Negative Symptoms

In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), the terms “negative symptoms” and “positive symptoms” are primarily used in the context of schizophrenia and related psychotic disorders. These terms describe two different categories of symptoms, each with distinct characteristics.

Negative Symptoms:
Negative symptoms refer to a reduction or absence of normal functions. They include:

1. Affective Flattening: Reduced emotional expressiveness, including facial expressions, voice tone, and gestures.
2. Alogia: Poverty of speech, characterised by a reduction in the amount or content of speech.
3. Avolition: Decreased motivation to initiate and perform purposeful activities.
4. Anhedonia: Diminished capacity to experience pleasure.
5. Asociality: Reduced interest in social interactions.

Positive Symptoms:
Positive symptoms involve the presence of abnormal behaviours or experiences. These include:

1. Delusions: Fixed false beliefs that are not amenable to change in light of conflicting evidence.
2. Hallucinations: Perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.
3. Disorganised Speech: This may include frequent derailment or incoherence, typically known as “word salad.”
4. Grossly Disorganised or Catatonic Behaviour: This can manifest as markedly disorganised behaviour, catatonia, or inability to perform daily activities.

Distinction Between Negative and Positive Symptoms:

Nature of Symptoms:

• Negative Symptoms: Represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. They are often chronic and persist across time.

• Positive Symptoms: Represent an excess or distortion of normal functions, including additional thoughts and perceptions like hallucinations and delusions. These symptoms can be episodic and often fluctuate in intensity.

Impact on Functioning:

• Negative Symptoms: Often have a more enduring and debilitating effect on a person’s ability to function in day-to-day life, particularly in social and occupational realms.

• Positive Symptoms: While they can be very disruptive and distressing, they are often more responsive to medication and can be transient.

Response to Treatment:

• Negative Symptoms: Tend to be less responsive to antipsychotic medications and pose significant challenges in treatment.

• Positive Symptoms: Often more responsive to antipsychotic drugs, which can reduce their severity or eliminate them.

Understanding the distinction between negative and positive symptoms is crucial for the effective treatment and management of schizophrenia and related disorders. It helps in tailoring individualised treatment plans that address both sets of symptoms and their impacts on the individual’s life.