Mental Illness

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By A. Marneros, M. T. Tsuang (auth.), Professor Dr. med. Andreas Marneros, Nancy C. Andreasen MD., Ph. D., Ming T. Tsuang MD., Ph. D., D. Sc. (eds.)

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Extra resources for Negative Versus Positive Schizophrenia

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1989a, b). Some of these studies find no correlation, while others find some relationship. To some extent, differences between the studies may depend on the patients sampled and the measures used to assess negative symptoms and depression. Nevertheless, the theme emerging from the bulk of these studies is that affective blunting is consistently distinguishable from depressed mood, suggesting that the presence of this symptom may be particularly powerful in investigations which attempt to separate core negative symptoms from negative symptoms that may be secondary to depression.

Some clinicians believe that they represent the "burnedout" stage of the illness, but to others it seems apparent that negative symptoms are a prominent feature of schizophrenia quite early on in the illness and that they may represent the first symptoms of schizophrenia to appear (although they may sometimes pass unrecognized). Early studies of negative symptoms discussed this issue but did not look at it empirically. One of the first studies to attempt to evaluate the longitudinal evolution of positive and negative symptoms was done by Pfohl and Winokur (1983).

This observation is consonant with clinical experience. That is, most patients who have one negative symptom tend to have another, but patients who have delusions do not necessarily have hallucinations or bizarre behavior or positive formal thought disorder. An additional perspective on this problem is provided through factor analytic studies. In our original report about the SANS and SAPS published in 1982, we found a first factor that was bipolar and had strong negative weights on positive symptoms and strong positive weights on negative symptoms.

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