, but family members will perceive the
§ Social skills training has been shown to improve
change in the quality of their interactions and may
social adjustment for people living with
experience and express distress.
schizophrenia (Velligan & Alphs, 2008).
Summary Learning skills to interact with others gives
more chance of successful initiation and
§ Severe negative symptoms are a predictor of maintenance of relationships.
low quality of life
§ Negative symptoms interfere with a person s
capacity to achieve some of the key
components of successful community living
§ People experiencing negative symptoms may Quantitative findings were taken from interviewer-
not necessarily be aware of them beyond a rated measures performed at each of the six
general sense of not really feeling motivated or interviews, and analysed in conjunction with the
involved in things. Relatives and significant MANSA Quality of Life scale.
others, if they notice them, may not know they
are part of the illness.
Recommendations
For people living with mental illness
§ Speak with your clinician about negative References:
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they can recommend medications that may of schizophrenia negative symptoms: future prospects.
alleviate some of the effects. Schizophrenia Bulletin. 32(2): 234-237.
§ Ask your clinician or support worker to speak Lindenmayer J, Bernstein-Hyman R & Grochowski S
(1994) A new five factor model of schizophrenia.
with any family members who are criticising or
Psychiatric Quarterly, 65 (4), 299-322.
distressed by changes in your behaviour arising
from the negative symptoms. Their greater Narvaez JM, Twamley EW, McKibbin CL, Heaton RK &
understanding of what s happening for you Patterson TL (2008) Subjective and objective quality of
may improve the interaction between you. life in schizophrenia. Schizophrenia Research. 98: 201-
208.
For psychiatrists, GPs and other mental health
Savilla K, Kettler L, & Galletly C (2008). Relationships
professionals between cognitive deficits, symptoms and quality of life
§ Clients and their families may not complain of in schizophrenia. ANZ Journal of Psychiatry 42: 496-504.
negative symptoms, despite the reduction in Velligan DI & Alphs LD (2008). Negative symptoms in
functioning they cause. Conduct a thorough schizophrenia. Psychiatric Times. March 2008: 39-45.
assessment to identify any negative symptoms
Whitty P, Clarke M, McTigue O, Browne S, Kamali M,
and the extent of the disruption to everyday Kinsella A, Larkin C & O Callaghan W (2008) Predictors of
functioning. Ask family members for outcome in first-episode schizophrenia over the first 4
corroborating or supplementary information. years of illness. Psychological Medicine. 38: 1141-1146.
Dr Helen Lette (Senior Researcher), Dr Duane Pennebaker (Principal Investigator), Ms Maryam Habibi (Senior Research
Analyst) ISBN 978-1-921984-09-9