A brief introduction to schizophrenia: Positive and Negative symptoms
Schizophrenia is a disorder characterised by an array of diverse symptoms including extreme addities in perception, thinking, action, sense of self, manner of relating to others and a significant loss of contact with the reality referred to as "psychosis".
The clinical picture of schizophrenia
The clinical presentation of schizophrenia differs from one patient to another. Some of the symptoms of schizophrenia are as follows:
1. Delusions: A delusion is essentially an erroneous belief that is fixed and firmly held despite clear contradictory evidence. A delusion involves a disturbance in the content of thought.
2. Hallucinations: A hallucination is a sensory experience that seems real to the person having it, but occurs in the absence of any external perceptual stimulus (it is different from illusion, which is a misperception of a stimulus that actually exists).
3. Disorganized speech and behaviour: Disorganized speech is the external manifestation of a disorder in thought-form. And affected person fails to make sense, despite seeming to confirm the semantic and syntactic rules governing verbal communication. In some cases, completely new, made-up words known as neurologists appear in the patients' speech.
Formal thought disorder is a term clinicians use to refer to the problems in the way that disorganised thought is expressed in disorganized speech.
4. Catatonia: A patient with catatonia may show a virtual absence of all movement and speech and be in what is called a catatonic stupor. At other times a patient may hold an unusual posture for an extended period of time without any seeming discomfort.
POSITIVE AND NEGATIVE SYMPTOMS OF SCHIZOPHRENIA
Two general symptom patterns or syndrome of schizophrenia have been differentiated- positive and negative syndrome. A disorganized symptom pattern is now also recognised.
Positive symptoms are those symptoms that reflect an excess or distortion in a normal repertoire of behaviour and experience.
One positive symptom of schizophrenia is the presence of delusions, or beliefs that are not based in fact.
Persecutory (or paranoid) delusions are the most common- the belief that someone is harming or attempting to harm the person. Other delusions are- delusions of influence (beliefs that behaviour or thoughts are controlled by others), the delusion of self significance- this involves delusion of grandeur (believing that they are famous, rich, talented), the delusion of reference (believing the behaviour of others is directed at the individual) or believe that a person is a special agent/individual. Somatic delusion is the belief that one's body is rotting away.
The second type of positive symptom is hallucinations. Types of hallucination are- auditory (noises or voices perhaps speaking to or about the person), visual (visions of religious figures or dead people), olfactory (smells), gustatory (taste), somatic (feelings of pain or deterioration of parts of one's body or feeling that things are crawling on, or are in the skin or the body).
Another positive symptom is an abnormality of speech, if not treated may lead to cognitive deterioration. Cognitive deterioration includes loose associations- a thought that has little or no logical connection to the next thought. Another symptom is thought blocking- an unusually long pause or pauses in a patient's speech that occurs during a conversation. A third symptom is clang association- a condition in which a person's speech is governed by words that sound alike rather than words that have meaning, rendering communication meaningless.
Another positive symptom is catatonia- a condition in which a person is awake but is non-responsive to external stimulation. One more positive symptom is waxy flexibility- a condition in which parts of the body (usually the arms) remain frozen in a particular posture when positioned that way by another person.
A second symptom category necessary for the diagnosis of schizophrenia is the negative symptoms. Negative symptoms are behaviours, emotions, or thought processes (cognitions) that exist in people without a psychiatric disorder but are absent (or are substantially diminished) in people with schizophrenia.
Common negative symptoms are:
- Blunted affect/emotional flattening: A condition characterised by diminished or immobile facial expressions and a flat, monotonic vocal tone that does not change even when the topic of conversation becomes emotionally laden.
- Anhedonia: The lack of capability for pleasure, a condition in which a person does not feel joy or happiness.
- Avolition: The inability to initiate or follow through on plans.
- Alogia/ poverty of speech: The decreased quality or quantity of speech.
- Psychomotor retardation: A condition in which a person has slowed mental or physical activities.
The third main category of symptoms among people with schizophrenia is cognitive impairment- the diminishment in visual and verbal learning and memory, inability to pay attention, decrease in the speed of information processing, and inability to engage in abstract reasoning, any or all of which may be found in different psychotic disorders. In addition to general cognitive impairment, people with schizophrenia have a deficit in social cognition.
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- Abnormal psychology- Beidel, Bulik, Stanley
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- Synopsis of Psychiatry- Kaplan and Sadock