Positive negative and cognitive symptoms of schizophrenia

Schizophrenia is a severe mental illness that affects how you think, feel, and act. It’s a chronic condition that can also have a powerful effect on loved ones.

The disorder is characterized by positive, negative, and cognitive symptoms:

• Positive symptoms: The presence of symptoms most people don’t have, such as exaggerated perceptions and ideas. Hallucinations and delusions can be so vivid that they impair a person’s ability to know what’s real and what’s not, negatively impacting their ability to care for themselves. This is sometimes called a “psychotic break.”
• Negative symptoms: The absence of things present in most people. This includes things such as facial expressions, emotional response, and interest in the world.
• Cognitive symptoms: Difficulties with concentration, working memory, and decision making.

Let’s take a closer look at the negative symptoms of schizophrenia, how to spot them, and how they’re treated.

There are two types of negative symptoms. Differentiating between the two can be a challenge.

Primary negative symptoms refer to those that are part of the disorder itself. These can occur during or between exacerbations.

Secondary negative symptoms refer to those due to other things, such as:

• medication
• withdrawal from medication
• substance use
• hospitalization
• isolation
• personality disorders
• depression

Negative symptoms can be more persistent than positive ones.

When it comes to negative symptoms of schizophrenia, there’s often more than meets the eye. For example, lack of facial or verbal expression doesn’t always mean lack of feeling. True emotional state may be masked by negative symptoms.

People with schizophrenia tend to have bouts of severe symptoms followed by remissions. But some symptoms may always be present to a certain degree.

Negative mental symptoms

• a seeming lack of interest in the world
• not wanting to interact with other people (social withdrawal)
• an inability to feel or express pleasure (anhedonia)
• an inability to act spontaneously
• decreased sense of purpose
• lack of motivation (avolition)
• not talking much
• difficulty speaking due to disorganized thinking (alogia)

Negative physical symptoms

• an inexpressive or blank face (flat affect)
• monotone or monosyllabic speech
• lack of gesturing when communicating
• lack of eye contact
• physical inactivity

Negative symptoms can be hard to recognize as symptoms of schizophrenia. Here are some examples of how a person with negative symptoms might behave:

• spending the day sitting or lying around (may have a hard time coming up with something to do and will be fairly unproductive)
• not sleeping
• not eating well
• neglecting personal hygiene
• lacking meaningful communication
• little to no eye contact, facial expression, or gestures
• unable to respond to questions or follow instructions
• appearing apathetic in a situation where most people would express emotion
• showing ambivalence when asked to make a decision
• social withdrawal and self-imposed isolation

Simply put, positive symptoms are those that are added. They differ from those of most people.

Positive symptoms of schizophrenia include:

• delusions, false beliefs with no basis in fact
• hallucinations, seeing or hearing things that don’t actually exist
• psychosis, a break with reality
• agitated body movements
• disorganized and dysfunctional thinking that shows itself in strange speech patterns
• bizarre ideas and plans
• inappropriate emotions for the situation

Positive symptoms are more apparent, so they’re likely to prompt diagnosis and treatment.

On the other end of the spectrum, negative symptoms mean something is missing. That makes them easier to overlook as being linked to schizophrenia.

Schizophrenia means you’ll always need mental healthcare. Treatment is typically managed by a mental health professional such as a psychiatrist or psychiatric nurse practitioner.

Positive symptoms are treated with antipsychotic drugs. These medications can effectively address positive symptoms. Most have little effect on negative ones.

Negative symptoms can have a profound effect on quality of life. They can also affect your ability to live independently. In this respect, they may have greater impact than positive symptoms. They’re also more difficult to treat.

Secondary negative symptoms may be easier to treat than primary ones.

Medications

Sometimes, secondary negative symptoms are a side effect of certain medications. In that case, a doctor can change the dosage or prescribe an alternative drug. You’ll be monitored to make sure positive symptoms aren’t getting worse. It may take a few adjustments before you see improvement.

Secondary negative symptoms caused by depression can sometimes be treated with antidepressants. Some people have more success with this treatment than others.

More studies are needed to learn which medications can target primary negative symptoms.

There’s some research to suggest that the antipsychotic drugs cariprazine (Vraylar) and amisulpride may help improve primary negative symptoms.

Your doctor will take all your symptoms into account when choosing medication to manage schizophrenia. Periodic adjustments will likely be needed.

Therapy

Therapy can help you manage negative symptoms of schizophrenia.

Therapy will probably be in addition to drug treatment for positive symptoms. Your doctor will recommend a particular type of therapy based on your needs. Some of these are:

• individual therapy
• group therapy
• family and marriage therapy

Within these frameworks, your therapist can guide you in:

• behavioral therapy
• social skills training
• vocational support
• family education

Lifestyle

With any treatment plan, it’s important to focus on your goals. Certain lifestyle choices can also help.

Avoiding harmful substances is a must. Alcohol, non-prescribed drugs, and nicotine can interfere with treatment. If you have trouble quitting, your doctor can recommend a cessation program.

Stress can aggravate symptoms. You can’t completely eliminate stress, but you can learn to manage it. Try some relaxation and stress management techniques such as:

• meditation
• deep breathing
• yoga
• tai chi

In general, it pays to take care of your overall health by:

• maintaining a healthy, balanced diet
• asking your doctor if you should take any dietary supplements
• engaging in regular exercise
• making sure you get adequate sleep
• talking to your doctor about complementary and alternative treatments
• adhering to your overall treatment plan
• reporting new or worsening symptoms

If you have some of the negative symptoms described, it doesn’t necessarily mean that you have schizophrenia. These symptoms could be due to a variety of other causes.

The only way to know for certain is to see a doctor as quickly as possible.

Making a diagnosis requires ruling out other causes, such as:

• medication
• substance use
• medical conditions
• other mental health disorders

This may include:

• a physical examination
• a drug and alcohol screening
• brain imaging studies, such as CT scan or MRI
• a psychiatric evaluation

Schizophrenia is a serious illness. Negative symptoms can affect every aspect of your life. Without treatment, symptoms will likely worsen and make it difficult to live independently. But there are ways to help manage the condition.

If you’re already being treated for schizophrenia and your symptoms aren’t getting better, talk to your doctor or seek a second opinion.

Negative symptoms can be difficult to spot in a doctor’s visit. That’s why it’s so important to discuss all your symptoms. It might help to describe a typical day in your life.

If you or someone you care about has schizophrenia, it will help to learn all you can about the disorder.

Ask your doctor where you can find educational materials and support services. Here are some additional resources:

• The American Psychiatric Association has a searchable database so you can find a psychiatrist in your community.
• The National Alliance on Mental Illness (NAMI) provides a searchable database of local chapters and family support groups. You can also call the Helpline at 800-950-NAMI or text “NAMI” to 741741.
• The Substance Abuse and Mental Health Services Association (SAMHSA) has a 24/7 National Helpline for individuals and families dealing with mental or substance use disorders. Call 1-800-662-4357 for information.
• Ask your local hospital about social services assistance.

Negative symptoms of schizophrenia are those involving the absence of something common to most people. This can include lack of communication, social interaction, and motivation.

Though less obvious than positive symptoms like hallucination and delusions, negative symptoms can be just as hard to cope with.

Treating negative symptoms is a challenge. But with a combination of drug therapy and psychotherapy, schizophrenia can be managed. It’s important to keep your doctor updated as symptoms change.

Following your treatment plan is crucial to your quality of life.