Abstract
Efficacy of antipsychotics in treatment of negative symptoms is generally low. Most of the data are based on the post-hoc analyses of short-term studies, where negative symptoms were not the primary efficacy measure, with no distinction between primary and secondary negative symptoms.
Antipsychotics with the most robust evidence in the treatment of predominant negative symptoms are cariprazine and amisulpride. We suggest that cariprazine should be used as the first-line treatment for patients with predominant negative symptoms and that amisulpride should be considered as an alternative in case of cariprazine failure.
Other treatment options are include the use of olanzapine (or quetiapinewith lower level of evidence), and add-on therapy with aripiprazole or antidepressants.