Positive Symptoms: The Disorganized Dimension
Disorganized thinking becomes apparent in patients’ speech patterns as schizophrenia progresses. Affected people lose their train of thought during conversations, make loose associations of topics (tangentially jumping from one topic to another apparently at random, or on the barest of associations), and give answers to unrelated questions. Speech may be highly circumstantial, meaning that affected people may speak continuously, providing numerous irrelevant details and never getting to the point. Occasionally, speech is so disorganized that it becomes a completely jumbled “word salad” devoid of discernible meaning despite being full of words.
Disorganized behavior may range from simple problems sustaining goal-directed self-care behaviors such as personal hygiene to unpredictable and bizarre socially inappropriate outbursts. For example, people may not dress according to the weather, (i.e., they may wear a heavy coat in the middle of summer), they may wear odd or inappropriate makeup, they may shout at people for no apparent reason, or they may mutter to themselves continuously, etc. They may even strip off their clothing and run naked through the streets, while chewing on road kill. Most anything is possible.
Catatonic motor behaviors are a type of disturbed behavior (and a negative as opposed to a positive symptom) that sometimes occurs when schizophrenia goes untreated. In catatonia, peoples’ reaction to their surroundings becomes remarkably decreased. They may assume a rigid, uncomfortable looking posture and then not move for hours or days, resisting efforts to move them. Catatonic patients may also display “waxy flexibility”, meaning that they allow themselves to be moved into new positions, but do not move on their own. Most of the time, this is not an act or a show but rather a genuine and unpremeditated symptom of the illness that patients cannot help. Catatonia is observed with less frequency today than in past years due to advances in treating schizophrenia.
Negative Symptoms: Affective Flattening, Alogia, and Avolition
“Affect” refers to emotional expression. Affective flattening, distinguished by a restricted range of expressed emotions, is a fairly common negative symptom among some schizophrenia patients. Patients with affective flattening show relatively immobile and unresponsive facial expressions, often accompanied by poor eye contact and little body language or movement.
Alogia refers to difficulty with speaking. In some schizophrenic patients, alogia manifests as reduced total speech output, and reduced verbal fluency (the ease with which words are chosen). Patients displaying alogia struggle to give brief answers to questions, for example.
Avolition describes a loss of motivation; the will or desire to participate in activities or to do things. Some schizophrenic patients show avolition in that they will sit still for long periods of time, seemingly indifferent to their surroundings, and without displaying any interest in work or social activities. In extreme cases, this behavior becomes catatonia (as described above).