Schizoaffective Disorder

Positive and Negative Symptoms

The Characteristic Symptoms of Schizoaffective Disorder

The diagnosis of schizoaffective disorder requires that the patient experience some decline in social functioning for at least a six-month period, such as problems with school or work, social relationships, or self-care. In addition, some other symptoms are commonly present. The symptoms of schizoaffective disorder can be divided into five broad classes:

1. positive symptoms
2. negative symptoms
3. symptoms of mania
4. symptoms of depression
5. other symptoms

A person with schizoaffective disorder will usually have some (but not all) of the symptoms described below.

Positive Symptoms

Positive symptoms refer to thoughts, perceptions, and behaviors that are ordinarily absent in people in the general population, but are present in persons with schizoaffective disorder. These symptoms often vary over time in their severity, and may be absent for long periods in some patients.

Hallucinations. Hallucinations are "false perceptions"; that is, hearing, seeing, feeling, or smelling things that are not actually there. The most common type of hallucinations are auditory hallucinations. Patients sometimes report hearing voices talking to them or about them, often saying insulting things, such as calling them names. These voices are usually heard through the ears and sound like other human voices.

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Delusions. Delusions are "false beliefs"; that is, a belief which the patient holds, but which others can clearly see is not true. Some patients have paranoid delusions, believing that others want to hurt them. Delusions of reference are common, in which the patient believes that something in the environment is referring to him or her when it is not (such as the television talking to the patient). Delusions of control are beliefs that others can control one's actions. Patients hold these beliefs strongly and cannot usually be "talked out" of them.

Thinking Disturbances. The patient talks in a manner that is difficult to follow, an indication that he or she has a disturbance in thinking. For example, the patient may jump from one topic to the next, stop in the middle of the sentence, make up new words, or simply be difficult to understand.

Negative Symptoms

Negative symptoms are the opposite of positive symptoms. They are the absence of thoughts, perceptions, or behaviors that are ordinarily present in people in the general population. These symptoms are often stable throughout much of the patient's life.

Blunted Affect. The expressiveness of the patient's face, voice tone, and gestures is diminished or restricted. However, this does not mean that the person is not reacting to his or her environment or having feelings.

Apathy. The patient does not feel motivated to pursue goals and activities. The patient may feel lethargic or sleepy, and have trouble following through on even simple plans. Patients with apathy often have little sense of purpose in their lives and have few interests.

Anhedonia. The patient experiences little or no pleasure from activities that he or she used to enjoy or that others enjoy. For example, the person may not enjoy watching a sunset, going to the movies, or a close relationship with another person.

Poverty of Speech or Content of Speech. The patient says very little, or when he or she talks, it does not amount to much. Sometimes conversing with the patient can be unrewarding.

Inattention. The patient has difficulty attending and is easily distracted. This can interfere with activities such as work, interacting with others, and personal care skills.

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