What Are Negative and Positive Symptoms in Schizophrenia?by Natasha Tracy - July 27th, 2015
Schizophrenia is a serious brain disorder that affect about 1% of people worldwide. Schizophrenia affects the way a person thinks, feels, and perceives the world around him or her. The symptoms of schizophrenia include both positive and negative symptoms. “Positive" and “negative" do not refer to the symptom’s benefit or lack thereof but, rather, the nature of how they affect the person with schizophrenia. Positive symptoms are additions to consciousness (such as hallucinations) whereas negative symptoms are decreases in functionality (such as poverty of speech). In addition to positive and negative schizophrenia symptoms, there are also cognitive and mood symptoms to schizophrenia.
Positive Symptoms of Schizophrenia
Positive symptoms include symptoms of psychosis. Hallucinations and delusions are the primary symptoms of psychosis. Hallucinations are any perception that doesn’t exist such as hearing or seeing things that aren’t there. Hallucinations in schizophrenia are usually auditory in nature. Delusions are strongly-held, false beliefs that exist in spite of evidence to the contrary. An example of a delusion might be that the person with schizophrenia is being followed by government agents.
Positive symptoms of schizophrenia also include disorganized speech and behavior. Disorganized speech and behavior generally consists of speech and actions that do not make sense to outsiders but may make sense to the person with schizophrenia. Examples of disorganized speech include frequent derailment or incoherence and disorganized behavior may include things such as unusual dress, hygiene neglect, silly or even agitated and aggressive acts without provocation.
Catatonia, which is a severe impairment in a person’s movement, posture and responsiveness, is also a positive symptom of schizophrenia.
Negative Symptoms of Schizophrenia
The negative symptoms of schizophrenia include a decrease in emotional range, poverty of speech, and loss of interest or drive. A decrease in emotional range is often known as a flattened affect. This refers to little emotional expression or response. Poverty of speech is associated with alogia, which is impoverished thinking that occurs when a person’s speech is very limited in terms of content and spontaneity. A loss of interest or drive is associated with avolition, wherein a person cannot initiate or participate in any task which is goal-oriented. This often affects a person’s ability to perform daily tasks such as meal preparation or dressing him or herself.
Other Symptoms of Schizophrenia
There are also cognitive and mood symptoms of schizophrenia. Cognitive symptoms include neurocognitive deficits and a difficulty in understanding nuance and subtlety in interpersonal cues and relationships. Examples of neurocognitive deficits include impairments in working memory, attention, and executive function.
Mood symptoms in schizophrenia often include symptoms of depression. People with schizophrenia may also appear to be happy or sad in inappropriate situations.
Using Symptoms of Schizophrenia for Diagnosis
It’s worth noting that not all people with schizophrenia suffer from all symptoms and schizophrenia presents differently in different people. That being said, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the following as diagnostic criteria for schizophrenia:
• The person must have experienced at least two of the following:
o Disorganized speech
o Disorganized or catatonic behavior
o Negative symptoms
• At least one of these symptoms must be the presence of delusions, hallucinations, or disorganized speech.
• Continuous signs of schizophrenia must exist for at least six months, with at least one month of active symptoms, for diagnosis.
• Social or occupational impairment must also occur over a significant period of time.
Treating the Symptoms of Schizophrenia
The positive symptoms of schizophrenia are treated with antipsychotic medication. Two commonly used medications are aripiprazole (Abilify) and quetiapine (Seroquel). While the side effects from this type of medication can be challenging, positive symptom control is usually effective.
The negative symptoms of schizophrenia are much harder to treat but psychosocial treatment is considered beneficial and essential. The best-studied psychosocial treatments include:
• Cognitive behavioral therapy (CBT) to address emotional, mood, and drive symptoms
• Cognitive remediation to address cognitive deficits
• Social cognition training to address interpersonal relationship difficulties
The goals of psychosocial treatment are to enable the person with schizophrenia to perform daily activities such as managing his or her or own funds and medication, to avoid hospitalization, to have fewer or more stable symptoms, and to be in school or work at least half-time.
Schizophrenia, Medscape, accessed February 12, 2015 https://emedicine.medscape.com/article/288259-overview
Schizophrenic Symptoms, Schizophrenic.com, accessed February 12, 2015 https://www.schizophrenic.com/content/schizophrenia/symptoms/schizophrenia-symptoms