Negative Symptoms of Schizophrenia

Negative Symptoms of Schizophrenia Schizophrenia Print Negative Symptoms in Schizophrenia By Adrian Preda, MD Medically reviewed by Medically reviewed by Steven Gans, MD on July 22, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on January 31, 2020 Schizophrenia Overview Symptoms & Diagnosis Causes & Risk Factors Treatment Living With In Children Verywell / Cindy Chung In This Article Table of Contents Expand Causes Types Diagnosis Treatment View All People with schizophrenia can experience both positive and negative symptoms. This doesnt mean that there are good versus bad symptoms. Positive symptoms are behaviors that appear in surplus in people with schizophrenia and are typically not found in otherwise healthy individuals. Positive symptoms, which include delusions, hallucinations, disorganized thoughts, and disorganized speech, can cause you or someone you love to lose touch with reality. Negative schizophrenia refers to the symptoms that are lacking or decreased in people with schizophrenia. As negative symptoms indicate deficits in functioning they are also called deficit symptoms. Negative symptoms, including lack of emotion, decreased joy or motivation, delayed speech, and difficulty beginning and sustaining activities, can be scary and extremely debilitating. If you or someone you love is struggling with negative symptoms, you may need help in order to complete daily tasks. Causes The cause of negative symptoms is not clear. While some studies say these deficits run in families, there is no known genetic association for negative symptoms or deficit schizophrenia. Interestingly, while winter birth increases the risk for schizophrenia, people with schizophrenia born in the summer appear to be at higher risk for negative symptoms. Causes and Risk Factors of Schizophrenia Types The first step in managing the negative symptoms of schizophrenia is to understand the different types, which typically have one of four defining features: Affective deficits: lack of facial expression, eye contact, gestures, and variations in voice patternCommunicative deficits: speech lacking in quantity or informationRelational deficits: lack of interest in social activities and relationshipsAvolition deficits: severe lack of motivation or initiative to accomplish purposeful tasks (also called conational). Since negative symptoms can include deficits in cognitive, emotional, and socio-abilities, there can be a large number of potential symptoms. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes negative symptoms as “restricted emotional expression and avolition,” and includes the following five types. Understanding Avolition Blunted Affect This limits a persons ability to convey his or her emotions, causing diminished facial and emotional expressions. A blunted affect is less severe than flat affect, in which a person has an extremely limited range of emotions; for instance, not even being able to crack a smile or laugh during a time of great joy. People can mistake blunted affect as someone being cold or unfeeling. Alogia Defined in DSM-5 as a decrease in verbal output or verbal expressiveness, alogia (also known as poverty of speech) can make it nearly impossible to communicate your thoughts and carry on a conversation. People with alogia may answer a monosyllabic yes or no when responding to questions and/or experience delays in getting the words out. It should be noted that these speech delays are not the same as those caused by positive symptoms like auditory or visual hallucinations and disorganized thinking. Asociality Other terms used to describe asociality are nonsocial, unsocial, social disinterest or a lack of social drive. Asociality causes a lack of involvement in social relationships or increased desire to spend time alone. This is different than a person who isolates him or herself after hearing voices or experiencing feelings of paranoia. Avolition Avolition is a form of emotional or behavioral paralysis that can diminish your drive to participate in social activities and meet goals as well as your ability to complete daily tasks. Many people mistake this negative symptom for laziness but, in the case of schizophrenia, avolition causes a pervasive lack of enthusiasm coupled with a striking lack of concern for both minor and major matters (e.g., what is to eat, how the bills will get paid, what will happen when the family will no longer be around for support). This can even carry over into basic activities like personal hygiene and grooming. Anhedonia In Greek, an means without and hedone means pleasure, so in simple terms, anhedonia is a state where you are unable to feel pleasure. For people with schizophrenia, this can mean a lack of enthusiasm for activities, hobbies, passions, and pleasures once enjoyed. Diagnosing Negative Symptoms Negative symptoms are not always easy to recognize and can be mistaken for depression as well as other mental illnesses. Whats more, they may come and go during the course of schizophrenia. Often times, people with schizophrenia might have one negative symptom in addition to the more commonly observed positive symptoms. At times, some of the medications prescribed for the treatment of schizophrenia, such as the first generation or typical  antipsychotics, also known as neuroleptics, have adverse effects such as decreased interest or decreased emotional response. Since these symptoms are due to the medications, they are called  secondary  negative symptoms. What Is Deficit Schizophrenia? Deficit schizophrenia, which is not synonymous with  deficit  symptoms or negative symptoms, is diagnosed when patients have:At least two  out of the six negative symptomsThe symptoms are persistent, or present for at least one year, and the patient experiences them even during times of clinical stabilityThe symptoms are primary, or not due to other causes like medication or other conditions People with deficit schizophrenia have a poorer response to treatment, social and occupational functioning, and overall quality of life than people with non-deficit schizophrenia. Treatment Treating negative symptoms is tricky due to the very nature of the negative symptoms; someone experiencing a lack of motivation, enthusiasm, or desire to be social, for instance, may be hesitant to seek and stick with treatment. In addition, the drugs used to treat positive symptoms of schizophrenia can increase secondary negative symptoms and do not work on primary and persistent negative symptoms. This is why effective treatment ideally includes a combination of drugs, therapy, and support. How Schizophrenia Is Treated Antipsychotics Antipsychotic medications (Haldol (haloperidol) and Thorazine (chlorpromazine), which are the first-line treatment for the positive symptoms of schizophrenia, such as hallucinations and delusions, are not effective in treating negative symptoms, such as lack of emotion, motivation, or interest in social activities. While effective against positive symptoms,  first-generation or typical  antipsychotics  have a number of neurological adverse effects, such as parkinsonism (when medications cause symptoms similar to Parkinsons disease), that can increase secondary negative symptoms. These drugs, also known as  neuroleptics  or major tranquilizers,  can help treat negative symptoms that are  secondary  to positive symptoms. For example, people can be socially isolated due to paranoid beliefs or voices commanding them not to leave their home. In such cases, antipsychotics that decrease paranoia and auditory hallucinations (hearing voices or sounds) will improve social affiliation. Atypical Antipsychotics If you are still experiencing side effects of antipsychotics, even after your health care provider has adjusted your dose, he or she may switch you to a newer class of medication referred to as second-generation or atypical  antipsychotics. There are many different atypical antipsychotics used to treat schizophrenia, including: Abilify (aripiprazole)Clozaril (clozapine)Geodon (ziprasidone)Invega (paliperidone) Antidepressant While it is by no means a cure, combining antipsychotics with antidepressants has been shown more effective than taking antipsychotics alone. Antidepressants work by increasing the availability of one or several of the following neurotransmitters: serotonin (mood, appetite, sleep, memory, social behavior, sexual desire), norepinephrine (alertness and motor function), dopamine (decision-making, motivation, signaling of pleasure and reward).   The 5 Major Classes of Antidepressants Psychosocial Interventions Psychosocial interventions, including behavioral therapy, support therapy, and family psychoeducation, aim to change a persons behaviors toward a more healthy interaction with society. These therapies can provide people with persistent negative systems as well as their families with tools to identify and cope with deficits in cognitive and emotional functioning and social skills. Find Support With the 9 Best Online Therapy Programs Supportive Therapy Supportive therapy provides an opportunity for companionship, non-judgmental validation, common sense advice, and reassurance from a trained therapist. Often, your therapist will step in on your behalf to facilitate communication with family members as well as authorities like schools and social agencies. Behavioral Therapy Behavioral therapy, including social skills training and cognitive-behavioral therapy (CBT), can teach you to recognize and engage in behaviors and activities that will improve the quality of life and day-to-day living. For example, during social skills training you will be taught how to express feelings and needs, ask questions, and control voice,  body, and facial expressions. CBT can teach you or someone you love to identify and change the deficits that have a negative influence on behavior and emotions. How Behavioral Therapy Is Used in Psychology Family Psychoeducation Family support plays a key role in the treatment of negative symptoms. Psychoeducation  for patients and families is helpful in decreasing stigma and improving opportunities for ongoing social engagement. It can also offer families effective strategies for communicating and coping with a loved one with schizophrenia. A Word From Verywell The negative symptoms of schizophrenia can cause severe disruptions in daily functioning, relationships, work, school, hobbies, and leisure activities. With an appropriate diagnosis, treatment, and support, you or someone you love can find relief from these symptoms and discover ways to cope effectively.