Comments and Controversies
I read and enjoyed Dr. Nasrallah’s excellent summary of schizophrenia symptoms in “The primary and secondary symptoms of schizophrenia: Current and future management” (Current Psychiatry, supplement to September 2011, p. S5-S9).
I have a suggestion to add to the list of secondary negative symptoms based only on my observations: demoralization caused by repeated failures in all dimensions—self, interpersonal, social, and industrial. I have seen demoralization in schizophrenia patients manifest as low self-esteem, hopelessness, apathy, and self reproach.
Robert A. Williams, MD
Biological Psychiatry Institute, Ltd.