# Situation: A 24-year-old man with schizophrenia is admitted to the psychiatric unit. He stopped taking his antipsychotic medicine 2 months ago. For weeks he has stayed in his room, has rarely bathed, and has stopped going to work. He has no history of violence. The nurse reviews the symptom groups of schizophrenia with a student. Which finding is a negative symptom?

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> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 24-year-old man with schizophrenia is admitted to the psychiatric unit. He stopped taking his antipsychotic medicine 2 months ago. For weeks he has stayed in his room, has rarely bathed, and has stopped going to work. He has no history of violence.

The nurse reviews the symptom groups of schizophrenia with a student. Which finding is a negative symptom?

## 보기

1. Lack of drive to start or finish daily tasks **✔ 정답**
2. A fixed belief that neighbors are spying on him
3. A voice that comments on what he is doing
4. Speech that jumps between unrelated ideas

**정답: 1**

## 해설

Negative symptoms are losses or reductions of normal function: blunted affect, alogia, avolition, anhedonia, and asociality. A lack of drive to begin and complete everyday activities is avolition. Delusions, hallucinations, and disorganized speech are positive symptoms because they add to or distort normal function.

## 심화 해설

Understanding the symptom groups

Schizophrenia symptoms are conventionally divided into positive and negative clusters. Positive symptoms represent an *addition* or distortion of normal mental function, while negative symptoms represent a *loss* or reduction of normal function. In this patient, the weeks of staying in his room, rarely bathing, and stopping work point toward a decline in motivation and self-initiated behavior, which belongs to the negative symptom domain.

A lack of drive to start or finish daily tasks is termed avolition, one of the core negative symptoms of schizophrenia. Avolition reflects diminished motivation to pursue goal-directed activities, including basic self-care, work, and social engagement. The patient’s poor hygiene and withdrawal from occupational responsibilities are clinical expressions of this motivational deficit.

Key point! Negative symptoms are not simply “bad behavior” or laziness. They are a core, biologically driven dimension of schizophrenia that accounts for a large part of long-term disability and poor functional outcomes [2]. Because they respond poorly to available antipsychotic treatments, they remain a primary driver of functional impairment [1].

Why the other options are positive symptoms

Positive symptoms add experiences or behaviors that are not normally present. The remaining options all fit this category.

| Option | Symptom type | Explanation |
| --- | --- | --- |
| 2 Fixed belief that neighbors are spying | Delusion (positive) | A fixed false belief that is added to normal thought content |
| 3 Voice commenting on his actions | Auditory hallucination (positive) | A sensory perception without external stimulus |
| 4 Speech jumping between unrelated ideas | Disorganized speech (positive) | Loose associations or derailment that distorts normal thought flow |

Watch out! Delusions, hallucinations, and disorganized speech are all positive symptoms because they add to or distort normal function. Negative symptoms, by contrast, subtract from normal function.

The five negative symptom domains

Negative symptoms are not a single entity. They cluster into recognizable domains that clinicians assess and document .

| Negative symptom | Definition | Clinical example |
| --- | --- | --- |
| Avolition | Reduced drive or motivation to initiate and persist in goal-directed activity | Stops going to work, neglects bathing, stays in room |
| Alogia | Poverty of speech or reduced verbal output | Gives brief, empty replies; long pauses before answering |
| Anhedonia | Diminished ability to experience pleasure | Shows no enjoyment in activities previously found pleasurable |
| Asociality | Reduced social drive and withdrawal from relationships | Declines invitations, avoids family contact |
| Blunted affect | Diminished emotional expression in face, voice, and gestures | Flat facial expression, monotone voice, reduced eye contact |

In this patient, the lack of drive to begin and complete everyday activities is specifically avolition, which is the correct answer. The poor hygiene and cessation of work are observable consequences of that motivational deficit.

Primary versus secondary negative symptoms

Negative symptoms can be primary, meaning they are an integral dimension of schizophrenia itself, or secondary, arising from other factors such as positive symptoms, depression, antipsychotic side effects, substance use, or social isolation . This distinction matters clinically because secondary negative symptoms may improve when the underlying cause is addressed, whereas primary negative symptoms tend to persist.

In this scenario, the patient stopped taking his antipsychotic 2 months ago. The worsening of negative symptoms after medication discontinuation may reflect an unmasking of primary negative symptoms, but could also be compounded by secondary factors such as social withdrawal or emerging depression. A thorough assessment is needed to differentiate these possibilities.

Key point! Negative symptoms are a core component of schizophrenia and are not simply a reaction to positive symptoms. They independently contribute to poor functional outcomes and are often the most disabling aspect of the illness [2].

Clinical and exam relevance

For nursing licensure examinations, the ability to classify symptoms as positive or negative is frequently tested. The mnemonic often used is that positive symptoms are “added” (hallucinations, delusions, disorganized speech, grossly disorganized behavior), while negative symptoms are “subtracted” (the five A’s: avolition, alogia, anhedonia, asociality, affective flattening).

When assessing a patient with schizophrenia, nurses should document both symptom clusters because they guide treatment priorities. Positive symptoms often respond to antipsychotic medication, while negative symptoms show limited response to current pharmacologic options and require psychosocial interventions such as social skills training, supported employment, and cognitive remediation [1][2]. The patient’s lack of drive to perform daily tasks is therefore not only a diagnostic clue but also a target for nursing interventions aimed at promoting function and preventing further decline.References (research sources)

- [1]Negative Symptoms in Schizophrenia: An Update on Research Assessment and the Current and Upcoming Treatment Landscape.Research articleGovil P, Kantrowitz JT (2025) · DOI: 10.1007/s40263-024-01151-7

- [2]Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment.Research articleCorrell CU, Schooler NR (2020) · DOI: 10.2147/NDT.S225643

## 임상 시나리오

Schizophrenia Symptom ClustersDistinguishing Negative from Positive Symptoms
Negative symptoms represent a loss of normal function. The core negative symptoms are blunted affect, alogia, avolition, anhedonia, and asociality. Avolition, the lack of drive to start or finish daily tasks, is a key finding.

Positive symptoms are an addition or distortion of normal mental function. They include delusions (fixed false beliefs), hallucinations (false sensory perceptions), and disorganized speech.

CautionNegative symptoms are a primary driver of long-term disability and respond poorly to available antipsychotics. Do not mistake avolition for laziness; it is a core, biologically driven dimension of schizophrenia.

## 핵심 개념

- **Avolition** — A negative symptom of schizophrenia characterized by a lack of motivation or drive to initiate and persist in goal-directed activities.
- **Negative Symptoms** — Losses or reductions of normal function in schizophrenia, including blunted affect, alogia, avolition, anhedonia, and asociality.
- **Positive Symptoms** — Additions to or distortions of normal mental function in schizophrenia, such as hallucinations, delusions, and disorganized speech.
- **Delusion** — A fixed, false belief that is not amenable to change in light of conflicting evidence, a positive symptom of schizophrenia.
- **Hallucination** — A sensory perception experienced in the absence of an external stimulus, such as hearing a voice, a positive symptom of schizophrenia.

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