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Gregory P Strauss, Anthony O Ahmed, Jared W Young, Brian Kirkpatrick, Reconsidering the Latent Structure of Negative Symptoms in Schizophrenia: A Review of Evidence Supporting the 5 Consensus Domains, Schizophrenia Bulletin, Volume 45, Issue 4, July 2019, Pages 725–729, https://doi.org/10.1093/schbul/sby169
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Negative symptoms have featured prominently as a core symptom of schizophrenia (SZ) since the earliest descriptions of the disorder.1,2 They predict a range of poor clinical outcomes, such as reduced rates of recovery,3 poor functional outcome,4 lower subjective well-being,5 and liability for the onset of a psychotic disorder.6 Unfortunately, interventions targeting negative symptoms have produced minimal benefits and no drug has received US Food and Drug Administration approval for an indication of negative symptoms.7
A factor likely to have contributed to the limited progress in developing effective treatments is that there is a lack of conceptual clarity regarding the latent structure of negative symptoms. Latent structure refers to how the universe of behaviors that comprise negative symptoms relate to underlying traits, factors, or domains. Practically, it indicates how many aspects of negative symptoms should be targeted by psychometrically sound clinical rating scales and diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases. The following review contends that contrary to the currently held convention, negative symptoms comprise 5 central domains. These domains are missed by most rating scales—in part because of their limited item coverage and the methodological shortcomings of previous attempts to decipher such domains.
