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Lethal Catatonia and Neuroleptic Malignant Syndrome

The review of schizoaffective disorders by Lapensee (1) is quite comprehensive, although one would have expected some mention of negative symptoms and their role in the diagnosis of schizoaffective disorders. We know now that negative symptoms occur frequently both in schizophrenia and depression (2-4). Since a diagnosis of schizoaffective disorders entails co-existing features of affective disorder and schizophrenia, the occurrence of negative symptoms could have a major confounding effect. In a study where negative symptoms were assessed using the Scale for Assessment of Negative Symptoms (5) in schizophrenia and depression (6), negative symptom subscale scores on alogia, avolition, anhedonia and attentional deficits were as high in depression as they were in schizophrenia. Also, negative symptoms occur as commonly in depression as in schizophrenia. Negative symptoms could be mistaken as the result ofeither schizophrenia or depression. For example, in schizophrenia, negative symptoms, such as feelings of anhedonia, reduced social interest, avolition, apathy, poverty of speech, reduced sexual interests and activity, could be construed as features of depression;since these negative symptoms occur more frequently in depression than in schizophrenia (6). Such cases are thus likely to be classified as schizoaffective disorder. However, in depression, negative symptoms, such as flat affect, poor eye contact and a paucity of expressive features, may be considered to be symptoms of schizophrenia, and thus such cases are also likely to be classified as schizoaffective -disorders, Andreasen and Akiskal (4) have reported that people with depression and schizophrenia do not differ substantially in the severity of their negative symptoms, which further compounds the difficulty. Even flat affect, which is considered to be a consistent feature of schizophrenia, occurred in 32% of the depressed subjects in one study (6) and in 24% of the depressed subjects at 18 month follow-up in another (2). The occurence of negative symptoms provides another dimension in which to examine the relationship between schizophrenia and affective disorders, or schizoaffective disorders in terms of negative symptoms (6). Lapensee (1) might have drawn upon this recent development, which has been the focus of numerous studies of negative symptoms in different psychiatric disorders.