Persistent negative symptoms in the EULAST cohort: impact on functional outcome

Why this matters for everyday life

When people think of schizophrenia, they often picture hallucinations or delusions. But another side of the illness—loss of motivation, emotional flatness, and social withdrawal—may quietly shape how well people can work, study, and maintain relationships. This study followed hundreds of people in the early years after developing schizophrenia to ask a simple but crucial question: what happens when these "quiet" symptoms don’t go away over time?

Two paths after diagnosis

The researchers analyzed data from over 500 adults participating in a large European treatment trial for early-phase schizophrenia and related disorders. Everyone was within seven years of their first psychotic episode and was receiving modern antipsychotic medications. At the start, about 6 in 10 participants showed at least one notable negative symptom—such as blunted emotion or withdrawal from others. The team focused especially on a subgroup whose negative symptoms could not be explained by other issues like depression or medication side effects similar to Parkinson’s disease.

When symptoms refuse to fade

After one year, only a smaller fraction still had these persistent negative symptoms. Roughly 8% had ongoing, “pure” negative symptoms that were not tangled up with depression or movement problems, and about 15% had negative symptoms that persisted regardless of whether they were mixed with those other conditions. Even though the overall numbers were modest, the consistency was striking: about one in three people who started out with these unconfounded symptoms still had them a year later. The most stubborn problems were blunted emotional expression and emotional withdrawal, showing how hard it can be to regain a rich emotional and social life once these traits take hold.

Hidden drag on work, study, and relationships

At the beginning of the study, people with persistent negative symptoms functioned about as well in daily life as those whose negative symptoms later improved. Everyone was struggling to some degree with self-care, social relationships, and socially useful activities such as work or school. Over the next 12 to 18 months, however, a clear split emerged. Patients whose negative symptoms eased tended to show meaningful gains in everyday functioning. By contrast, those whose negative symptoms persisted showed little improvement, despite ongoing treatment and similar exposure to antipsychotic medications. The same pattern held when the researchers used a broader definition that included people whose negative symptoms were mixed with depression or medication side effects: if the negative symptoms endured, long-term functioning was worse.

Signals for clinicians and families

Interestingly, persistent negative symptoms did not make people more likely to drop out of the study, suggesting that these enduring problems may not be obvious through attendance or treatment adherence alone. Yet they were strongly tied to poorer real-world outcomes. The authors argue that clinicians should treat the persistence of negative symptoms—whether or not they are “pure” or secondary to other problems—as an early warning sign that someone is at risk for long-term difficulties in work, education, and social life. Tracking these symptoms over time, rather than just at a single visit, may help identify who needs extra psychosocial support, rehabilitation, or new treatment approaches.

What this means going forward

For people living with schizophrenia and their families, these findings underscore that it is not only the dramatic symptoms that matter. Subtle, lingering problems with motivation, emotional expression, and social connection can quietly limit recovery even when hallucinations and delusions are under control. This study shows that when such negative symptoms persist over a year or more, they are closely linked to poorer everyday functioning, regardless of how severe someone’s problems were at the start. Recognizing and targeting these enduring symptoms early—through tailored therapies, support programs, and future treatments—may be key to improving long-term independence and quality of life.

Citation: Giuliani, L., Pezzella, P., Giordano, G.M. et al. Persistent negative symptoms in the EULAST cohort: impact on functional outcome. Schizophr 12, 36 (2026). https://doi.org/10.1038/s41537-026-00739-w

Keywords: schizophrenia, negative symptoms, functional outcome, early psychosis, longitudinal study