HOW TO DISTINGUISH BETWEEN THE NEUROLEPTIC-INDUCED DEFICIT SYNDROME, DEPRESSION AND DISEASE-RELATED NEGATIVE SYMPTOMS IN SCHIZOPHRENIA

A major challenge in the clinical assessment of schizophrenia is the d ifferentiation between depressive features, negative symptoms and neur oleptic side effects, including the adverse subjective experiences ass ociated with this medication, The problems include the degree of sympt om overlap, and the lack of precise operational definitions, particula rly for negative symptoms and the putative, neuroleptic-induced defici t syndrome. The diagnostic process is further confounded by the need t o discriminate between primary negative symptoms as persistent, enduri ng deficits, and social and emotional withdrawal secondary to positive symptoms, or related to depressive features or drug effects such as s edation and the bradykinesia component of parkinsonism. To distinguish between these elements is likely to require careful observation of pa tients with schizophrenia, over time, by trained raters using appropri ate rating scales for depression and negative symptoms that are sensit ive to change, Ratings of patients' subjective experiences regarding m ood and awareness of behavioural and cognitive deficits should also be included. The associations between the subjective data and the object ive ratings of depression, negative symptoms and drug side effects may help with clinical discrimination in these areas of dysfunction and w ith the refinement of their phenomenological descriptions.