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Schizophrenia: Negative Symptoms and Cognitive Deficits

Schizophrenia: Negative Symptoms and Cognitive Deficits

The experience of persons with schizophrenia often involves more than hallucinations (e.g., hearing voices that are not truly there) and delusions (false beliefs). Many persons with schizophrenia also experience “negative” or “deficit syndrome” symptoms such as avolition, affective flattening, and anergia. Avolition refers to a lack of social, work, and/or academic motivation. Schizophrenia patients often have great difficulty initiating and persisting in social relationships, work tasks, and academic activities. Affective flattening refers to the reduced facial expressions and expressive gestures often seen in persons with schizophrenia. The fans smile broadly and throw their fists in the air when the home football team scores, except for John. Although he might react somewhat, his affective expression is muted relative to those around him. Anergia refers to a lack of energy. Whereas others are engaged in mental, physical, or social activities during the significant majority of their waking hours, persons with schizophrenia are often engaged in such activities for just a few hours a day. Rather, persons with schizophrenia may be more likely to be sitting by themselves, watching a TV show they are not particularly engaged in, laying down, or napping.

Many persons with schizophrenia also experience deficits in their cognitive skills. Deficits in attention, verbal memory, and organizational skills are commonly observed. In fact, schizophrenia researchers have identified deficits in over 20 cognitive skills. These cognitive deficits have great relevance for the great social and work dysfunction that is characteristic of schizophrenia. Unable to focus on a conversation (attention) or remember what their social partner just said (verbal memory), persons with schizophrenia have difficulty conversing with others so as to build a friendship or resolve a work dispute. The organizational deficits often seen in persons with schizophrenia affect their ability to attend or be prompt for doctor appointments, classes, job interviews, and therapy groups.

Schizophrenia: Treatment Plan

Schizophrenia is often chronic and disabling. The pre-med student who had so much promise at age 19 has not worked, studied, or socialized like he did prior to the onset of his illness. What can be done to improve his functioning and reduce the probability of recurrent hospitalization?

  • Take medications as prescribed by your psychiatrist. The current antipsychotic medications reduce the frequency and functional impact of positive symptoms such as hallucinations and delusions.

  • See your psychiatrist and psychologist regularly. Promote strong relations with your psychiatrist and psychologist by seeing them at the frequency that they wish. Psychiatrists prescribe medications, monitor symptoms and medication side effects, adjust medications as needed, and facilitate hospitalization when need. When their symptoms are stable, persons with schizophrenia typically see their psychiatrist once every month or two. Psychologists help with everything else: psychoeducation (education about the illness, its course, etc), stress management, building social and interpersonal problem solving skills, symptom monitoring, facilitating good relations with family members, and improving motivation for socialization, work, and self-care.

  • Avoid street drugs. Street drugs de-stabilize the user’s brain chemistry. For persons with schizophrenia or persons with a genetic liability toward psychosis (a family history of schizophrenia), street drugs can initiate or intensify positive symptoms (hallucinations and delusions).

  • Manage your stress. Stress, whether due to family strife or work pressure, can lead to a worsening of symptoms and even hospitalization. Persons with schizophrenia can work or volunteer, but these activities should be at a rate that does not cause stress. Family and social relationships should involve good communication and positive expressions. Criticism or negativism toward the person with schizophrenia can cause stress, and potentially a worsening of symptoms and potentially hospitalization.

  • Be active. Be active socially. Healthy friendship and family relationships are essential to life satisfaction. Set aside time to socialize with the people in your life that care about you and make you feel good about yourself. Get physically active. Exercise promotes positive changes in brain chemistry, self image, and energy level. Make your exercise fun. We are more likely to persist in an exercise routine when we enjoy the activity or see it as “play”; playing basketball or soccer with friends is more enjoyable than walking alone.

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