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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Maniz on November 30, 2000, at 17:36:35
Hi,
I have read in this forum references to "negative symptoms". Are these only for psychosis or also for inhibition, procrastination, social phobias, etc?.
Which medication can help?.
Thanks
Posted by JohnL on December 1, 2000, at 5:25:22
In reply to negative symptoms, posted by Maniz on November 30, 2000, at 17:36:35
> Hi,
>
> I have read in this forum references to "negative symptoms". Are these only for psychosis or also for inhibition, procrastination, social phobias, etc?.
>
> Which medication can help?.
>
> ThanksHi Maniz. How's it going?
Negative symptoms are used to describe certain parts of schizophrenia, such as anhedonia (lack of pleasure in ordinary hobbies and activities), social withdrawal, apathy, emotional numbness. I think though that there is considerable overlap between this form of schizophrenia, depression, dysthymia, bipolar, social anxiety, etc. Though doctors attempt to draw clear boundaries between these different diagnosis, I don't see that that can realistically be done. There is just too much overlap. Too many gray areas. It's seldom black and white. In his book "Dysthymia, the Spectrum of Chronic Depression" the world renowned psychiatrist Hagop Akiskal pretty much says the same thing.
In my worst moments I clearly qualify for a diagnosis of major depression. When I've recovered somewhat, I more clearly qualify for dysthymia. But on the other hand, negative symptoms of schizophrenia actually describe my symptoms even more accurately than dysthymia. Which diagnosis is correct? Who knows. Who cares. I think what's important is that there is some chemical imbalance or malfunction underlying the whole mess, and finding a drug(s) that corrects those problems is all that matters. Putting a name on it just seems too inaccurate. It does though help to decide what class of drugs might work better than another. Any class of drugs could work, but the odds may be better with one than another, and that would be the place to start.
I think negative symptoms can easily be confused with certain kinds of depression. I'm not so sure there's any difference actually. For these kinds of symptoms though, whatever someone wants to name them, I think noradrenaline and dopamine drugs have better odds of working than serotonin drugs. Generally speaking, this is how different neurotransmitters are hypothesized to affect mood:
Serotonin-Overall wellbeing and calmness.
Norepinephrine-Drive, energy, and motivation.
Dopamine-Pleasure.Serotonin drugs for me work in a sense that they can make me undepressed. Yet even though I'm undepressed, I have no drive, no motivation, and no interest or pleasure in anything. Adrafinil which works on noradrenaline, and Amisulpride which works on dopamine, wipe out these symptoms almost completely. Other drugs that may be effective for so-called negative symptoms would include: Ritalin or Adderall; Effexor; Zyprexa or Risperdal; Nortriptyline or Desipramine; Lithium.
In a nutshell I think that one's symptoms can help to determine which class of drugs might be more helpful, but giving that set of symptoms a name is not all that clinically useful. There is just so much overlap and too many gray areas. That's how I see it anyway.
John
Posted by Maniz on December 1, 2000, at 15:27:37
In reply to Re: negative symptoms, posted by JohnL on December 1, 2000, at 5:25:22
editing john´s reply....
>
> Hi Maniz. How's it going?A bit "negative" haha :-)
>
> Negative symptoms are used to describe certain parts of schizophrenia, such as anhedonia (lack of pleasure in ordinary hobbies and activities), social withdrawal, apathy, emotional numbness. I think though that there is considerable overlap between this form of schizophrenia, depression, dysthymia, bipolar, social anxiety, etc.Yes, as far as I know I am not psychotic :-) but when I read those symptoms related to psychosis I get scared.
But you are right, those symptoms can be present (in different degrees and fashion) in social phobia or obsessive personalities.
> Though doctors attempt to draw clear boundaries between these different diagnosis, I don't see that that can realistically be done
You must be right, but how difficult it is to try not to "label" oneself. It seems if we could put a name to what happens to us we will be more secure, even if it is a bad condition.
> I think negative symptoms can easily be confused with certain kinds of depression. I'm not so sure there's any difference actually.
I think an important difference is if one is psychotic or a depressed neurotic.
> For these kinds of symptoms though, whatever someone wants to name them, I think noradrenaline and dopamine drugs have better odds of working than serotonin drugs. Generally speaking, this is how different neurotransmitters are hypothesized to affect mood:
> Serotonin-Overall wellbeing and calmness.
> Norepinephrine-Drive, energy, and motivation.
> Dopamine-Pleasure.
>
> Serotonin drugs for me work in a sense that they can make me undepressed. Yet even though I'm undepressed, I have no drive, no motivation, and no interest or pleasure in anything. Adrafinil which works on noradrenaline, and Amisulpride which works on dopamine, wipe out these symptoms almost completely.From what you say, I think I should try adrafinil. If only I can take a decision for once and put away the fears of side effects, dependency, etc.
Sometimes I feel like my brain is not well connected to my motor system (acethylcholine problem ?:-))
I may think "go clean and wash the dishes"...but after too much time I am still sitting or in bed...
How would you call this? I mean when you have difficulty with action (especially "social"), it it a negative symptom?.
Some years ago I used to be anxious but more active, now it seems like I wasted all that energy anxiety gives (well, I have some psychological reasons to feel sad) and can not feel it again, ordinary efforts feel as too much to cope with, like I am tired in advance (no, I am not lazy :-)).
If I did not get it wrong, according to your post, this could be Norepinephrine related and I should consider a drug acting on this area.
The psychotherapists I consulted all these years were reluctant (me too) about medication (maybe because i do not have a severe condition and for periods I function well) but I have come to a point where if I do not act things can get worse (I am work impaired, sort to say).
BTW: I am increasing the dose of SJW as you suggested. Although I do not expect much.
Posted by Noa on December 1, 2000, at 16:33:50
In reply to Re: negative symptoms » JohnL, posted by Maniz on December 1, 2000, at 15:27:37
anergic depression perhaps?
I know that feeling well--thinking about an action, and finding oneself still not getting into gear a few hours later.
Maniz, a lot of disorders seem to have overlapping symptoms, and it can be easy to get scared that you have this that or the other disorder.
To me, labels are only as good as they are useful.
Posted by stjames on December 1, 2000, at 21:53:07
In reply to Re: negative symptoms » JohnL, posted by Maniz on December 1, 2000, at 15:27:37
Put your mind at ease, if you had schizophrenia
or were psychotic it would be clear. It is hard to
miss schizophrenia.james
Posted by SLS on December 2, 2000, at 7:59:42
In reply to Re: negative symptoms, posted by JohnL on December 1, 2000, at 5:25:22
> I think though that there is considerable overlap between this form of schizophrenia, depression, dysthymia, bipolar, social anxiety, etc. Though doctors attempt to draw clear boundaries between these different diagnosis, I don't see that that can realistically be done.It can be done, and it is done - every single day - successfully.
It might be hard for you to distinguish between schizophrenia and mania, but this is not to your discredit. I doubt you went to medical school and attended those classes devoted to one of the kingpins of medical practice: differential diagnosis. It can be done and it is done - even with two presentations located within the same spectrum of illnesses.
Differential diagnosis of many illnesses is very often more difficult than the treatments of that illness. Another one - childhood AD/HD and bipolar disorder. Not only do they have some similar symptoms (overlap?), but both can occur comorbidly. If you were to treat one without treating the other, the goal of attaining a healthy behavioral and attentional state is not realized. They are not one disorder. They are two.
I do not believe that schizophrenia, bipolar affective disorder, and schizoaffective disorder are located along a spectral line of one disorder. More like three.
> There is just too much overlap. Too many gray areas. It's seldom black and white. In his book "Dysthymia, the Spectrum of Chronic Depression" the world renowned psychiatrist Hagop Akiskal pretty much says the same thing.
I didn't read his book, but does Akiskal state that schizophrenia, bipolar disorder, and major depression are simply multiple presentations along a single biological thread? In what ways? Akiskal is a smart guy. I would be surprised if this were so. A single thread containing dysthymia and depression makes sense to me, but not schizophrenia and depression.
I think it is a mistake to think of two disorders related simply because they have some clinical symptomology in common. Manic psychosis and schizophrenic psychosis look very much alike to some people. They are not at all similar in biological presentation or prognosis. The brains of uncomplicated bipolar individuals do not have the enlarged ventricle seen with schizophrenia. Schizophrenic psychosis does not respond to lithium. Then, there is psychotic depression and schizoaffective disorder. All four of these disorders present with psychosis in which thoughts are distorted and disorganized, and effective reality-checking is all but non-existent. That bipolar disorder and schizophrenia have features in common does not imply that they represent a continuum of the same disorder. I believe they are unrelated.
- Scott
------------------------------------------------------
* Robert M. Post is pretty smart too. *
22: Schizophr Res 1999 Sep 29;39(2):153-8; discussion 163Comparative pharmacology of bipolar disorder and schizophrenia.
Post RM
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892-1272, USA. robert.post@nih.gov
The treatment of acute mania and schizophrenia overlap considerably in terms of the typical and atypical neuroleptics, but begin to diverge with the recognized mood stabilizers for bipolar affective illness--lithium, carbamazepine, and valproate--which are substantially less effective in schizophrenia than in affective illness. Moreover, the L-type calcium channel blocker verapamil is reported to be effective in mania, but it may exacerbate schizophrenia. A series of new putative mood stabilizing anticonvulsants (such as lamotrigine, gabapentin, and topiramate) and possible second-messenger targeted treatments (tamoxifen and omega-3 fatty acids) deserve further study in both affective and schizophrenic syndromes. Repeated transcranial magnetic stimulation (rTMS) of the brain offers considerable promise in the treatment of a variety of neuropsychiatric syndromes, especially with preliminary evidence of frequency-dependent effects on regional cerebral blood flow. New insights about the potential neurotrophic effects of lithium and the gene transcriptional effects of other psychotropics offer exciting new targets for therapeutics and strategies for future clinical trials and therapeutic applications in both syndromes.
Publication Types: Review Review literature
PMID: 10507527, UI: 99435361
Posted by JohnL on December 2, 2000, at 9:29:25
In reply to Re: negative symptoms, posted by SLS on December 2, 2000, at 7:59:42
Nice try Scott, but I don't buy it. :-)
We'll have to agree to disagree.
Have you read the book called "Dysthymia, the Spectrum of Chronic Depression", by Hagop Akiskal? Good book. Highly esteemed author. He makes the case for the opinions I have concerning 'diagnosis'. That is, different psychiatric conditions have considerable overlap; they are in constant evolving change; and they don't breed true from generation to generation. I read this book a few years ago and its influence still sticks. That's because I haven't seen realworld evidence to prove otherwise.
Certainly I think an attempt at an accurate diagnosis is a crucial starting point for narrowing down initial drug choices. But after that, might as well toss a coin. Heck, I had four different diagnosis from four different pdocs. Who was right? Did any of them matter? I still think it's an exercise in futility. Better suited to the world of academic study than in the real world of suffering people. Just because some doctors do it everyday doesn't make it accurate, valid, or even useful. It's a starting point, that's all. If anything, I think it actually prolongs suffering instead. Someone diagnosed with anxiety as an example may go through years and years of SSRIs, benzodiazepines, eventually antipsychotics, with no success, yet may never consider Lithium. A diagnosis of anxiety does not warrant Lithium. But 22% of anxiety patients in one doctor's office found total cure with Lithium. So what good was an accurate diagnosis in the first place? And what about the majority of the population of this board? How has their supposed diagnosis helped them? Obviously not enough. Like I said, there are just too many gray areas. It's not as black and white as textbooks make it seem.
John
Posted by Jim on December 3, 2000, at 10:14:05
In reply to Re: negative symptoms, posted by JohnL on December 2, 2000, at 9:29:25
> Nice try Scott, but I don't buy it. :-)
>
> We'll have to agree to disagree.
>
> Have you read the book called "Dysthymia, the Spectrum of Chronic Depression", by Hagop Akiskal? Good book. Highly esteemed author. He makes the case for the opinions I have concerning 'diagnosis'. That is, different psychiatric conditions have considerable overlap; they are in constant evolving change; and they don't breed true from generation to generation. I read this book a few years ago and its influence still sticks. That's because I haven't seen realworld evidence to prove otherwise.
>
> Certainly I think an attempt at an accurate diagnosis is a crucial starting point for narrowing down initial drug choices. But after that, might as well toss a coin. Heck, I had four different diagnosis from four different pdocs. Who was right? Did any of them matter? I still think it's an exercise in futility. Better suited to the world of academic study than in the real world of suffering people. Just because some doctors do it everyday doesn't make it accurate, valid, or even useful. It's a starting point, that's all. If anything, I think it actually prolongs suffering instead. Someone diagnosed with anxiety as an example may go through years and years of SSRIs, benzodiazepines, eventually antipsychotics, with no success, yet may never consider Lithium. A diagnosis of anxiety does not warrant Lithium. But 22% of anxiety patients in one doctor's office found total cure with Lithium. So what good was an accurate diagnosis in the first place? And what about the majority of the population of this board? How has their supposed diagnosis helped them? Obviously not enough. Like I said, there are just too many gray areas. It's not as black and white as textbooks make it seem.
>
> JohnI guess (?) my point of targeting symptoms then rather looking for
a quick Dx is what I have found most valuable in
getting some effective relief. That is also part of
my belief that GP's should not be prescribing
psych meds, but also everyone has a right to
an affordable and good psych doc. I think all meds,
from benzos, antipsychotics can play a role in the
wide variety of conditions. But, the pdoc has to
be extremely knowledgeable and confident with every med.
Sadly, many aren't, and are often only 'comfortable'
with a small range of medications. We should not be used as
human test rats, but denying a good Rx can be just
as inhumane.
Posted by Maniz on December 4, 2000, at 12:35:05
In reply to negative symptoms, posted by Maniz on November 30, 2000, at 17:36:35
Hi,
There is a mention here regarding the use of glycine for negative symptoms in schizofrenia
From http://home.vicnet.net.au/~mecfs/general/goldstein_treatment.html
21. Glycine powder 0. 4 Gm/kg/day in juice or Cycloserine 15 - 50 mg od
(available otc in USA- read potential risks and precautions before prescribing-J. S.)Significantly reduces the negative symptoms in schizophrenia.
I do not know what the supposed risks are or if it will work for other negative symptoms (I guerss no).DMG and TMG are easily available, could they have this effect?.It seems to act on glutamate. From another part of the article: ...dorsolateral prefrontal cortex lesions may cause glutamatergic hypofunction and may be attenuated by glycine, as are negative symptoms in schizophrenia.
Posted by AndrewB on December 11, 2000, at 1:56:59
In reply to glycine? Re: negative symptoms, posted by Maniz on December 4, 2000, at 12:35:05
Maniz,
I will be brief because it is bed time for me. If you have symptoms that resemble negative symptoms it does not mean you have schizophrenia. However, this similarity can give you important clues as to what medicines may work for you.
Background: Schizophrenia is postulated to involve hypofunction of parts of the dopaminergic system and hyperfunction of others. Negative symptoms may involve hypofunction of the dopaminergic system in the prefrontal cortex. It is important to know that the prefrontal cortex directly effects the shell of the nucleus accumbens. In both of these areas dopamine receptor function is mediated by the glutaminergic system, especially the NMDA receptor. Glycine agonists (including glycine) increase NMDA receptor function.
Now you don't have schizophrenia, but you may have dysfunction at the dopaminergic prefrontal cortex and the shell of the nucleus accumbens. If you do, the same drugs that work for negative symptoms may work for you. These drugs include the antipsychotics amisulpride, sulpiride and Zyprexa taken in small doses. Email me for more info on amisulpride to treat such symptoms (andrewb@seanet.com).
Glycine and cycloserine are more experimental but may be considered as a second option or an add on to the above drugs. Both glycine and cycloserine lack neurotoxicity. Effective glycine doses may need to be as high as 30mg./day though. Cycloserine is effective in the 50-100mg. range. It also has been shown to improve cognition, but tolerance for this effect may develop shortly.
Please research and then discuss with your p-doc about the safety and possible interactions involving cycloserine.
Best Wishes,
AndrewB
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