## Positive vs. Negative Symptoms in Schizophrenia **Key Point:** Positive symptoms represent an excess or distortion of normal mental functions (hallucinations, delusions, disorganized behavior/speech). Negative symptoms represent a diminution or loss of normal functions (alogia, avolition, affective flattening, anhedonia). ### Positive Symptoms (Present in the Question) - **Delusions of reference**: False belief that external events have special personal significance - **Command hallucinations**: Auditory hallucinations instructing the patient to perform actions - **Disorganized speech**: Incoherent, tangential, or circumstantial speech reflecting thought disorder ### Negative Symptoms (The Correct Answer) - **Alogia**: Poverty of speech; reduced quantity and spontaneity of speech - Other negative symptoms: Avolition, affective flattening, anhedonia, apathy **High-Yield:** Alogia is a **negative symptom** (loss of normal function), not a positive symptom. It reflects a reduction in the quantity and quality of speech output, often accompanied by reduced thought content. **Clinical Pearl:** Negative symptoms are often more disabling and harder to treat than positive symptoms. They correlate more strongly with poor functional outcomes and cognitive impairment. **Mnemonic:** **PAID** = Positive symptoms (Additions): Psychosis, Auditory hallucinations, Ideas of reference, Disorganized behavior. **NANA** = Negative symptoms (Subtractions): No speech (alogia), Avolition, No affect (blunting), Anhedonia.
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