Background: Negative symptoms are categorized by some of the scholars into
‘primary vs secondary ‘, ‘enduring vs transitory ‘and ‘treatment-resistant vs treatmentresponsive’
groups. But it seems that such kind of grouping may not be practically
Objective: Exploring the genuineness of the abovementioned grouping and reports regarding
resistance of negative symptoms against current treatments.
Method: After a primary survey regarding the frequency of negative symptoms amongst two hundreds and
seventy schizophrenic patients, by means of Scale for Assessment of Negative Symptoms (SANS), in three
random, double-blind, clinical trials (RCTs), and based on definite inclusion and exclusion criteria, the
effectiveness of different adjunctive drugs respecting improvement of negative symptoms had been assessed.
Results: the frequency of affecting blunting, alogia, avolition-apathy, anhedonia-asociality and attention
deficit was %96.28, %94.80, %99.62, %98.88 and %99.25, respectively. Citalopram, alprazolam, and
clomipramine in the first tryout, nortriptyline in the second study, and maprotiline in the third trial were
significantly more efficacious then placebo. In 31.2%, 28%, 26.4%, 24%and 22.4% of the patients there was
about 20% reduction in the severity of attention deficit, alogia, affective blunting, anhedonia- asociality and
Conclusion: Conventional classification of negative symptoms into above-mentioned groups may not be
practically supportable. Also maybe it is better to consider them solely in the Criterion B of diagnostic
criteria, which considers the level of functioning.