Schizophrenia — Negative Symptoms & Function

Negative symptoms represent what is taken away from the client's baseline personality and functioning. They are deficits, not additions. The classic cluster is remembered by the 5 A's: Affective flattening (near-complete absence of emotional expression — flat face, monotone voice, poor eye contact), Alogia (poverty of speech — brief, empty replies, not pressured speech), Avolition (inability to initiate or sustain goal-directed activity — the client sits in bed all day, not from sadness but from absent motivation), Anhedonia (loss of pleasure in previously enjoyed activities), and Asociality (withdrawal from social interaction). These symptoms often appear before the first psychotic break and persist after positive symptoms are controlled with medication. Negative symptoms are harder to treat than positive ones; typical (first-generation) antipsychotics primarily target positive symptoms. Atypical (second-generation) antipsychotics like clozapine have better — though still limited — efficacy against negative symptoms. Nursing assessment focuses on functional changes: ADL participation, social engagement, speech quantity, and emotional responsiveness. These symptoms are the primary driver of long-term disability.