A negative symptom presentation can also be the result of psychotic processes. Social withdrawal can be caused by paranoia or by immersion in the psychotic process to the exclusion of real-life relationships. Primary and enduring negative symptoms are frequently referred to as the “deficit syndrome.” Individuals with the deficit syndrome have been found to have greater cognitive deficits and poorer outcomes than patients who do not have this syndrome.7
This brief narrative describes a typical day in the life of a patient with schizophrenia. It is apparent that the patient demonstrates several classic negative symptoms, including blunted emotional responsiveness, blunted affect, and decreased motivation.
Jesse is a 32-year-old Hispanic man with a 12-year history of schizophrenia. He responds slowly to questions and elaborates very little. He presents with blunted affect and makes few expressive gestures during the interview. Below he describes a typical day.
Jesse: I get up about 2 or so.
Interviewer: In the afternoon?
Jesse: Yes. Then I smoke a cigarette. Then I eat.
Interviewer: What do you usually have?
Jesse: Cereal or something leftover like a hamburger from [fast food restaurant].
Long pause in conversation
Interviewer: OK, what do you do next?
Jesse: After I eat? I smoke another cigarette.
Interviewer: What about after that?
Jesse: Then . . . I don’t know, I watch TV.
Interviewer: Anything else?
Jesse: Sometimes I walk to the store if I am out of cigarettes.
Further questioning by the interviewer gets each piece of the information.
Jesse: I haven’t done that in a while. I take a nap around 6. Then I eat dinner.
Interviewer: And what do you do between dinner and bedtime?
Jesse: Smoke and watch TV.
Interviewer: What do you watch?
Jesse: Bonanza, Get Smart . . . that stuff.
Interviewer: Can you tell me about a show you saw in the past week?
Jesse: Not really. Don’t remember [further coaxing produces no additional information].
Interviewer: OK, do you ever watch the news?
Jesse: Sometimes it goes to news.
Interviewer: Can you tell me about something going on in the world right now?
Jesse: The war.
Interviewer: Anything specific about the war?
Jessie: It’s bad.
Interviewer: Anything else?
Interviewer: Do you call anyone or go see any family or friends?
Jesse: My dad comes over once a week to check on me.
Interviewer: Do you see anyone else, or call someone.
Jesse: I don’t have anyone to call.
Interviewer: Do you have any hobbies, things you like to do.
Jesse: Smoke [and after further questioning] I like to play basketball.
Interviewer: When was the last time you played?
Jesse: I don’t have a ball.
Jesse seldom speaks spontaneously and needs to be prompted repeatedly by the interviewer to describe his day. When he speaks, he does not elaborate, which requires more detailed questioning. He is not physically active and spends most of his day watching television and smoking. He has no friends and is visited by his father once a week. In response to questions about his interests, he indicates that he likes basketball, but he neither plays nor watches basketball games. His affect is blunted throughout the conversation, and he is not emotionally responsive. Indeed, he cannot convincingly describe any recent emotional experiences from any portion of the emotional spectrum.
When asked, Jesse states that he wants to get a job, but he has done nothing to find a job in more than a decade. In general, Jesse claims to be content with his life and has no issues that he wishes to bring to his doctor’s attention. Interviews with family members reveal that these traits have characterized Jesse for many years.
Dr Velligan is Professor and Director of the Division of Schizophrenia and Related Disorders in the department of psychiatry at the University of Texas Health Science Center at San Antonio. Dr Alphs is Therapeutic Area Leader in Psychiatry, Medical and Scientific Affairs, for Janssen, LP, Ortho-McNeil Janssen Scientific Affairs, LLC, Titusville, NJ. Dr Velligan reports that she has the following relationships: Lundbeck-Otsuka: consultant, travel expenses, honoraria, speakers’ bureau, and advisory board; Bristol-Myers Squibb: consultant, honoraria; Janssen: consultant, honoraria advisory board; Genentech-Roche, consultant, honoraria, travel expenses, advisory board, research grant. Dr Alphs reports that he is employed by Ortho-McNeil Janssen.
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