Negative and cognitive symptoms of schizophrenia — structured clinical viva

Secondary causes have been reasonably excluded (no EPS, no major depression, substances and basic medical mimics negative; positives controlled). The presentation is consistent with primary negative symptoms, potentially a deficit-type enduring pattern (Carpenter), plus clinically important cognitive impairment that predicts functional disability (Green).^[2][3]

Name NIMH five domains (blunted affect, alogia, asociality, anhedonia, avolition) and the two-factor frame (diminished expression vs avolition–apathy). Measure with SANS/PANSS conceptually; structure cognition with MATRICS domains; keep risk assessment explicit even when affect is flat.^[1][7]

Treatment honesty. Overall effects of many interventions on negatives are modest (Fusar-Poli). Consider whether she meets a predominant-negatives phenotype in which cariprazine versus risperidone evidence (Németh) is relevant — she is not on risperidone and positives are controlled, so any switch needs informed consent, local formulary, and realistic expectations, not marketing overclaim. Do not jump to clozapine without TRS criteria. Prioritise cognitive remediation integrated with supported employment/rehabilitation (Wykes).^[4][5][6][7]