Antidepressants for negative symptoms of schizophrenia. 4–6 We therefore wanted to review and analyse the efficacy of antidepressants in treating negative symptoms of chronic schizophrenia. Higher scores on these scales correspond to an increased severity of the illness. This may include (but is not limited to) blunted affect, which is a scarcity of facial expressions of emotion, reduced frequency and range of gestures and voice modulation, and restricted eye contact; alogia (poverty of speech); asociality (reduced social interaction); avolition Dec 20, 2014 · Introduction. [Galling B, et al. trials of antidepressants in treating the negative symptoms of schizophrenia. 1–6 months of retrospectively stable negative symptoms; low levels of positive, depressive, and extrapyramidal. This case series suggests that the anti-depressive effects of bupropion might be a valuable treatment option in the treatment of negative symptoms of schizophrenia. The combination of antipsychotics and antidepressants may be effective in treating negative symptoms of schizophrenia, but the amount of information is currently too limited to allow any firm conclusions. Large, pragmatic, well-designed and reported long term trials are justified. With an appropriate diagnosis, treatment, and support, you or someone you love can find relief from these symptoms and discover ways to cope effectively. Positive symptoms include hallucinations and delusions and are often the most responsive to treatment. Finding a diagnosis of schizophrenia may include: Physical exam. The present article reviews the neurobiological basis of 5-HT1A receptor (5-HT1A-R) function and the role of pre- and postsynaptic 5-HT1A-Rs in the treatment of MDD, anxiety and psychotic Background: Schizophrenia is a chronic, most devastating psychiatric illness that impairs mental and social functioning. Schizophrenia is a heterogeneous clinical syndrome comprising a number of psychopathology domains and patients vary in which pathologies are manifest. e. impassive or blank facial expression. The authors used a randomized, placebo-controlled design to Sep 1, 2010 · However, antidepressants have been found in some studies to significantly reduce negative symptoms [86][87][88][89] [90], but also depressive symptoms in schizophrenia patients with comorbid MDD There is some evidence that TMS may be good at treating depression and negative symptoms in people with schizophrenia. Aug 3, 2021 · The negative symptoms of schizophrenia can include: Avolition: lack of motivation; antidepressants are effective for treating negative symptoms in some people when used with antipsychotic Most frequently depressive symptoms were evaluated using the HRSD, which is not designed to distinguish depressive from negative and extrapyramidal symptoms. Although consensus on the precise components of the negative syndrome and on definitions for specific negative symptoms have not been reached, for the purpose of this review, negative symptoms include blunted affect, poverty of thought content and speech, apathy, social The review concluded that antidepressants plus antipsychotics were more effective in treating negative symptoms of schizophrenia than were antipsychotics alone. In addition, a meta-analysis on adjunctive antidepressants in stable antipsychotic treatment reported that these drugs have small-to-medium effects on negative symptoms . , those at clinical high risk of developing the illness), 107 first-episode schizophrenia, 108 and chronic schizophrenia. , depression). It is also possible that clinicians used antidepressants to try to treat negative symptoms of schizophrenia, for which there is some evidence of effectiveness (14, 15). Most literature has classically distinguished between primary and secondary NS. Negative symptoms of schizophrenia remain a major therapeutic challenge. Clinical recommendations This systematic review and meta-analysis demonstrates qualified evidence that antidepressants may be effective in treating depression in people with schizophrenia. Negative symptoms are common in people with schizophrenia and are often difficult to treat with antipsychotic drugs. Apr 9, 2019 · Background Schizophrenia is a chronic, most devastating psychiatric illness that impairs mental and social functioning. Reboxetine. Multiple classes of substances are used for the treatment of schizophrenia. Antidepressants are safe and used frequently in schizophrenia patients to address depressive and negative symptoms (Rummel et al. Improvement of negative and positive symptoms in treatment-refractory schizophrenia: a double-blind, randomized, placebo-controlled trial with memantine as add-on therapy to The relative absence of a group of psychological experiences and social interactions in patients with schizophrenia is termed negative symptoms ( 1 ). Consequently, antidepressants are widely used in persons with schizophrenia to treat a variety of symptoms, such as negative and depressive symptoms. , 2018). Phenothiazines were the first drugs shown to be effective in easing the positive symptoms of schizophrenia; they were, however, less effective against negative and cognitive symptoms and had multiple adverse side effects. Depressive and negative symptoms (primary outcomes), overall symptoms, positive symptoms, side effects, exacerbation of psychosis Jan 13, 2023 · Patients with depression and those with negative symptoms of schizophrenia do not respond favorably to antidepressants and antipsychotics. Repetitive transcranial magnetic stimulation applied over the prefrontal cortex (PFC) has been proposed as an adjuvant to pharmacological treatment of negative symptoms in schizophrenia, but whether the improvements obtained are specific to negative symptoms or attributable to Dec 1, 2005 · We conclude that the combination of antipsychotics and antidepressants might be an effective strategy for negative symptoms in schizophrenia, but further studies are definitely needed, as the total number of 202 participants was still very small and the above discussed limitations – especially the difficulty to measure predominant negative Jan 6, 2021 · There is little to suggest that depressive symptoms of schizophrenia respond to antidepressant augmentation of antipsychotic drug treatment, although it may be beneficial for negative symptoms (Galling et al. Mar 17, 2021 · Abstract. 109 An earlier systematic review of the use of antidepressants for the treatment of May 19, 2015 · Methods: To analyze the efficacy of add-on antidepressants for the treatment of negative, positive, cognitive, depressive, and antipsychotic-induced extrapyramidal symptoms in schizophrenia, published randomized controlled trials assessing the efficacy of adjunctive antidepressants in schizophrenia were reviewed using the following parameters Dec 9, 2022 · Primary and secondary NS. 41 The distinction The ketamine model of acute schizophrenia is useful for explaining the positive and negative symptoms, cognitive deficits, dopaminergic dysfunction, GABAergic dysfunction, age of onset, functional dysconnectivity, and abnormal cortical oscillations observed in schizophrenia in terms of NMDAR hypofunction and interactions with D 2, opioid, and The study found adjunctive citalopram did not improve negative symptoms in schizophrenia, but there was a positive effect on avolition/amotivation. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Substances Applied in Schizophrenia – An Overview. Jun 21, 2021 · Therefore, the use of an antidepressant that preferentially desensitizes 5-HT 1A autoreceptors and increases the synaptic transmission of serotonin may have a higher potential as an adjunctive treatment for targeting the negative symptoms that remain present for most patients with schizophrenia. Jul 13, 2017 · Retrospective studies have shown that depressive symptoms frequently occur prior to the onset of psychotic symptoms in schizophrenia (i. However, in general, patients seem to do better on an SSRI than with placebo. This could thus be a reasonable goal of treatment during the acute phase. This is important news for Jun 27, 2016 · June 27, 2016. Combinations of different antipsychotics are employed to address treatment-refractory positive and negative symptoms, whereas antidepressants, mood stabilizers, cognitive enhancers and experimental substances are used to treat chronic aspects such as affective Antipsychotics are known to produce a significant remission of positive symptoms. They are associated with long-term impairment and do not respond well to current treatment approaches. This observation can be interpreted in 2 ways: either the antipsychotic drugs themselves have antidepressant action making May 18, 2024 · Symptoms. Fifty-eight patients with Mar 26, 2022 · We added bupropion to manage the negative symptoms, and all three patients achieved a good treatment response. Method: Multiple databases and previous publications were searched through June 2015 to identify all randomized controlled trials of any add-on antidepressants compared with placebo or no-treatment in schizophrenia. The treatment of negative symptoms is a major challenge for mental health care in schizophrenia. Dec 1, 2005 · Negative symptoms account for a clinical dimension of schizophrenia. , 2010; Hecht & Landy, 2011). Antidepressants have a small but nevertheless favorable effect in patients with schizophrenia who have negative or depressive symptoms and who are not at risk for worsening Jul 17, 2023 · Specifically, it is an inhibitor of the serotonin reuptake transporter, which is the mechanism of action of SSRI antidepressants, resulting in potential antidepressant activity and efficacy against the negative symptoms of schizophrenia (i. Aug 4, 2023 · The diagnosis of depression in schizophrenia is complicated by a differential diagnosis that includes depression-like extrapyramidal side effect symptoms of antipsychotic drugs, negative symptoms of schizophrenia, and general medical conditions. Even 1 year after the last episode, up to 50% of the patients suffer from negative symptoms. Negative symptoms occur alongside positive symptoms such as delusions and hallucinations in acute psychotic episodes, where they generally respond to treatment with antipsychotic medication, but for the 15-20% of We examined whether noradrenergic and specific serotonergic antidepressants (NaSSAs: mirtazapine and mianserin), as augmentation therapy, have therapeutic potential for schizophrenia treatment. 16 Sources. Introduction. 2, 3 Negative symptoms are viewed as secondary if they are a result of side effects of medications or are a Nov 5, 2018 · Another study exploring the association between folate and symptoms of schizophrenia indicated that low folate was associated with negative symptoms severity in schizophrenia subjects 94. People with schizophrenia are also sometimes prescribed antidepressants to manage low-mood symptoms or negative symptoms. They found a statistically significant effect forcombinationtreatment,antidepressants,second-generationanti-psychotics, and psychosocial treatments. clozapine in Jan 26, 2018 · A correct diagnosis and distinction from schizophrenia with negative symptoms has a great impact on therapy in these diseases: while for schizoaffective disorder and major depressive disorder the therapy includes antidepressants next to antipsychotics , for negative symptoms of schizophrenia, this has not been shown as effective . The aim of this review is to gather existing data on the treatment of negative symptoms with antidepressants. The evidence correlates well with clinical observations, suggesting that new atypical antipsychotic drugs are effective against negative and cognitive symptoms of schizophrenia, as well as against affective symptoms observed in depression. One possible role of folate in mental health is its action on DNA methylation and gene expression which have been wildly reported in human psychiatric disorders. Oct 25, 2018 · de Lucena, D. Even though antidepressants are commonly prescribed in schizophrenia, their Negative symptoms account for a clinical dimension of schizophrenia. Atypical antipsychotic drugs have some efficacy in alleviating the negative and some cognitive symptoms of schizophrenia but those effects are small and mechanisms of this action are still unknown A few clinical reports have suggested that antidepressants (ADs), are able to augment the activity of atypical antipsychotic drugs. 138,139 In a recent Feb 12, 2022 · A Word From Verywell. 916 of add-on TCP with TFP in 147 patients from three studies is higher than the effect sizes of other antidepressants in negative symptoms of schizophrenia, and similar or even higher than effect-sizes for other antidepressants in negative schizophrenia because SMDs of 0 Apr 21, 2015 · Effective treatment of negative symptoms is one of the most important unmet needs in schizophrenic disorders. Negative symptoms include apathy, anhedonia and flat affect whereas cognitive symptoms Jul 5, 2021 · Among individual drugs, selegiline, duloxetine, citalopram, fluvoxamine, and mirtazapine have been reported to benefit the negative symptoms in schizophrenia . Omega 3 supplements. 2 Although atypical Jun 1, 2011 · Schizophrenia is a chronic psychiatric disorder that encompasses several different symptom domains: positive, negative, affective, aggressive and cognitive. Keywords: case report series, residual, secondary negative symptoms The authors found a “justification for the use of antidepressants in negative symptoms in chronic schizophrenia. Diagnosis of schizophrenia involves ruling out other mental health conditions and making sure that symptoms aren't due to substance misuse, medicine or a medical condition. This is when people believe in things that aren't real or true. The pharmacotherapy of negative symptoms in schizophrenia includes novel/atypical antipsychotics and classical antipsychotics, as well as antidepressants, glutamatergic compounds However, the patient’s predominant negative symptoms of schizophrenia were not significantly changed by DBS. Depressive and negative symptoms (primary Dec 20, 2012 · Possible areas of interest are, for example, the comparative efficacy of various antidepressants in treatment of negative and depressive symptoms of schizophrenia, as well as head-to-head comparison of an add-on antidepressant with plausible additive antipsychotic potential (such as mirtazapine), combined with FGAs or SGAs vs. The negative symptoms of schizophrenia are an unmet treatment target as currently approved treatments mostly control positive symptoms. Nov 1, 2014 · Antidepressants are safe and used frequently in schizophrenia patients to address depressive and negative symptoms (Rummel et al. appearing unmoved or unresponsive to Oct 1, 2019 · Background. While primary NS are considered to be intrinsic to schizophrenia, secondary NS are thought to depend on other factors, such as suspicious withdrawal or other positive psychotic symptoms, extrapyramidal side effects, depression, substance abuse, and mental retardation. The small size of some of the included studies and the fact that details of quality assessment were not reported suggest some caution is warranted when interpreting the authors’ conclusions. 2. Based on an analysis of 23 RCTs (n = 819), the authors found that add-on treatment with antidepressants was more effective for negative symptoms in chronic schizophrenia than monotherapy with antipsychotics. The blockade of the glycine There are the positive symptoms such as delusions and hallucinations and then there are the negative symptoms such as apathy, lethargy and social withdrawal. monotone speech. Overcoming the barriers to recruiting an adequate sample size May 26, 2023 · However, the Scottish guideline for the management of schizophrenia proposes that antidepressants may be trialed for persistent negative symptoms and depressive symptoms 24. , 2006, Singh et al. These agents appear to improve comorbid affective or anxiety symptoms, but earlier evidence of improvement in psychotic or negative symptoms has not been replicated consistently. 2010; Hecht and Landy 2011). , Georgia and Romania), cariprazine was unavailable at the time of writing Overlap between negative symptoms of schizophrenia and vegetative symptoms of depression, (e. In earlier studies, the prevalence of antidepressant use in schizophrenia has been evaluated to be from 15% to 58%, however, there are differences between regions and how prevalence was measured 3 Apr 13, 2011 · The investigators concluded that antidepressants added to antipsychotics are more effective in treating the negative symptoms of schizophrenia than antipsychotics alone. Antidepressants have a small but nevertheless favorable effect in patients with schizophrenia who have negative or depressive symptoms and who are not at risk for worsening Jul 28, 2023 · Negative symptoms of schizophrenia include: Avolition. Mar 1, 2015 · Antidepressants may have been initiated in the prodromal phase to treat the relatively nonspecific prodromal symptoms. A meta-analysis has shown that antidepressant augmentation may be potentially beneficial in treating negative symptoms of studies. Nevertheless, there is a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. symptoms; and a trial Jan 25, 2021 · The Cognitive and Negative Symptoms in Schizophrenia Trial (CONSIST) was the most significant trial testing D-cycloserine and glycine antipsychotic-adjunctive therapy. Feb 13, 2021 · At this point, there is no clear evidence for atypical antipsychotics with α-2 adrenoreceptor blockade in the treatment of negative symptoms. There is overwhelming research evidence Jan 6, 2021 · There is little to suggest that depressive symptoms of schizophrenia respond to antidepressant augmentation of antipsychotic drug treatment, although it may be beneficial for negative symptoms (Galling et al. Moreover, antipsychotic drugs are partly effective in positive symptoms of schizophrenia, yet they poorly treat negative symptoms and cognitive deficits. , apathy, amotivation) further complicates clinical decision-making. The persistence of these symptoms holds back the patient's reinstatement in society, making them incapable of fulfilling their social, professional, or family roles. Methods The aim of the present study was to investigate the Objectives: It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. Future work: Further studies of the viability of adjunctive antidepressant treatment for negative symptoms in schizophrenia should include appropriate safety monitoring and use rating scales that allow for evaluation of avolition/amotivation as a discrete negative symptom domain. Clinical trials of selective serotonin reuptake inhibitors (SSRIs) have overall been in favour of an effect on depressive symptoms in schizophrenia. 1, 2 Patients with schizophrenia experience “positive” psychotic symptoms as required by diagnostic criteria and include delusions, hallucinations, and disorganization of thought and behavior. Schizophrenia is a severe mental illness that Aug 8, 2021 · For persistent positive symptoms, adding aripiprazole, amisulpride, or ECT was suggested. They are partly the cause of functional disability of this disease. For example, people with schizophrenia could think that they're being harmed or harassed when they aren't. Citalopram. In this trial, the placebo's efficacy was comparable to treatment, even though there were reported effects in some patient subpopulations (3,27). Jul 12, 2013 · In the present study, we aimed to investigate the effect of serotonergic versus noradrenergic antidepressant add-on therapy on negative symptoms in schizophrenia. , (22–24)] are in line with the current literature, including suggested algorithms, guidelines, and reviews about the treatment of negative symptoms (3, 25, 26). A systematic review was conducted of PubMed, Cochrane Library and PsycINFO in December 2012 and meta-analyses of double-blind, randomized placebo-controlled trials were performed. Schizophrenia involves a range of problems in how people think, feel and behave. Sep 1, 2016 · Method: Multiple databases and previous publications were searched through June 2015 to identify all randomized controlled trials of any add-on antidepressants compared with placebo or no-treatment in schizophrenia. In addition to thorough assessment, treatment trials can be used to differentiate these conditions. The second patient showed a 62% reduction in positive symptoms and 33% improvement in negative symptoms after 4 weeks of unilateral left side stimulation May 8, 2014 · For example, if the definition used is the presence of one or more negative symptoms at any given time, regardless of etiology, severity, or duration, then the reported prevalence rates of negative symptoms in first-episode patients range from 41% to 54%, and up to 58% in patients with chronic schizophrenia. , 1987) (PANSS) (n = 2) to assess positive and negative symptoms associated with schizophrenia such as delusions, hallucinations, blunted affect, and social withdrawal. Some of the studies have focused more on negative symptoms and have not included patients with severe depressive symptoms. This observation can be interpreted in 2 ways: either the antipsychotic drugs themselves have antidepressant action making Jun 10, 2011 · The negative symptoms of schizophrenia comprise a range of deficits in communication, emotional responsiveness, socialisation, capacity for experiencing pleasure, and motivation. Very promising work was carried out in the later part of the 20th century into the benefits of Omega 3 fatty acids in diet for people living with schizophrenia. Theoretically, antidepressants could improve cognition via enhanced serotonergic, adrenergic, and dopaminergic transmission. Depression is a mood disorder that is characterized by apathy, low mood and social withdrawal. This may be an essential factor in lumateperone's efficacy in both bipolar depression as Jul 28, 2023 · Negative symptoms of schizophrenia include: Avolition. Negative symptoms are common in schizophrenia, but often difficult to differentiate from depression. Antidepressants. In some countries (e. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant Older reports have explored the use of antidepressants, mood stabilizers, and anxiolytics as augmenting agents. Augmentation with antidepressants was recommended for negative symptoms while adding antidepressants, antipsychotics, mood stabilizers, or ECT to clozapine was proposed for CRS with increased risks of aggression or self-harm. Feb 9, 2023 · The schizophrenia studies used the Positive and Negative Syndrome Scale (Kay et al. Importantly, DBS did not cause symptoms of psychosis ( Plewnia et al. There have been mostly positive outcomes regarding the effectiveness, however there are reports of negative findings as well. Feb 1, 2006 · Abstract. When negative symptoms improve with anti-depressants, it often is unclear whether the attenuation in negative symptoms is a consequence of improvement in depression. Jul 15, 2016 · Phenomenology of Depression in Schizophrenia: Interplay of Depression and Negative Symptoms. Symptoms may include: Delusions. Aug 29, 2012 · This article presents a systematic review of pharmacological treatment for negative symptoms of schizophrenia, based on MEDLINE searches from 1995 to September 2002 to identify pertinent clinical trials. ” 13 The nature of the phenomenology of depression in schizophrenia, however The improvement of negative symptoms and cognition with atypical antipsychotics may be due to 5-HT 2A antagonism in combination with D 2 blockade, resulting in the release of dopamine into the prefrontal cortex (the area of the brain in which dopaminergic receptors are hypoactive in untreated individuals with schizophrenia). Serotonin Uptake Inhibitors. Without a doubt, the advent of the Background: Negative symptoms of schizophrenia show limited response to both typical and atypical antipsychotics. Antipsychotics are less effective in management of negative symptoms, therefore a mild to moderate reduction in negative symptoms is often acceptable. Feb 6, 2024 · Symptoms include: not making eye contact. Conclusion Consequently, antidepressants are widely used in persons with schizophrenia to treat a variety of symptoms, such as negative and depressive symptoms. Such phenomena have been recognised as part of a Jan 25, 2006 · Several meta-analyses support the adjunctive use of antidepressants in subjects with predominant negative symptoms 137 and patients with mixed positive and negative symptoms. Dec 1, 2005 · The aim of our meta-analysis was to review the evidence base for the efficacy and safety of antipsychotic and antidepressant combinations in the treatment of the negative symptoms of schizophrenia and schizophrenia-like psychoses. 1 Negative symptoms have been divided into primary and secondary symptoms. May 21, 2020 · In the 1960s, NMDA antagonists, such as ketamine, were identified as inducing clinical symptoms similar to those seen in schizophrenia, more so than other psychotomimetics used in past drug models of psychosis. 10 – 12 In contrast, the estimated Feb 15, 2022 · Negative symptoms are referring to an absence of normal functions. g. The negative symptoms of schizophrenia can cause severe disruptions in daily functioning, relationships, work, school, hobbies, and leisure activities. Randomized controlled trials comparing the combination of antidepress … Feb 3, 2022 · Approaches to the treatment of negative symptoms in schizophrenia in the CEE [e. et al. , 2018] negative symptoms [12]. 2005; Singh et al. A few clinical reports have suggested that antidepressant drugs are able to augment the activity of atypical antipsychotic drugs, thus effectively improving treatment of some negative symptoms of schizophrenia. Jun 12, 2015 · The efficacy of add-on antidepressants on negative symptoms of schizophrenia was reviewed by Singh and coauthors (2010). ” They further analyzed the efficacy of individual antidepressants and found a statistically significant role of fluoxetine, trazodone, and ritanserin while an equivocal role of mirtazapine, sertraline, paroxetine, reboxetine Apr 1, 2017 · nant negative symptoms are generally defined by requiring. 3,4 In particular, in addition to inducing positive symptoms, such as perceptual changes and delusions, ketamine induces negative . Previous studies have demonstrated significant relationships between Sep 13, 2022 · Many psychotropic drugs are available but achieving optimal therapeutic effect can be challenging. 12 Beck describes a “cognitive triad” in depression of “life is pointless, the future hopeless and the self is worthless. Oct 13, 2020 · Morpholines. The authors used a randomized, placebo-controlled design to assess the therapeutic efficacy of adjunctive imipramine, added to fluphenazine decanoate and benztropine, among well-stabilized, negative-symptom schizophrenia and schizoaffective disorder patients who additionally met operationalized criteria for postpsychotic depression. Anti-anhedonic effects of subanesthetic dosages of ketamine have been observed without a deleterious impact on the long-term psychotic symptomatology of schizophrenia patients. Clinical experience shows that antipsychotics have little or no effect on these symptoms. Nov 24, 2012 · The negative symptoms of schizophrenia comprise one of several identified symptom clusters associated with the disorder. An assessment of side-effect burden did not identify any serious safety or tolerability issues, and addition of citalopram as a long-term prescribing strategy may merit further investigation. More research is needed to assess the impact of May 18, 2024 · Diagnosis. , 2008 ). To understand more about how these symptoms affect people with schizophrenia take a look at our information sheet on understanding negative symptoms. Standardized mean Mar 30, 2020 · In schizophrenia, lack of motivation, difficulty experiencing pleasure, limited range of emotions, and speech challenges are common negative symptoms. Treatment often involves the use of various add-on medications such The negative symptoms of schizophrenia represent an important dimension of psychopathology and reflect the absence or diminution of normal behaviours and functions. Dec 15, 2020 · 1. Schizophrenia is a chronic, most devastating psychiatric illness that impairs mental and social functioning. This may be done to rule out other problems that could cause similar symptoms and check for any Jun 10, 2016 · Objective: The authors examined the safety and efficacy of antidepressants added to antipsychotic drugs in the treatment of schizophrenia. The first antipsychotic drug, chlorpromazine, a member of the phenothiazine family, was discovered serendipitously in 1951. They include deficiencies in emotional responsiveness (blunted or flat affect), poverty of speech, poor rapport, emotional and social withdrawal, anhedonia, apathy and avolition. absence of nonverbal emotional cues, like hand gestures. In a comparison with this data, the large effect size of pooled logOR = 0. Because the evidence on current psychopharmacological treatments is unclear, the authors reviewed the findings published to date by searching PubMed with the keywords negative symptoms, antipsychotics, antidepressants, glutamatergic compounds, monotherapy and add-on therapy and Aug 1, 2018 · Background. These symptoms are very common, and include anergia, apathy, affective flattening, alogia and social withdrawal ( 2 - 5 ). qg gj iw er ke pv cd kx rh il