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Negative Symptoms

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Douglas Davidson

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Negative symptoms  Consist of behavioural deficits, such as avolition, alogia, anhedonia, flat affect, and asociliaty  These symptoms tend to endure beyond an acute episode and have profound effects on the lives of patients with s. they are also imp as the presence of many negative symp is a strong predictor of a poor quality of life two years following hospitalization  Some evidence that negative symp are associated with earlier onset brain damage (enlarged ventricles) and progressive loss of cognitive skills (IQ decline)  Ex; flat effect (lack of emotional expressiveness) can be a side effect of antipsychotic medication  Observing patients over extended periods of time negative symp such as flat affect and anhedonia are difficult to distinguish from aspects of depression so specifity becomes an issue Avolition  apathy or avoliytion referred to lack of energy and a seeming absence of interest in or an inability to persist in what are usually routine activities.  Patients may become inattentive to grooming and personal hygiene  They have difficulty persisting at work, school or household chores and may spend much of their time sitting around doing noting Alogia  A negative thought disorder, alogia can take several forms. In poverty of speech, the sheer amount of speech is greaydly reduced.  In poverty of content of speech the amount if discourse is adequate but it conveys little info and tends to be vague and repetitive Anhedonia  An inability to experience pleasure. its manifested as a lack of interest in recreational activities, failure to develop close relationships with other ppl and lack of interest in sex. Patents are aware of this symp and report that normally pleasurable activities are not enjoyable for them Flat affect  Virtually no stimulus can elicit an emotional response. The patient may stare vacantly, the muscles of the face flaccid, the eyes lifeless  When spoken to the patient answers in a flat and toneless voice.  Flat affect was found in 66% of a large sample of patients with s  The concept of flat affect refers only to the outward expression of emotion and not to the patients inner experience which may not be improvishered at all  While the patients were much less facially expressive than were the non patients they reported about the same amount of emotion and were even more physiologically aroused asociality  Some have severely impaired social relationships  They have few friends, poor social skills, and little interest in being with other ppl  Ppl diagnosed with s have lower socialability and greater shyness  Ppl with s also reported more childhood social troubles  These manifestations of s are often the first to appear beginning in childhood before the onset of more psychotic symp  Confirmed that ppl with s did less well on facial affect recognition and facial recognition tasks  These deficits persisted and were evident when the patients were reassessed three moths later even though there were substantial improvements in the # of both positive and negative symp since initial hospitalization Other symptoms  One problem is that the positive and negative symp do not necessarily reflect exclusive subtypes cyz they are dimensions that often coexist within the same patient.  Moreover several other symp of s do not fit neatly into the positive negative scheme. Two important symp in this category are catatonia and inappropriate affect. Many patients also exhibit various forms of bizarre beh. They may talk to themselves in public, hoard food or collect garbage Catatonia  Several motor abnormalities. Some patients gesture repeatedly, using peculiar and sometimes complex
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