Schizophrenia-Negative Mode

Question.

What is going on inside the mind of an adult currently suffering from schizophrenia-negative mode?

Answer.

It is always hard to know what is truly “going on inside the mind” of any patient, particularly patients with psychotic disorders. I am also not quite sure what you mean by “schizophrenia-negative mode,” but I assume you are referring to the so-called deficit type of schizophrenia, in which primary “negative” symptoms predominate; e.g., lack of verbal output (alogia), lack of emotional responsiveness (affective flattening), lack of social connectedness, and apathy. (These are in contrast to so-called positive symptoms, such as hallucinations, delusions, and incoherent thinking.)

Carpenter and his colleagues at the Maryland Psychiatric Research Center have further distinguished negative symptoms due to “extraneous” factors (such as depression, prolonged institutionalization or medication side effects) from negative features that are enduring “core” features of schizophrenia–the so-called deficit form of schizophrenia. Deficit symptoms seem to be correlated with poor social and work function in this illness, and are present during and between episodes of positive symptoms.

Recent work by Buchanan et al (Arch Gen Psychiatry 51:804-811, 1994) suggests that the deficit form of schizophrenia is associated with greater impairment in executive functioning (e.g., carrying out complex tasks), visuo-spatial ability, and memory, when compared to the nondeficit form. Negative symptoms per se may coexist with positive symptoms, and both may respond to the newer atypical antipsychotics, such as clozapine and olanzapine. It is important to rule out “secondary” negative symptoms, due to side effects of antipsychotic medication or depression.

As to what is going on inside the mind of any given patient–the best way to find out is to ask. Often, the answers are very prosaic and “human”; e.g., “I’m bored,” or “I’m angry,” or “I don’t like this medicine.” Then again, many schizophrenic patients with pronounced negative features will simply not talk about their “voices” or other comorbid positive symptoms; these must be inferred by oberving the patient’s nonverbal behavior.