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  MOOD AND ANXIETY DISORDERS


Minerva Psichiatrica 2013 March;54(1):15-29

language: English

Negative symptoms and related disorders of diminished goal directed behavior

Pluck G., Lee K. H.

Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, Sheffield, UK


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Negative symptoms are most widely recognized as being a common feature of schizophrenia and were recognized even in the first clinical descriptions of the disorder by Kraepelin. These negative features can be understood in psychological terms as representing a wide spectrum impairment of goal directed behavior. However, there are many other clinical disorders both within psychiatry and neurology that also involve significant reductions in goal directed behavior. Apathy is recognized as an important factor of many neurodegenerative disorders, including Alzheimer’s and Parkinson’s diseases. Although they probably represent distinct clinical problems, depression and apathy can often be difficult to delineate. One reason for this is that negative symptoms such as apathy and anhedonia are themselves prominent features of major depression. Indeed, depression can be diagnosed under DSM-IV or ICD-10 criteria in the absence of depressed mood, in which case negative features indicative of reduced goal directed behavior are important symptoms. More extreme examples of reduced goal directed behavior can be seen in neurological disorders such as psychic akinesia, abulia and akinetic mutism. In general, reduced goal directed behavior is observed in disorders in which there is impairment of the prefrontal-subcortical-thalamic circuits. Though the human Kluver-Bucy syndrome is probably best not seen in this way, many of the disorders can be viewed as existing on a continuum of diminished goal directed behavior.

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