Negative symptoms in psychosis: a scoping review of qualitative studies

Introduction: Negative symptoms in schizophrenia, characterised by the absence or reduction of normal processes, are understudied and effective treatments remain elusive. Qualitative research can provide novel and patient-centred insights into these complex phenomena. This scoping review synthesizes findings from previously published qualitative studies aiming to explore previous results and identify gaps in the published literature.

Methods: A systematic search was conducted on MEDLINE, CINAHL, and PsycINFO databases between April and June 2023. Qualitative studies on negative symptoms in psychotic illnesses were eligible for inclusion. Screening and data extraction procedures were performed by two reviewers working independently. Extracted findings were summarised using narrative synthesis based on consensus meetings with the research team.

Results: A comprehensive search yielded 4753 articles, with six studies deemed eligible for inclusion. The included studies collectively delved into the experiences, causes, and consequences of negative symptoms. Participants reported a spectrum of negative symptom experiences influenced by social dynamics, societal stigma, and childhood trauma. There was a noticeable interaction between different symptom domains, including negative symptoms, such as motivation and sociability, being influenced by positive symptoms, such as hallucinations and delusions. Studies have also highlighted the impact of prescribed medication and substance use on negative symptoms. Areas needing further qualitative research were identified, including exploring the differentiation between primary and secondary negative symptoms, and gaining a deeper understanding of negative symptom evolution over time.

Conclusions: This scoping review provides valuable insights into the subjective experience of negative symptoms and the multifactorial contributory factors to negative symptoms in schizophrenia. The findings, such as the interplay between negative and positive symptoms, emphasise the importance of a holistic understanding of these complex symptoms, which can be informed by qualitative exploration. Furthermore, the qualitative perspectives can enhance future research avenues, and have potential for assisting the development of more effective approaches for treating negative symptoms.