Schizophrenia is a severe mental illness that is characterized by hallucinations, delusions, and paranoia. Although most people think of “hearing voices” and associate them with schizophrenia, those are just some of the symptoms. The symptoms experienced are divided into two subtypes including “negative” symptoms and “positive” symptoms.
Negative symptoms usually involve subtracting something from the person’s life such as emotion or happiness. In other words “negative” means absence of normal behavior or should be considered something the person “lacks.” Positive symptoms involve adding something to the person’s experience such as hallucinations, delusions, etc.
Even though most people know about positive symptoms that can be experienced, most experts agree that the negative symptoms have a greater impact on overall functioning and wellbeing. In other words it’s not the voices that necessarily cause the most difficulties for people with schizophrenia. It’s the social withdrawal, anhedonia, blunted emotion, and major depression that are most difficult to cope with.
Negative Symptoms of Schizophrenia
The PANSS or Positive and Negative Syndrome Scale is used to diagnose the severity of symptoms among individuals with schizophrenia. Below are some of the negative symptoms that individuals are evaluated upon with this scale as well as some others that you may want to keep in mind. Negative symptoms tend to be a major burden for individuals with schizophrenia because they reduce functional ability, quality of life, and motivation.
They have a profound cognitive effect as well and typically do not respond to medication. These symptoms typically involve reduced ability to socialize, stay motivated, engage in speech/conversation, and express emotion. This makes performing simple, every-day tasks a major struggle for people with this illness.
- Anhedonia: This is characterized by the inability to experience pleasure. The person with schizophrenia may find nothing in life pleasurable. No activity, no hobby, nothing. Since nothing seems pleasurable while experiencing anhedonia and other negative symptoms, their overall functioning may become extremely impaired.
- Apathy: The person may no longer care about anything or become apathetic. This is characterized by a “lack of emotion,” interest, and concern. In other words the person with schizophrenia may become indifferent to important aspects of life. This leads to neglect of social, emotional, physical, and cognitive aspects of life. There is a lack in overall sense of purpose and the person may appear very sluggish. This is also very common among individuals with dementia.
- Avolition: Inability to initiate work towards goal-oriented activities. As a result, this makes productivity on a job or at school very difficult. The person with schizophrenia may have zero interest or drive to participate in social activities for long periods of time. This is one of the 5 main negative symptoms of schizophrenia. This is different than anhedonia in the respect that individuals with avolition may want to complete a task, but they do not have even an ounce of motivation to finish it.
- Alogia (Poverty of Speech): A key negative symptom that psychiatrists look for to diagnose a person with schizophrenia is alogia. This is considered a form of aphasia, which is a form of impairment when it comes to speech-related functioning. This is often found among individuals with dementia as well as mental retardation. The person with schizophrenia is unable to come up with any material to contribute to conversation and they may not be able to respond to questions.
- Asociality: This specifically refers to lack of motivation to partake in social interactions accompanied by the preference for solitary activities. This is common among introverts and people with schizoid personality disorder. In schizophrenia, this symptom can makes the person want to avoid socialization.
- Blunted or Flat affect: The individual may lack emotions or experiencing what’s called a “flat affect.” This is essentially the inability to feel any emotion – they are blunted. Subtract all forms of emotion and they have no desire to do anything.
- Difficulty in abstract thinking: It may be difficult for the person with this illness to think with any degree of complexity. They may be able to think in very simple terms, but they will not be able to solve complex problems, plan ahead or organize their thoughts. This is likely due to functional deficits in the prefrontal cortex.
- Emotional withdrawal: The person with schizophrenia doesn’t share their emotions with others and doesn’t remain open about how they feel. They retreat and keep their emotions to themselves. This coincides with social withdrawal so basically the person no longer shares anything with the world.
- Flat expressions: The person may lack emotional expression which may be noticeable when they speak or are involved in a conversation. They may have an inexpressive face, appear dazed or boring, have a very flat or unemotional voice, and be unable to make eye contact. They may stare at you blankly while you are talking and not produce any sort of facial-emotional response to any outside stimuli.
- Lack of motivation: The individual may experience significant problems getting motivated to hold down a job, get dressed in the morning, or perform simple tasks. They may not take care of themselves and severely lack personal hygiene and forms of self-care. There is no enthusiasm or inspiration to fuel the person to take action in a certain direction.
- Lack of relationships: The person with schizophrenia may have no social ties or any sort of relationships. This is due to their impaired cognitive functioning, as well as poverty of speech, and lack of emotion. The totality of the negative symptoms makes it difficult for anyone to form relationships – even with family members.
- Lack of spontaneity: The individual with schizophrenia has a difficult time being spontaneous, especially in social conversations. If you discuss a certain topic with the person, they may not know how to adequately carry on a conversation that relates to what you were talking about. Similarly, they will be unable to transition or make connections to the topic.
- Poor rapport: The person is unable to create any sort of emotional bond or connection with another person. This is evidenced in conversation and lack of social connections.
- Social withdrawal: The person may experience passive or apathetic social withdrawal. They may not have any friends and completely withdraw from society. At a younger age before onset of the illness, they may have had friends. Schizophrenia causes individuals to completely withdraw from social functioning.
- Speech difficulties / abnormalities: The individual may not speak much, even if they are in a situation where they are forced to interact. They also may exhibit confusing speech or abnormal speech during a conversation.
- Stereotyped thinking: An individual with stereotyped thinking often has repetitive thoughts that interfere with their ability to think. The person holds certain beliefs that are unreasonable and could be excessive. Basically an individual may be able to talk about a certain topic, but will be unable to transition to talking about something new. Some people have their conversational ability limited to very few topics or their conversation seems highly repetitive.
- Unawareness of environment: The individual may be unaware of their current situation or environment. This results in a state of confusion and disorientation.
What causes the Negative Symptoms of Schizophrenia?
As a whole, researchers are still trying to figure out what causes schizophrenia, but they have been able to come up with some theories regarding the causes of negative symptoms. It is hypothesized that degeneration of the brain, circuitry dysfunction, and imbalances in neurotransmitter levels all play a role in leading to the negative symptoms. Many believe that too much dopamine can lead to the positive symptoms, and too little dopamine can lead to the negative symptoms.
Most of the primary negative symptoms are related to the core pathophysiology of this mental illness. However, there are secondary negative symptoms that can be caused by other mental illnesses, medications (atypical antipsychotics), as well as the environment. Antipsychotic medications have been shown to cause “blunted affect” or “akinesia.” Having something as simple as comorbid major depression can cause people to experience anhedonia, lack of motivation, unemotional speech, and social withdrawal.
It also has been established that poor environmental conditions can also lead to motivational deficits and social isolation. Therefore the environment that the person with schizophrenia is in could also influence symptoms. People that experience persistent negative symptoms for an extended period of time are said to have the “deficit syndrome.” People with deficit syndrome are said to have poorer overall cognition and outcomes compared to individuals who do not have this syndrome.
Treatment for Negative Symptoms of Schizophrenia
Although atypical antipsychotics do a great job at helping treat the positive symptoms of schizophrenia, some would argue that they don’t even treat the negative symptoms. Most medications reduce dopamine receptor activity, which in some cases can actually contribute to the worsening of negative symptoms.
- Antidepressants (SSRI’s): In some cases if depression is causing many of the negative symptoms, a psychiatrist may prescribe an SSRI or other antidepressant medication to augment an atypical antipsychotic. This has become pretty common practice for individuals experiencing overwhelming negative symptoms.
- Changing antipsychotics: Although most antipsychotics don’t target negative symptoms, some can actually make them worse. In some cases, a simple switch of antipsychotic medication may significantly reduce negative symptoms that a person is experiencing.
- Cognitive Enhancement Therapy (CET): This is an evidence-based treatment option that works towards improving a patient’s cognitive functioning through computer exercises and group meetings. The aim of this type of treatment is to improve cognitive functioning and essentially target areas in which the person is “lacking” to improve symptoms.
- Environmental changes: In many people, making necessary environmental changes can help improve negative symptoms. It helps if the person has social contact and a support network in their immediate environment. A therapist could help a person with schizophrenia make some necessary changes to better cope with their symptoms and create a constructive environment.
- Natural remedies: A person with this illness may want to try some natural remedies for schizophrenia as a treatment augmentation to determine if they help with negative symptoms. Various natural remedies can be very effective at improving symptoms when used with an antipsychotic.
- Psychosocial treatment: This may involve seeing a therapist or attending a rehabilitation clinic for individuals with schizophrenia and/or other mental illnesses. This will help people with the condition to learn how to cope with symptoms, stay on course with treatment, and could even teach them how to hold down a job or stay productive members of society.
- Physical exercise: Getting some form of physical exercise a few times a week can help boost cognitive function and mental performance. I already highlighted this in the article “Psychological Benefits of Exercise.” Many people think that exercise helps all form of mental illness, including schizophrenia.