Symptom Definition

The extent to which symptomatic remission must occur in order to achieve improved functioning and ultimately recovery is dependent on how stringent a definition of remission is used. As shown in table 3, over the first 2 years following an FEP, patients who failed to achieve at least 3 consecutive months free of threshold-level positive and negative symptoms invariably did not have a good level of functioning at the end of a 2-year period, while 10% of subjects who failed to achieve 6 consecutive months free of positive and negative symptoms did go on to achieve good functioning nonetheless. This may constitute a key finding of the study, indicating that remission, defined by near absence of core symptoms sustained for a minimum of 3 months, may be necessary to achieve a good functional outcome during the early phase of psychotic disorders. However, remission of both positive and negative symptoms even for 6 months is obviously not sufficient for achieving functional outcome because many patients did not achieve such improvement in functional outcome despite being in remission.

In FEP, the 3-month consecutive remission of positive and negative symptoms may have further advantages over the 6-month definition. The ROC curve suggests that 3 months is a threshold before which prediction of good functional outcome is very low and after which further maintenance of remission does not contribute much more to prediction of good functional outcome. Also a 3-month remission can be affirmed sooner while the relatively high proportion of patients (70% of cases within 2 years of an FEP) being able to meet this status makes it a very realistic goal. It should, however, be emphasized that these patients had received ongoing treatment in a specialized early intervention service where intensive psychosocial interventions and close monitoring are likely to have achieved high rates of symptomatic remission, and future work will need to determine if it applies equally well to regular care environments. This definition is consistent with the results from a survey of experts suggesting that the best definition of remission in schizophrenia is 3-month remission of both positive and negative symptoms.7

Symptom Definition

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On the other hand, the 6-month definition has the advantage of higher specificity and positive predictive value of good outcome. To ultimately determine the question of the ideal duration of sustained remission, it will be necessary to compare the results from studies in the early and later stages of illness. No study in long-term schizophrenia has yet examined a time criterion shorter than 6 months.8,10,11 Because the 6-month criterion performed as well under analysis as the 3-month criteria, we would not discourage its continued use especially in the interest of consistency across studies. Our findings may provide impetus for clinicians to work with patients to ensure they maintain at least 3-month remission of positive and negative symptoms with some confidence that this may be a threshold after which good clinical and functional status may be more likely to persist.

People may confuse signs and symptoms, but there are important differences that affect their use in the field of medicine. Any objective evidence of a disease, such as a skin rash or a cough, is a sign. A doctor, family member, and the individual experiencing the signs can identify these.

However, less obvious breaks in normal function, such as stomachache, lower back pain, and fatigue, are symptoms and can only be recognized by the person experiencing them. Symptoms are subjective, meaning that other people only know about them if informed by the individual with the condition.

This MNT Knowledge Center article will look at the implications of signs and symptoms as well as their history. The piece will also introduce the different types of sign and symptom and their uses in medicine.

Some conditions show no symptoms at all. For example, a person can have high blood pressure for years without knowing, and some cancers have no symptoms until the later, more aggressive stages. These are known as asymptomatic conditions, and even though the idea of symptoms is often linked to discomfort or abnormal function, a condition without symptoms can be deadly.

Many types of infection do not show symptoms. These are known as subclinical infections, and they can be contagious despite not causing noticeable symptoms in the person carrying the infection. The infection can still be transmitted to other people during the incubation period, or the period during which the infectious agent takes hold of the body.

The first time a person will be aware of many asymptomatic conditions is during a visit to a doctor, normally concerning a different problem. It is important to undergo regular health checks to identify any underlying problems that may not be obvious.

Many cancers are asymptomatic during their early stages. Prostate cancer, for example, does not show symptoms until it has advanced to a certain point. This is what makes some cancers so dangerous, as early treatment is often crucial when treating cancer.

Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.

In addition, medical conditions such as tumors, vitamin deficiencies, medication side effects, or problems with the thyroid, kidney, or liver can also cause serious memory problems that resemble dementia. Some causes of dementia symptoms can be halted or even reversed with treatment. For example, normal pressure hydrocephalus often resolves with treatment.

To diagnose dementia, doctors first assess whether a person has an underlying, potentially treatable, condition that may relate to cognitive difficulties. A physical exam to measure blood pressure and other vital signs, as well as laboratory tests of blood and other fluids to check levels of various chemicals, hormones, and vitamins, can help uncover or rule out possible causes of symptoms.

Early detection of symptoms is important as some causes can be successfully treated. However, in many cases, the cause of dementia is unknown and cannot be effectively treated. Still, obtaining an early diagnosis can help with managing the condition and planning ahead. In the early stages of dementia, it may be possible for people to continue with their everyday activities. As the disease progresses, people will need to adopt new strategies to help adjust.

Differentiating primary negative symptoms (intrinsic to the underlying pathophysiology of schizophrenia) from secondary negative symptoms (related to other factors) can be challenging. Secondary symptoms, which can respond to treatment, occur in association with or result from positive symptoms, affective symptoms, medication side effects, environmental deprivation, or other treatment- or illness-related factors (Figure 1).7 For example, negative symptoms could be a secondary effect of primary positive symptoms in a patient who becomes socially withdrawn after experiencing delusions of persecution or paranoia; or diminished expression could be a coping strategy in a patient who is unable to process overwhelming external stimuli associated with psychotic episodes in schizophrenia.

Schematic course of negative symptoms in schizophrenia. Negative symptoms are present throughout the course of schizophrenia. They can occur early, persist over time, increase in severity, and remain between acute episodes of illness. Correll, C. The Prevalence of Negative Symptoms in Schizophrenia and Their Impact on Patient Functioning and Course of Illness. The Journal of Clinical Psychiatry. 74(2):e04, 2013. Copyright 2019, Physicians Postgraduate Press. Reprinted by permission.15

Negative symptom severity in schizophrenia has been consistently linked to worse functional outcomes in areas such as impaired occupational and academic performance, household integration, social functioning, participation in activities, and quality of life.25 Avolition has been proposed as a key negative symptom construct related to functional deterioration.5 Loss of motivation is thought to be associated with clinical features that are observable as changes in both individual (ie, apathy, blunted affect) and social (ie, asociality and alogia) behaviors. Although affective symptoms may appear to be anhedonic in nature, individuals with schizophrenia seem to be able to experience consummatory pleasure, with functional decline specifically related to the inability to anticipate pleasure in pursuing or achieving goal-directed behavior.25 Deficits in anticipatory pleasure and reduced pleasure-seeking behavior may be related to reward processing disturbances (eg, deficits in reward learning, reward prediction, accurate and adaptive internal value representations), with subsequent impairment resulting from the inability to use reward-associated information to guide future motivated behavior.25

Key negative symptom constructs. Blunted affect=decreased expression of emotion; alogia=reduction in quantity of words spoken; avolition=reduced initiation and persistence of goal-directed activity due to decreased motivation; asociality=reduced social interactions and initiative due to decreased interest in relationships with others; anhedonia=reduced experience of pleasure during an activity or in anticipation of an activity.

For patients with more severe negative symptoms, some fundamental signs can be identified solely by observation of behaviors, such as poor grooming and hygiene, and reduced or impoverished content of speech. In the future, data collected through digital technology, such as smartphone applications, are expected to become increasingly available and used to enhance various aspects of patient assessment and care in the management of schizophrenia generally and negative symptoms in particular.73 Technologies to track symptoms in outpatients, prevent relapse, encourage medication adherence, offer real-time support, encourage physical activity, and increase access to services may help clinicians better assess and manage negative symptoms and patient status. 006ab0faaa