The Negative Symptom Challenge

Fenton and McGlashan¹note the relatively recent attention to the proposition that deficit or negative symptoms in schizophrenia have a distinct pathophysiologic process from that which underlies the production of positive psychotic symptoms. Although the attention is new, the proposition is not. Kraepelin²asserted that two See also p 179.maladies characterized dementia praecox: the dissociative processes, so well described by Bleuler,³and "the weakening of those emotional activities which permanently form the mainsprings of volition." The latter process is the source of those primary negative symptoms in schizophrenia that defined the deficit syndrome.⁴,⁵ Kraepelin's distinction between two pathologic processes yielded to two prominent alternative paradigms, the most influential of which has been the presumption that a fundamental or primary pathologic process underlies schizophrenia (eg, Bleuler's dissociative process). In this paradigm, schizophrenia is a single disease entity associated in all cases with the same fundamental pathologic