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The Burden of Negative Symptoms and Cognitive Impairment Associated with Schizophrenia

Recognizing the overlooked symptoms of schizophrenia: Negative symptoms and cognitive impairment

Symptoms of schizophrenia can be categorized into three symptom domains: positive symptoms, negative symptoms, and cognitive impairment.1 While positive symptoms, such as hallucinations and delusions, are often the most recognized and targeted in treatment,1,2 >90% of people experiencing first-episode psychosis present with at least one negative symptom at first admission,3 and at least 80% of people with schizophrenia have cognitive impairment.4–6 Negative symptoms, such as reduction of emotional expression and lack of motivation, along with cognitive impairment, including memory and executive functioning deficits, are often overlooked despite their significant impact on the quality of life for people with schizophrenia.1,7,8 These symptoms not only present diagnostic challenges but also affect employment prospects, social functioning, and medication adherence.8–13 There are no approved pharmacological therapies for the treatment of negative symptoms and cognitive impairment associated with schizophrenia.14

Integrating guidelines: Comprehensive approaches to the management of schizophrenia

Recent guidelines have emphasized the importance of assessing and managing negative symptoms and cognitive impairment.15,16 For negative symptoms, psychosocial interventions are recommended by the American Psychiatric Association (APA) and European Psychiatric Association (EPA) to enhance patients’ daily functioning and overall well-being.15,16 Similarly, organizations such as the APA and EPA stress the need for comprehensive and routine assessments to better identify cognitive impairment and tailor care accordingly.7,15 A holistic and integrated approach, addressing the social, psychological, and biological aspects of schizophrenia, may offer an effective strategy for managing all symptom domains, ultimately improving the lives of people with schizophrenia.17

Watch our video below to find out more about the burden of negative symptoms and cognitive impairment associated with schizophrenia.

Further reading

  • Yolland COB, et al. The relationship between negative symptoms and both emotion management and non-social cognition in schizophrenia spectrum disorders. J Int Neuropsychol Soc 2021;27:918–928.
    This study explores the potential relationships between negative symptoms and social and non-social cognition.

  • He C, et al. Exploring the link between cognitive deficit, self-esteem, alexithymia, and depressive symptom of schizophrenia. Brain Behav 2022;12:e2648.
    Article examining the risk factors associated with impairment of cognitive function, alexithymia, and self-esteem among a sample of patients with schizophrenia.

Cite this article as The Burden of Negative Symptoms and Cognitive Impairment Associated with Schizophrenia Connecting Psychiatry. Published March 2025. Accessed [month day, year]. [URL]

  1. Stahl SM. Stahl’s Essential Psychopharmacology, 5th ed., 2020. Cambridge University Press, Cambridge, UK.

  2. Correll CU & Schooler NR. Neuropsychiatr Dis Treat 2020;16:519–534.

  3. An der Heiden W, et al. Eur Arch Psychiatry Clin Neurosci 2016;266:387–396.

  4. Carbon M & Correll CU. CNS Spectr 2014;19(Suppl. 1):38–53.

  5. Keefe RS, et al. Biol Psychiatry 2005;57:688–691.

  6. Zaragoza Domingo S, et al. Schizophr Res Cogn 2015;2:146–158.

  7. Vita A, et al. Eur Psychiatry 2022;65:e58.

  8. Butcher I, et al. Br J Clin Psychol 2020;59:319–334.

  9. Gold JM, et al. Am J Psychiatry. 2002;159:1395–1402.

  10. Ventura J, et al. Schizophr Res 2015;161:407–413.

  11. Patterson TL, et al. J Clin Psychopharmacol 2002;22:11–19.

  12. Jeste SD, et al. Schizophr Res 2003;63:49–58.

  13. Tripathi A, et al. Clin Psychopharmacol Neurosci. 2018;16:7–17.

  14. Maroney M. Ment Health Clin 2022;12:282–299.

  15. American Psychiatric Association. Practice Guideline for the Treatment of Patients With Schizophrenia, 3rd ed., 2021. American Psychiatric Association Publishing; 2021, Washington, DC.

  16. Galderisi S, et al. Eur Psychiatry 2021;e21:1–15.

  17. Sarris J, et al. Adv Int Med 2014;1:9–16.

SC-US-77221

SC-CRP-17044

October 2024

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