4 Symptoms of Psychosis: Negative Symptoms

Avolition (or Apathy)

Characterised by seeming lack of energy, drive and interest .

Observers will notice:

Little interest in grooming, hygiene or personal presentation.

Little interest in education or employment.

Physically inert, slow or imobile.

Alogia: Greek "a"=no, "logos"= mind,thought.

Characterised by seemingly slow thinking processes- which comes across when observing speech, or how the person talks, particularly in direct coversation.

Observers will notice:

Poverty of Speech i.e. restrictions in amount of spontaneous speech

Poverty of Content of Speech, i.e. speech that relays very little information.

Blocked or severe interruption in train of speech

Latency of response, i.e. very slow in reponding

Affective Flattening (also referred to as "Blunted Affect")

Characterized by flat and unemotional expression and/or reacts to conversation with little feeling or emotion.

Observers will notice:

Unchanging facial expression

Decreased spontaneous movements

Limited or no use of hands or body in expressing ideas

Poor eye contact

Failure to laugh, smile or frown when appropriate

Little vocal inflection and flat, monotonic voice.

Quiz Time

Get your pen and paper ready.

Note down what you think are the key features of each of the symptoms as we go along. The images are clues.

Anhedonia

Characterized by an inability in experiencing pleasure or maintaining interest.

Observers will notice:

Person reports lack of interest or fun in activities they used to enjoy.

Diminished interest in sex and/or diminished sexual activity.

Diminished interest in spending social time with loved ones, family and friends and lack of interest in developing new relationships.

Attentional Impairment

Characterized by inability to focus attention for any length of time.

Observers will notice

Person seems inattentive in social situation. may look away in conversation, appear uninterested, terminate conversation or seem "spacy" and "out of it".

Poor performance on simple intellectual tests such as counting backwards in threes or spelling words backwards

Spot the difference..

So, the five categories of negative symptoms listed from SANS are : Alogia, Affective Flattening (Blunted Affect), Avolition, Anhedonia and Attentional Impairment

SANS was produced in the 1980s. More recent categorization of negative symptoms gives the following list: Blunted Affect ,

Alogia, Asociality, Anhedonia, and Avolition

What has changed? Can you think of why, given our previous presentation?

Answers:

SANS has Attentional Impairment where "modern categories" have dropped it and added Asociality.

("Asociality" is characterized by decreased interest in spending time with others; most commonly identified as a lack of meaningful relationships with friends or families. In SANS it is a sub-feature of Anhedonia, but now it is given prominence in it's own right)

But why drop Attention? Because we've seen it before folks!

Do you member.....

What is the relationship?

Actually, its a bit complicated as, with SANS, there has often been crossover in definitions.

BUT it does seem they should be treated as separate symptom groups. They can both be detected in the same people but they can also improve independent of one another.

So, they are not thought to be the same, but the exact nature of how they correlate is not known at present.

For clinical nurses, the main take home lesson is that both can cause functional and social deficits and these should be identified and addressed.

Both negative symptoms (NS) and cognitive symptoms (COG) lead to functional difficulties. Both are often noted to be present before the other symptoms and their presence indicates a poorer prognosis.

It is a fair question, therefore - are they the same? Are they connected in some way? Are they separate?

Negative

Symptoms

Cognitive

Symptoms

The crushing weight of negative symptoms

Negative Symptoms are highly indicative of loss of function, although this may be reversible. It is this loss of function that needs concerted efforts to overcome and, to date, is particularly resistive to medication.

In acute states, the negative symptoms may be less flamboyant than Hallucinations and Delusions, but will also be more persistent.

In helping people with these symptoms, the focus is on regaining, rediscovering or simply learning core functional skills rather than the removal or mitigate unwanted mental experiences.

As such, negative symptoms demand more of an emphasis on psychological and social assessment and intervention. Let us see what advice the research paper has on the nursing approach.

Congratulations

You have now completed

Symptoms of Psychosis 4:

Negative Symptoms

Address Functional Needs.

Negative Symptoms:

What do the expert nurses say?

Pages 13 - 16

Contents.

Negative Symptoms

Negative Symptoms: Overview

Positive and Negative

In this section we shall examine:

Following from Moral Foundations, one of the largest sections in the research paper is titled

"GETTING THINGS DONE."

This section is full of advice and techniques for addressing the reality of socializing and carrying out activities of everyday living. It includes behavioural techniques such as breaking tasks into small steps and a discussion on when to be assertive. To finish, read this section from pages 36 - 42.

The symptoms of schizophrenia are often divided into two groups - positive symptoms and negative symptoms.

In this presentation we shall be examining negative symptoms as a symptom group in their own right.

In order to define and describe negative symptoms we will need to look at them in conjunction with positive symptoms.

One criticism of acute psychiatry has been on the emphasis on the so called positive symptoms.

They are also a symptom group that has much in common with cognitive symptoms previously described, which we shall look at later.

So far we have avoided describing symptoms in terms of the so called "positive symptom " and "negative symptom" dichotomy.

This is for two reasons:

1) The positive and negative dichotomy is used to describe symptoms of schizophrenia, rather than all psychosis.

2) The dichotomy can reduce our consideration of other symptoms such as cognitive symptoms or mood.

The next slide shows the five categories of Negative Symptoms as defined by the Scale for the Assessment of Negative Symptoms (SANS).

Before we go into an explanation of the headings, see if you can jot down the key features of each.

You may want to do this all in one go, or pause the presentation and jot down key features as we go along the 5 symptom types.

POSITIVE signifies that the symptom would be considered an addition to or exaggeration of so called normal experience.

• What are meant by "positive" and "negative" symptoms.

• The 5 categories of negative symptoms as defined by the Scale for the Assessment of Negative Symptoms (SANS).

• The relationship between Negative Symptoms and Cognitive Symptoms.
• Where to find strategies to assist patients within the core text.

NEGATIVE signifies that the symptom would be considered a reduction or limitation of so called normal experience.

The paper begins with a set of "Moral Foundations" which, although pertinent to all symptom groups, could be seen as particularly relevant to negative symptoms.

The emphasis of Moral foundations is notice, encourage, empathize and give respect to the individual.