Updated March 02, 2015.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Antipsychotics are effective in treating negative symptoms that are secondary to positive symptoms. For example, patients can be socially isolated due to paranoid beliefs or voices commanding them not to leave their home. In such cases, antipsychotics effective against paranoia and auditory hallucinations will also result in improved social affiliation. Unmedicated patients experiencing positive symptoms with secondary negative symptoms should start a neuroleptic; if already treated, the dose might need to be increased or alternatively, if the medication is deemed ineffective, a switch to an alternative medication is recommended.

While effective against positive symptoms first generation/typical antipsychotics have a number of neurological adverse effects, such as parkinsonism, that can increase secondary negative symptoms. When patients treated with a typical neuroleptics appear withdrawn and slowed down, that could be a side effect of their neuroleptic. If that is the case, the medication dose can be lowered or the medication might need to be changed to a second generation/atypical antipsychotic.

Depression, with secondary lack of interest and motivation, can be treated with an antidepressant.

Neither first generation/typical antipsychotics or second generation/atypical antipsychotics improve primary and persistent negative symptoms.

Psycho-social interventions with a focus on the social disconnection play an important role in the treatment of persistent negative symptoms.

Supportive therapy provides an opportunity for companionship, where the patient is offered non-judgmental validation, common sense advice, and reassurance.

Behavioral therapy teaches patients to recognize and engage in behaviors and activities that will improve their quality of life. Social skills training is a specific type of behavioral therapy where the patients are taught how to express feelings and needs, ask questions, and control their voice, body and facial expressions.

Cognitive therapy aims to train the patient to question and correct patterns of thoughts that result in overwhelming feelings.

Psycho-education for patients and families is helpful in decreasing stigma and improve opportunities for ongoing social engagement.

As medications efficacy is limited, it is best to combine medications with psycho-social interventions.

Further reading:

Kirkpatrick B, Fenton WS, Carpenter WT, Marder SR. The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull. 2006;32(2):214–9. doi:10.1093/schbul/sbj053.

Kirkpatrick B1, Galderisi S. Deficit schizophrenia: an update. World Psychiatry. 2008 Oct;7(3):143-7

Kring AM1, Gur RE, Blanchard JJ, Horan WP, Reise SP. The Clinical Assessment Interview for Negative Symptoms (CAINS): final development and validation. Am J Psychiatry. 2013 Feb 1;170(2):165-72