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Assessing Negative Symptoms 1

This document provides a 5-item tool for assessing negative symptoms in patients with schizophrenia. It rates speech, anhedonia, affect, motivation, social drive on a scale from 0-4. It also includes a global rating and tips for conducting interviews to evaluate negative symptoms.

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106 views3 pages

Assessing Negative Symptoms 1

This document provides a 5-item tool for assessing negative symptoms in patients with schizophrenia. It rates speech, anhedonia, affect, motivation, social drive on a scale from 0-4. It also includes a global rating and tips for conducting interviews to evaluate negative symptoms.

Uploaded by

nicduni
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Assessing Negative Symptoms: A 5-Item Tool

Instructions
This tool aids in the rapid clinical assessment of 5 key negative symptoms in patients with
schizophrenia: speech, anhedonia, affect, motivation, and social drive. It is based on several
recently validated assessment tools including the 4-Item Negative Symptom Assessment
Instrument (NSA-4), the Brief Negative Symptom Scale (BNSS), and the Clinical Assessment
Interview for Negative Symptoms (CAINS), with the added benefit of requiring minimal
training only.

To use the tool, rate each symptom on a scale of 0 to 4, with 0 representing normal behavior
(compared with the general population) and 4 representing a severe behavioral deficit. A final
item of this tool is a separate global symptom rating that helps quantify the overall presence
of negative symptoms and any negative symptoms not assessed by this tool, such as poor
hygiene or slowed movements.

Details for choosing the most appropriate score are incorporated into the rating system. Also
included at the end of this tool is a list of tips for conducting successful patient interviews
when evaluating for negative symptoms.

This activity is supported by an educational grant from Genentech.


Negative Symptom Assessment Tool
1. Speech Quantity
 0 = Normal: normal amount of speech or excessive speech quantity
 1 = Mild: patient’s comments or answers are somewhat brief
 2 = Moderate: many of patient’s responses are 1-2 words; may require prompting
 3 = Moderately severe: all of patient’s responses are 1-2 words; requires prompting
 4 = Severe: patient does not speak
2. Pleasure/Anhedonia
 0 = Normal: patient enjoys daily activities, hobbies
 1 = Mild: patient reports somewhat decreased pleasure from activities
 2 = Moderate: patient reports a moderate decrease in pleasure from most activities
 3 = Moderately severe: patient gets little pleasure from most activities
 4 = Severe: patient experiences no pleasure from any activity
3. Emotional Expression/Affect
 0 = Normal: patient easily expresses emotions via facial expressions, vocal tone, and/or gestures
 1 = Mild: patient can express emotions using facial expressions, vocal tone, and/or gestures but frequency
of expression is somewhat reduced
 2 = Moderate: patient displays a noticeably reduced capacity to express emotions using facial expressions,
vocal tone, and/or gestures but still responds emotionally on occasion
 3 = Moderately severe: patient has a significant lack of emotional expression but may respond infrequently
at times during a conversation
 4 = Severe: patient does not respond emotionally at all; complete lack of affect
4. Motivation/Goals
 0 = Normal: patient feels motivated to pursue work-, school-, or activity-related goals
 1 = Mild: patient may still feel motivated to pursue interests but is less motivated than what is
considered normal
 2 = Moderate: patient demonstrates a significant lack of interest in work or other activities but still
occasionally feels motivated to pursue goals
 3 = Moderately severe: patient shows a profound lack of motivation and interest in work or activities but
may infrequently express interest in goals
 4 = Severe: patient has no interest in pursuing work-, school-, or other activity-related goals
5. Social Drive
 0 = Normal: patient desires contact with other people and is able to develop friendships
 1 = Mild: patient has a somewhat diminished desire to interact with others and has a slightly decreased
capacity for friendships/intimacy
 2 = Moderate: patient has lower desire for contact with people and has significant problems developing
friendships, although patient may still express interest in others
 3 = Moderately severe: patient generally prefers isolation from others and has few or no friends
 4 = Severe: patient desires complete isolation from others and has no relationships
Global Negative Symptom Rating
 0 = Normal: patient has no negative symptoms
 1 = Mild: patient has some negative symptoms, but symptoms interfere minimally with functioning
 2 = Moderate: patient has 1-2 negative symptoms that interfere significantly with functioning
 3 = Moderately severe: patient has 3 or more moderately severe negative symptoms that substantially
interfere with functioning
 4 = Severe: patient has 3 or more negative symptoms that are categorized as severe

PAGE 2 OF 3
Tips for Negative Symptom Assessment
In actual practice, it can be difficult to assess and quantify negative symptomatology in patients with schizophrenia.
Interviewing technique is key in eliciting patient responses that help identify the presence of negative symptoms;
however, engaging the patient in conversation may be difficult, as some patients may lack self-awareness or the
capacity to understand concepts such as pleasure, emotional expression, and motivation.
When assessing negative symptoms, asking the patient open-ended questions rather than questions that can be
answered with a “yes/no” response can yield useful information. Below is a list of sample questions to aid in the
evaluation of each negative symptom. These questions are suggestions only and should be tailored to make them
relevant to an individual patient’s circumstances.

Speech Quantity Motivation/Goals


To assess speech quantity, it is crucial to engage the To assess a patient’s motivation, consider asking
patient in conversation to the extent that it is possible. questions about the patient’s work, school, other
Questions should be designed to elicit a broad activities, or living situation, depending on his or her
response. Examples include: individual circumstances, such as:
1. How have you been doing since our last visit? 1. What might you like to do for work? Do you have any
2. Tell me about how you spend a typical day, from the interest in possibly getting a job?
time you wake up until you go to bed. 2. Did you make it to your group therapy this week?
3. What are you looking forward to in the next few days? 3. How do you feel about starting to look for an
apartment?
Pleasure/Anhedonia
4. What hobbies do you think you’d like to try? Would
The patient’s capacity for enjoyment should be
you like to come up with a plan to do that?
differentiated from the motivation to engage in
activities or pursue goals. Questions should be aimed Social Drive
at identifying how often the patient feels pleasure, Social motivation may be assessed by asking
whether he or she looks forward to enjoyable activities, questions about the patient’s desire for interpersonal
and how much pleasure is taken in enjoyable activities. interactions or motivation to develop relationships.
1.  What did you do for fun since our last meeting? How 1. Who did you talk to or visit with this week? How did
did you feel when you were doing those activities? that go?
2. What activities or hobbies do you enjoy? Are you 2. Would you like to have more contact with people or
looking forward to doing those activities again soon? do you prefer to spend time alone?
3. Are there other activities you think you might enjoy? 3. How did you feel when you were around other
people this week?
Emotional Expression/Affect:
When evaluating for emotional expression, consider Global Negative Symptoms
the patient’s vocal tone, facial expressions, and This score should be derived from your overall
gestures. impression of your discussion with the patient. You
1. Can you think of a time when you had strong may observe things like poor hygiene, slowness
feelings about something, good or bad? What were of movement or speech, lack of interest in the
you feeling exactly? Have you felt that way at any discussion, or lack of emotion during your discussion.
other time?
2. How do you feel today? What kind of mood are you in?
3. Has anything made you feel happy, angry, or sad in
the past week?

© 2014 Med-IQ®. All rights reserved. PAGE 3 OF 3

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