Schizophrenia: Positive vs Negative Symptoms — What's Added vs What's Missing
The word 'positive' doesn't mean good and 'negative' doesn't mean bad — yet students pick wrong answers on the NCLEX because they misclassify symptoms. Mixing them up changes your nursing priority, your expected medication response, and your discharge teaching.
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- Excess — added to normal experience
- ★Excess dopamine (mesolimbic)
- Deficit — missing from normal function
- Dopamine deficit (mesocortical)
- Hallucinations (auditory most common)
- Delusions
- Disorganized speech
- Thought broadcasting
- Bizarre behavior
- ★Flat/blunted affect
- Alogia
- Avolition
- Anhedonia
- Social withdrawal
- Often acute onset
- Prominent in psychotic episodes
- Insidious, gradual onset
- Persist between episodes
- Don't argue with delusions
- Present reality calmly
- Maintain safety
- PRN for agitation
- Structure the daily routine
- Brief, concrete communication
- Small achievable goals
- Reinforce self-care
- Respond well to typicals & atypicals
- Clozapine if treatment-resistant
- Typicals (1st gen) do little
- Atypicals help only modestly
- Clozapine if treatment-resistant
- Adherence prevents relapse
- Report worsening voices
- Avoid alcohol & drugs
- Keep a daily routine
- Encourage social engagement
- Adherence prevents relapse
- Avoid alcohol & drugs
- ★Command hallucinations — harm self/others
- Acting on delusional beliefs
- Self-neglect, malnutrition
- Severe isolation, poor hygiene
- Acute relapse, rehospitalization
- Harm from acting on delusions
- Greatest cause of long-term disability
Positive Symptoms
- Excess — added to normal experience
- ★Excess dopamine (mesolimbic)
Negative Symptoms
- Deficit — missing from normal function
- Dopamine deficit (mesocortical)
Positive Symptoms
- Hallucinations (auditory most common)
- Delusions
- Disorganized speech
- Thought broadcasting
- Bizarre behavior
Negative Symptoms
- ★Flat/blunted affect
- Alogia
- Avolition
- Anhedonia
- Social withdrawal
Positive Symptoms
- Often acute onset
- Prominent in psychotic episodes
Negative Symptoms
- Insidious, gradual onset
- Persist between episodes
Positive Symptoms
- Don't argue with delusions
- Present reality calmly
- Maintain safety
- PRN for agitation
Negative Symptoms
- Structure the daily routine
- Brief, concrete communication
- Small achievable goals
- Reinforce self-care
Positive Symptoms
- Respond well to typicals & atypicals
- Clozapine if treatment-resistant
Negative Symptoms
- Typicals (1st gen) do little
- Atypicals help only modestly
- Clozapine if treatment-resistant
Positive Symptoms
- Adherence prevents relapse
- Report worsening voices
- Avoid alcohol & drugs
Negative Symptoms
- Keep a daily routine
- Encourage social engagement
- Adherence prevents relapse
- Avoid alcohol & drugs
Positive Symptoms
- ★Command hallucinations — harm self/others
- Acting on delusional beliefs
Negative Symptoms
- Self-neglect, malnutrition
- Severe isolation, poor hygiene
Positive Symptoms
- Acute relapse, rehospitalization
- Harm from acting on delusions
Negative Symptoms
- Greatest cause of long-term disability
★ marks the fact that sets a column apart.
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Positive = plus (something added that shouldn't exist). Negative = minus (something lost that should be there).
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