Schizophrenia’s Positive and Negative Symptoms

· May 3, 2019
Today we'll talk about schizophrenia's positive and negative symptoms. This mental illness is one of the most disabling and devastating.

Schizophrenia’s positive and negative symptoms make it one of the most devastating mental illnesses. Approximately 20 million people in the world suffer from it.

In order to diagnose a patient with schizophrenia, the DSM5 states that there must be two or more characteristic symptoms, each one of them for at least one month. These symptoms are:

  • Delusional ideas
  • Hallucinations
  • Disorganized speech
  • Catatonic or highly disorganized behavior

Schizophrenia’s positive and negative symptoms diagnosis

In order to get a diagnosis, the patient must be suffering in both social and work settings, in one or more important parts of their life. Furthermore, this alteration goes on for at least six months and this period might include prodrome and residual stages.

So, schizophrenia can be identified depending on its main symptoms. But this illness may present itself in two ways: one with positive symptoms and one with the negative symptoms.

In the first case, patients are able to recognize it because the symptoms are very striking and beautiful in a way. So for example, they have hallucinations, delusions or motor alterations: they’re all odd symptoms that the patient notices.

In the second case, negative symptoms go unnoticed because they’re not as “eye-catching”, but still make for a worse prognosis.

Patients who suffer the negative symptoms tend to be at greater risk of chronic schizophrenia, suicide, or substance abuse. Also, the effects are much more visible than in patients with positive symptoms. Let’s dive deeper into the two kinds of symptoms.

a woman who suffers from schizophrenia's positive and negative symptoms

Schizophrenia’s positive symptoms

The main positive symptoms associated with schizophrenia are the following:

Auditory hallucinations

They’re the most common type of hallucination, although the patient may also experience visual, somatic or even gustatory hallucinations.

This specific type appears in the form of voices that talk to the patient in various ways. The voices can be of any gender, familiar or unknown. Other sounds like music or snaps can occur, although less common. Sometimes, the patient prefers to hear voices that talk to each other about the patient’s personality.

Delusional ideas

Delusions are stories that the patient tells people with high conviction, without realizing that it’s the product of their own mind; the opposite of obsessive ideas, for instance. Changing a delusion is therefore impossible; as much as you try to convince them that what they’re saying is incoherent, they won’t change their minds.

Some types of delusions depending on their content are:

  • Delusions of control- This is when the patient believes an external force controls their thoughts or actions
  • Delusions of reference- This type of delusion is when they think anything that happens has to do with them; including grandiose, guilt, religious, jealousy delusions, etc.

Motor impairment

This is a sign of schizophrenia as a physical illness and it can also be associated with medication use, which causes akathisia, dyskinesia, and extrapyramidal side effects. These characteristics are what doctors call catatonic behavior.

Some of these motor impairment symptoms are:

  • Stupor, that leads the patient to isolate from the external world to the point of not talking
  • Inhibition or agitation
  • Catalepsy, or is the adoption of strange and stiff positions
  • Mannerisms or unnatural gestures
  • Stereotypy

Language Impairment

Usually, this means fluent speech but without any substance to it. An example of this is derailment or tangential speech, where the speech pattern goes from one idea to another completely unrelated one.

There’s also circumstantial speech, where the patient replies indirectly and with many details to stall the part of the message they want to convey. Neologisms (words invented by them) are also typical, as well as resonance or using words depending on their sound and not on their meaning.

Extravagant behavior

Some schizophrenic people may express this symptom in the way they dress, social and sexual behavior (like masturbating in public), talking to themselves out loud in public, and aggressive, agitated or repetitive behavior.

Negative symptoms

Negative symptoms, as we’ve mentioned so far, are not as “spectacular” as the positive ones, but still, they lead to a worse prognosis. If a patient has these symptoms, neuroleptics may not work.

They’re related to neuron dysfunction in the temporal lobe and the parahippocampal gyrusPlus, they’re more common in men, who actually tend to have a chronic and irreversible illness development. Some of these symptoms are:

Emotional blunting

Emotional blunting is a poor expression of emotions and feelings. This lack of affection is usually accompanied by a straight face, decreased movements or hand gestures, avoiding eye contact, effective inconsistency, and unresponsiveness, like smirking when talking about a serious topic, monotonous talking, etc.

Alogia

Slow, rigid and empty thinking and it shows in the patient’s speech quality. They take longer to reply when asked something.

Abulia and apathy

Abulia is the lack of interest or willpower to do something. Patients are therefore incapable of starting or finishing a task on their own. It can manifest in behavioral aspects such as hygiene, leaving projects unfinished, or not taking initiative.

Anhedonia is a lack of interest in social relationships. The schizophrenic patient with negative symptoms is often incapable of feeling pleasure and also avoids social relationships that could potentially give them gratification. So, there’s no interest whatsoever in sexuality, intimacy, or even leisure activities.

a man's profile that shows schizophrenia's positive and negative symptoms

Therapy and treatment

Pharmacotherapy is the most common treatment for schizophrenia. In fact, it’s been demonstrated that psychological treatment also improves antipsychotics’ effects. However, it’s important here to distinguish schizophrenia’s positive and negative symptoms in regards to treatment.

So, the issue is that medication works when the patient has positive symptoms since it blocks dopamine receptors, which reduces hallucinations and delusions.

On the other hand, it looks like medication not only doesn’t work when there are negative symptoms, but it can actually make them worse. So there’s still much more research to do in order to help those patients who suffer from schizophrenia’s negative symptoms.

  • Belloch, A., Sandín, B. y Ramos, F (2008). Manual de psicopatología. Volúmenes I y II. McGraw-Hill.Madrid
  • American Psychiatric Association (APA) (2014): Manual de Diagnóstico y Estadísitico de los Trastornos Mentales, DSM5. Editorial Médica Panamericana. Madrid.