Gejala Negatif Skizofrenia

Oleh Henry A. Nasrallah, MD
Wakil Presiden Eksekutif dan Direktur Ilmiah, The CURESZ Foundation

Schizophrenia is a complex neuropsychiatric syndrome with multiple symptom domains. The most recognizable symptom cluster is psychosis (classically, hallucinations and delusions)  which is the reason many patients are initially hospitalized. However, most patients with schizophrenia also suffer from three other symptom clusters including negative symptoms (deficits in normal brain function such as lack of motivation and interest that impair social and vocational functioning), cognitive impairments and mood symptoms. In fact, the negative and cognitive symptoms are what causes functional disability, even after the psychotic symptoms subside with antipsychotic medications.

Negative symptoms were not widely recognized until the 1980’s. Prior to that, the focus in schizophrenia was on the psychotic symptoms (hallucinations and delusions). The persistence of negative symptoms after the psychosis is controlled led to many studies that characterized the various negative symptoms.

Berikut ini adalah gejala-gejala negatif skizofrenia yang biasanya diamati oleh keluarga atau psikiater, bukan oleh pasien itu sendiri:

1. AFFECT PATHOLOGY This refers to a flat, blunted or restricted facial expression. In addition, other manifestations include poor eye contact, decreased spontaneous movements, monotone speech (referred to as aprosody), and failure to recognize the facial expression of other people (such as neutral, angry, sad, disgusted or anxious).

2. ALOGIA Which is a reduction in the quantity of thought, and poverty of speech, including speaking in monosyllables rather than sentences. Sometimes, patients may suddenly stop speaking in mid-sentence (called “blocking”) which is an interruption of thought. There is often a prolonged pause before responding to a question.

3. ASOSIALITAS Yaitu ketiadaan atau berkurangnya minat untuk mengadakan hubungan sosial atau berinteraksi dengan orang lain. Pasien juga tidak dapat merasakan keintiman atau kedekatan dengan orang lain.

4. AVOLITION AND APATHY Hilangnya kemampuan untuk memulai atau bertahan dalam aktivitas yang diarahkan pada tujuan. Ini termasuk tidak mandi, berdandan buruk, dan tidak melakukan apa pun sepanjang hari, yang sering disalahartikan sebagai “kemalasan”.

5. ANHEDONIA Which is the loss or reduction of the capacity to experience pleasure, manifested by lack of interest in enjoyable activities. This is also a decrease in sexual activity, interest or enjoyment. Unlike the anhedonia of depression, it is not reversible in most patients.

6. INATTENIVENESS Yaitu ketidakmampuan mempertahankan suatu tugas atau keterlibatan/keterikatan untuk jangka waktu yang wajar. Pasien tampak asyik dengan dunia internal dengan mengesampingkan tugas-tugas eksternal.

7. ANOSOGNOSIA Also referred to as non-awareness of illness. The patient lacks insight into their illness or disability. It can also be regarded as a cognitive deficit. This lack of insight prevents patients from seeking treatment or help to alleviate symptoms or to solve personal problems. Anosognosia can be reversible with continuous adherence to antipsychotic therapy.

Researchers sometimes classify the above negative symptoms into two major subdivisions:

1. Ekspresi Berkurang, yang meliputi perataan afektif dan alogia, dan

2. Apatis/avolisi, yang meliputi kurangnya motivasi dan asosialitas.

In contrast to “positive” psychotic symptoms for which dozens of medications are available, there are no treatments yet for negative symptoms. It is a huge unmet need in the field of schizophrenia. So far, many attempts have been futile in developing a pharmacological treatment for negative symptoms. Thus, psychotherapy is the main approach to help patients recognize and overcome their negative symptoms. Occupational and recreational therapies can also be helpful. There are a couple of promising medications on the horizon. However, the FDA has not approved any of these yet.