Positive and negative symptoms of schizophrenia

Schizophrenia is one of the most devastating diseases that exist. It is estimated that approximately 20 million people in the world suffer from it. In order to diagnose someone with schizophrenia, the DSM5 tells us that they must be given two or more characteristic symptoms, each for a significant part of at least one month.

These symptoms are: delusional ideas, hallucinations, disorganized language, catatonic or severely disorganized behavior and negative symptoms such as affective flattening or alogia, which we will explain later.

For him diagnosis it is necessary that the patient sees his socio-occupational situation affected in one or more important areas of his life. Furthermore, lThe alteration persists continuously for at least 6 months and this period may include the prodromal and residual phases.

On the other hand, Schizophrenia can be distinguished based on its predominant symptoms. Thus, we can divide the disease into those cases that present positive symptoms and those that present negative symptoms. In the first case, patients recognize themselves because the symptoms are very striking or flowery. We can include here hallucinations, delusions or motor alterations. These are rare symptoms that attract attention.

On the other hand, negative symptoms are those that go unnoticed because they are not so extravagant or striking, but nevertheless, they have a worse prognosis.

Those patients affected by negative symptoms usually have a greater risk of chronicity, suicide or substance abuse.. Furthermore, the deterioration at all levels is much more marked than in patients with positive symptoms. We move on to explain the positive and negative symptoms of schizophrenia.

Positive symptoms

The main positive symptoms associated with schizophrenia are the following:

auditory hallucinations. They are the most common type of hallucination, although visual, somatic or even gustatory hallucinations may also exist. Usually These are voices that speak to the patient or call him in various ways.. The voices can be male, female, familiar or unknown. Less characteristics than voices would be acoasmas; that is, noises like music or clicking. On some occasions, the patient reports hearing voices talking to each other, commenting on something about him.delusional ideas. Delusions are stories that the patient comments with great conviction without being able to become aware that they are a product of his own mind; contrary to what would happen with obsessive ideas, for example. Modification of delirium, therefore, is almost impossibleno matter how much we try to convince the person that what they are saying lacks logic or coherence.

Motor disorders. Motor impairment, apart from being a symptom of schizophrenia as a disease, can also be associated with the use of medication. This produces akathisia or motor restlessness, dyskinesia and extrapyramidal symptoms. They are characteristics of catatonic type schizophrenia. Some of these motor symptoms are: stupor, isolating the patient from the outside world and may even lead to mutism. Inhibition or motor agitation, catalepsy through which the patient acquires rigid and strange postures, mannerisms – caricature-like gestures with a lack of naturalness – or motor stereotypies.Language alterations. They tend to be fluent speeches but poor in content. Examples include derailment or loose associations in which the speech pattern consists of ideas going off course, moving on to another unrelated idea. We can also find the circumstantiality, with which the patient responds indirectly and full of details, thus delaying the part of the message you really want to convey. The neologisms -words invented by the person- are also typical, as is resonance or speaking with words chosen based on their sound and not their meaning.Extravagant behavior. Schizophrenic patients may manifest this symptom in relation to clothing – wearing a corduroy coat in the middle of summer -, social and sexual behavior – masturbating in public, talking loudly to oneself in the street -, aggressive or agitated behavior or with repetitive behaviors.

Negative symptoms

The negative symptoms, as we have said, are not as spectacular or attractive as the positive ones, but they nevertheless have a worse prognosis. With these symptoms, neuroleptics are not effective. They are related to neuronal losses in the temporal lobe and parahippocampal gyrus. They are more common in men and normally have a chronic and irreversible course. Some of these symptoms are:

dulled affect. There is a characteristic impoverishment of the expression of emotions and feelings. This emotional poverty is manifested in: immutable facial expression – wooden or frozen face, without expression -, diminished movements or lack of gestures, little eye contact, emotional incongruity and absence of response – “stupid smile” while talking about a serious topic – and absence of vocal inflections – monotonous speech, without changes in tone or volume.Alogia. Thought is empty, rigid and slow. We infer this from the quality of the language when expressed. The answers have a longer duration and take longer to respond to what is asked. When they do, the content is poor.Abulia and apathy. Avolition is the lack of interest or will to do something. Patients are unable to initiate or complete different tasks on their own. It can manifest itself in behavioral aspects, such as hygiene, abandonment of projects or lack of initiative.Anhedonia and withdrawal in social relationships. The schizophrenic patient with negative symptoms is in many cases unable to experience pleasure, in addition to avoiding social relationships that could give him that gratification. In this sense, there is no interest in sexual topics, intimacy or proximity with others or in recreational activities.

Pharmacotherapy is currently the treatment of choice for schizophrenia. Furthermore, it has been proven that added psychological treatment improves the effectiveness of antipsychotics.

The problem is that heThe drugs are effective when the patient has positive symptoms, as they act by blocking dopaminergic receptors. D2 and thus inhibiting its activity, which attenuates hallucinations and/or delusions. On the other hand, it seems that drugs not only do not improve negative symptoms, but in some cases they can worsen them. Therefore, more research is necessary in this regard.

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