Negative symptoms are “subtractions” from normal functions. They represent severely diminished or missing traits. Although most people think of delusions or auditory hallucinations when they think of schizophrenia, negative symptoms are just as much a part of the disease. In fact, three of the four negative symptoms discussed in this section are part of the definition of schizophrenia.
The Negative “A's”
Psychiatrists have four terms, all beginning with the letter “A,” that they use to describe negative symptoms:
Alogia refers to difficulty communicating; people with alo-gia don't speak much.
Affective flattening, also known as blunted affect, reflects a lack of emotional expression displayed by many people suffering from schizophrenia.
Avolition is a medical term used to describe the inability to form or initiate plans and to motivate oneself. It is pretty much the same as apathy.
Anhedonia describes an impaired ability to enjoy life and find pleasure in previously interesting activities. While it is not part of the definition of the disorder, it is an important associated feature of it.
Compared to the more obvious, attention-getting displays of psychotic symptoms, negative symptoms naturally took a backseat for doctors in the years after the first effective antipsychotic medications such as chlorpromazine were introduced into the practice of psychiatry. The introduction of antipsychotic drugs was welcomed by physicians, but progress in treating negative symptoms has lagged. In fact, there is still no drug specifically approved by the U.S. Food and Drug Administration for the treatment of these persistent and troubling symptoms of the disease. Newer antipsychotic drugs, however, do show some effectiveness in some patients.
Lack of Emotional Response
Schizophrenia can produce a lack of emotional response in some people. Their facial expressions don't vary and they appear uninterested in what is going on around them. Psychiatrists call this a blunted or flat affect. This behavior is accompanied by withdrawal from other people. People with schizophrenia commonly won't leave home, preferring instead to remain alone for long periods. When pressed, the person will have little or nothing to say, a condition psychiatrists call impoverished thought.
Examples of Negative Symptoms
Inability to enjoy books, music, celebrations, television, and hobbies
A blank facial expression
An inability to act, plan, and move toward a goal
A disinclination to speak or having nothing to say about anything
No interest in dating, attending parties, or socializing
Lack of response or reaction to emotional events
Speech is uninflected and delivered in a monotone. Not surprisingly, a person in such a state will display little or no ambition, motivation, or interests. In extreme cases, this lack of motivation can result in near complete inactivity that extends even to personal cleanliness.
Some medications may have cognitive side effects. Familiarize yourself with side effects of medications and discuss them with your doctor if you suspect that one or more medications are impairing thinking ability or speed. An adjustment in dosage or choice of medication may solve the problem.
Some patients may use invented words, or neologisms, in their speech. The unique words may mean something to the inventor, but listeners are rarely able to follow their meaning. Other patients may speak in rhyme (a speech pattern called clang) when answering questions or making statements. Still others repeat the same thing over and over, a symptom called perseveration.
Speaking to someone who is easily distracted and who apparently cannot distinguish relevant from irrelevant material is very disconcerting for people who do not understand the symptom. Consequently, the affected individual may be shunned by others. This obviously only adds to feelings of isolation.