Negative symptoms in primary psychotic disorders

This specifier may be used together with a diagnosis from the grouping of Schizophrenia or Other Primary Psychotic Disorders to indicate the degree to which negative psychotic symptoms are a prominent part of the current clinical presentation. Negative symptoms include constricted, blunted, or flat affect; alogia or paucity of speech; avolition (general lack of drive, or lack of motivation to pursue meaningful goals); asociality (reduced or absent engagement with others and interest in social interaction) and anhedonia (inability to experience pleasure from normally pleasurable activities). To be considered negative psychotic symptoms, relevant symptoms should not be entirely attributable to depression or to an under-stimulating environment, be a direct consequence of a positive symptom (e.g., persecutory delusions causing a person to become socially isolated due to fear of harm), or be attributable to the direct physiological effects of substances or medications, including withdrawal effects. Catatonia, including catatonic mutism, should be considered as part of the rating of the Psychomotor Symptoms specifier, rather than here.

The rating should be made based on the severity of negative symptoms during the past week.

Table 6.8: Rating Scale for Negative Symptoms in Primary Psychotic Disorders

| | |

| - | - |

| None
6A25.1&XS8H
| No significant negative symptoms have been present during the past week.

|

| Mild
6A25.1&XS5W
| Example symptoms (not all are required):
Blunted emotional experience or expression, with subtle but detectable affective changes. Limited initiation of speech, but is responsive to questions. Little interest in external events, but exhibits sufficient motivation to engage in basic activities of daily living or to complete a task when prompted. |

| Moderate
6A25.1&XS0T
| Example symptoms (not all are required):
Flat emotional expression. Minimal initiation of speech for purposes other than indicating immediate needs and desires, but is responsive to questions with terse phrases. Lack of volition leads to neglect of hygiene or required activities, but will complete them with significant prompting.
|

| Severe
6A25.1&XS25
| Example symptoms (not all are required):
Person reports feeling empty or robotic most of the time. <u>Generally</u> does not initiate speech, even to indicate immediate needs and desires. Person is not capable of initiating behaviour even with significant prompting, which may lead to serious neglect of self-care to the extent that it puts the person at risk of harm (e.g., infrequently taking life-sustaining medication).
|

| Severity Unspecified
6A25.1
| Negative symptoms have been present during the past week, but it is not possible to make a severity rating based on the available information. |