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UNIT 3 ■ Care of Patients With Psychiatric Disorders
BOX 15–2 Positive and Negative Symptoms of Schizophrenia*
POSITIVE SYMPTOMS Delusions (Fixed, False Beliefs) (examples) Persecutory—belief that one is going to be harmed by other(s) Referential—belief that cues in the environment are specifi- cally referring to them Grandiose—belief that they have exceptional greatness Somatic—beliefs that center on one’s body functioning Hallucinations (Sensory Perceptions Without External Stimuli) Auditory (most common in schizophrenia)
Hostility Agitation Childlike silliness
Catatonia (ranging from rigid or bizarre posture and decreased responsivity to complete lack of verbal or behavioral response to the environment) Catatonic excitement (excessive and purposeless motor activity) Stereotyped, repetitive movements Unusual mannerisms or postures NEGATIVE SYMPTOMS Lack of Emotional Expression Blunted affect Lack of movement in head and hands that adds expression in communication Lack of intonation in speech Decreased or Lack of Motivation to Complete Purposeful Activities (Avolition) Neglect of activities of daily living Decreased Verbal Communication (Alogia ) Decreased Interest in Social Interaction and Relationship (Asociality) Withdrawal Poor rapport Diminished Ability for Abstract Thinking Concrete interpretation of events and communication from others
Visual Tactile
Olfactory Gustatory (NOTE: Hallucinations may be a normal part of religious experience in some cultural contexts.) Disorganized Thinking (Manifested in Speech) Loose association Tangentiality Circumstantiality Incoherence (includes word salad) Neologisms Clang associations Echolalia Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia) Hyperactivity Hypervigilance
*Positive symptoms refer to symptoms that are present (“added”) in people with schizophrenia and not typically present in people without the disease. Negative symptoms are referred to as deficits or impairments (things “taken away” by the illness) in individuals with schizophrenia. Sources: Compiled from APA (2022); Kay et al. (1987).
for this illness. Okazaki and associates (2016) stud- ied gene expression in peripheral blood samples of patients admitted with acute psychosis and found that a specific combination of genes ( CDK4, MCM7 , and POLD 4 ) differentiated these patients from controls. This finding suggests that the combination could be a genetic biomarker for schizophrenia and may also influence certain pathophysiological aspects of schizophrenia. The authors conclude that messen- ger ribonucleic acid (mRNA) expression changes occurring in CDK4 are potentially biomarkers for
both trait (stable features) and state (temporary changes) symptoms in schizophrenia. The strongest genetic associations to date have been variations in the major histocompatibility complex (MHC), particularly C4 alleles that are involved in synaptic pruning that occurs during adolescence and young adulthood (Boland & Verduin, 2022). Research is ongoing to identify genetic influences in schizophre- nia that will hone our understanding of the multi- variate influences in the development of this disease and perhaps identify treatment implications.
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