Which of the following is a NEGATIVE symptom of schizophrenia?

Avolition — an inability to start or finish tasks

Hallucinations — hearing voices no one else hears

Delusions — false beliefs held firmly

Derailment — rapidly jumping between topics

Assertion (A): Major depressive disorder involves a period of depressed mood and/or loss of interest in most activities, together with other symptoms. Reason (R): Women are more likely than men to report depressive disorders.

Both A and R are true, but R is not the correct explanation of A

Both A and R are true, and R is the correct explanation of A

Both A and R are true, but R is not the correct explanation of A

Major Psychological Disorders — Mood, Schizophrenia, Neurodevelopmental, Conduct, Eating and Substance-Related

This chapter completes the book's survey of disorders. It begins with disorders of mood — depression and bipolar disorder — and with what the book says about suicide, then turns to schizophrenia and the way its symptoms are grouped. It goes on to disorders that begin in childhood, those involving disruptive behaviour, and finally eating and substance-related disorders. The paper asks for the defining feature of each and for the categories of symptoms, so the chapter keeps each description close to the book. As before, these descriptions are for understanding, not for labelling anyone; a person in difficulty deserves support and professional help.

Depressive and Bipolar Disorders

Major depressive disorder is a period of depressed mood and/or loss of interest or pleasure in most activities, together with other symptoms: a change in body weight, constant sleep problems, tiredness, an inability to think clearly, agitation, greatly slowed behaviour, excessive guilt or feelings of worthlessness, and thoughts of death and suicide. The book lists the factors that put people at risk: genetic make-up or heredity; age — women are more at risk in young adulthood, men in early middle age; gender — women are more likely than men to report depressive disorders; negative life events; and a lack of social support.

In bipolar and related disorders, a person experiences episodes of mania as well as depression. Mania is a state in which the person becomes euphoric ("high"), extremely active, excessively talkative and easily distractible; manic episodes rarely appear by themselves and usually alternate with depression. In bipolar I disorder, both mania and depression are alternately present, sometimes interrupted by periods of normal mood; it was earlier called manic-depressive disorder.

ℹ️ Suicide is a call for help

Thoughts of death and suicide can be part of depression, and the book treats them with care. Warning signs include talk of hopelessness or of not wanting to live, withdrawal from friends and activities, and giving away possessions. Such signs mean a person needs help now: listen without judging, take what they say seriously, stay with them, and involve a trusted adult or a mental-health professional. Prevention works best when people feel connected and are taught to cope with failure and stress.

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia is the descriptive term for a group of psychotic disorders in which personal, social and occupational functioning deteriorate as a result of disturbed thought processes, strange perceptions, unusual emotional states and motor abnormalities. It is a debilitating disorder, and the social and psychological costs to the person and the family are heavy. Its symptoms fall into three categories.

Symptoms of schizophrenia
Category	Symptoms
Positive symptoms — excesses of thought, emotion and behaviour	Delusions; disorganised thinking and speech; heightened perception and hallucinations; inappropriate affect
Negative symptoms — pathological deficits	Poverty of speech (alogia); blunted and flat affect; loss of volition (avolition), an inability to start or complete a course of action; social withdrawal
Psychomotor symptoms	Moving slowly, unusual gestures; at the extreme, catatonia — catatonic stupor (motionless and silent for long periods), catatonic rigidity (a rigid, upright posture for hours) and catatonic posturing (awkward, bizarre positions held for long)

A delusion is a false belief that is firmly held on inadequate grounds. Delusions of persecution — believing that one is being plotted against, spied on or mistreated — are the most common. In delusions of reference people attach special and personal meaning to the actions of others or to objects and events. In delusions of grandeur they believe themselves to be specially empowered persons, and in delusions of control that their feelings, thoughts and actions are controlled by others. Formal thought disorders make communication difficult: derailment or loosening of associations (rapidly shifting from one topic to another), neologisms (inventing new words) and perseveration (persistent and inappropriate repetition of the same thoughts). Hallucinations are perceptions that occur in the absence of external stimuli; auditory hallucinations, hearing sounds or voices, are the most common, and tactile, somatic, gustatory, visual and olfactory hallucinations also occur.

⚠️ "Positive" means added, not good

Positive symptoms are things present that should not be — delusions, hallucinations, disorganised speech. Negative symptoms are things absent that should be — speech, emotional expression, will, social contact. Flat affect is negative; inappropriate affect is positive. The paper builds whole items on this one distinction.

Neurodevelopmental and Disruptive Behaviour Disorders

Neurodevelopmental disorders appear early in development, often before the child enters school, and involve deficits in personal, social, academic or occupational functioning. Attention-deficit hyperactivity disorder (ADHD) has two main features. Inattention: children find it difficult to sustain mental effort during work or play, have trouble keeping their minds on any one thing, are easily distracted and do not follow instructions. Hyperactivity–impulsivity: they seem unable to control their immediate reactions or to think before acting, fidget, squirm and climb, and find it hard to wait their turn. Autism spectrum disorder involves marked difficulties in social interaction and communication, a restricted range of interests and a strong desire for routine; many children with it find it hard to express feelings and to understand others' feelings. Intellectual disability is below-average intellectual functioning (an IQ of about 70 or below) with deficits in adaptive behaviour, beginning before 18. Specific learning disorder is a difficulty in perceiving or processing information efficiently and accurately, showing up in the early school years in reading, writing or mathematics.

Among disruptive, impulse-control and conduct disorders, children with oppositional defiant disorder (ODD) display age-inappropriate amounts of stubbornness, are irritable, defiant, disobedient and behave in a hostile manner. Conduct disorder refers to age-inappropriate actions and attitudes that violate family expectations, societal norms and the personal or property rights of others. Its typical behaviours include aggressive actions that cause or threaten harm to people or animals, non-aggressive conduct that causes property damage, major deceitfulness or theft, and serious rule violations. Aggression itself may be verbal, physical, hostile (aimed at inflicting injury) or proactive (dominating and bullying others without provocation).

Feeding and Eating Disorders; Substance-Related Disorders

Feeding and eating disorders
Disorder	Description
Anorexia nervosa	A distorted body image: the person sees himself or herself as overweight, often refuses to eat, exercises compulsively and may develop unusual habits such as refusing to eat in front of others; it can be life-threatening
Bulimia nervosa	Eating excessive amounts of food and then purging the body by vomiting or by using medicines such as laxatives or diuretics
Binge eating	Frequent episodes of out-of-control eating, at a higher speed than normal and continuing even when not hungry, without purging

Substance-related and addictive disorders involve maladaptive behaviours resulting from the regular and consistent use of a substance. Substance abuse brings recurrent and significant damaging effects — failing to meet obligations at home, school or work, and problems in relationships and with the law. The substances the book discusses include alcohol, whose long-term heavy use damages the family, social relationships, work and health — including the liver and nutrition; heroin, an opioid derived from opium that depresses functioning; and cocaine, a stimulant obtained from the coca plant, which produces a feeling of energy and confidence followed by a crash. Dependence and withdrawal make these disorders hard to escape without treatment and support.

Key takeaways

Major depressive disorder: depressed mood or loss of interest with other symptoms; risk factors include heredity, age, gender, negative life events and lack of social support.
Bipolar I disorder alternates mania and depression; it was earlier called manic-depressive disorder. Suicidal signs mean a person needs help now.
Schizophrenia symptoms are positive (delusions, hallucinations, disorganised speech), negative (alogia, flat affect, avolition) and psychomotor (catatonia).
Delusions of persecution are the most common; auditory hallucinations are the most common hallucinations.
Neurodevelopmental: ADHD (inattention, hyperactivity–impulsivity), autism spectrum disorder, intellectual disability, specific learning disorder. ODD and conduct disorder involve defiance and rule-breaking.
Anorexia: distorted body image and refusal to eat; bulimia: bingeing then purging; binge eating: out-of-control eating without purging. Substance disorders include alcohol, heroin and cocaine.

Practice questions (8)

Attempt each one before opening the answer. Every explanation names the tempting wrong option as well as the right one, because that is where marks are lost.

A person with schizophrenia firmly believes, without adequate grounds, that his neighbours are plotting against him and spying on him. This is a delusion of:
1. Grandeur
2. Persecution
3. Reference
4. Control
Show answer
Answer: B — Persecution
Believing that one is being plotted against, spied on or mistreated is a delusion of persecution, the most common kind. A delusion of reference attaches personal meaning to others' actions or to events, and a delusion of control is the belief that one's thoughts and actions are controlled by others.
Hallucinations are perceptions that occur without external stimuli. The most common kind of hallucination in schizophrenia is:
1. Visual
2. Olfactory
3. Tactile
4. Auditory
Show answer
Answer: D — Auditory
Auditory hallucinations — hearing sounds or voices that no one else hears, which may speak to or about the person — are the most common. Visual, tactile and olfactory hallucinations also occur, which is why they are plausible, but they are less frequent.
Which of the following is a NEGATIVE symptom of schizophrenia?
1. Avolition — an inability to start or finish tasks
2. Hallucinations — hearing voices no one else hears
3. Delusions — false beliefs held firmly
4. Derailment — rapidly jumping between topics
Show answer
Answer: A — Avolition — an inability to start or finish tasks
Negative symptoms are deficits — something normally present is missing — and avolition, the loss of will to begin or complete a course of action, is one of them, along with alogia, flat affect and social withdrawal. Hallucinations, delusions and derailment are all positive symptoms: excesses of perception, belief and thought.
Match the disorder with its description. A. Anorexia nervosa B. Bulimia nervosa C. Binge eating D. ADHD — 1. Eating excessive amounts of food and then purging 2. Frequent out-of-control eating, without purging 3. Distorted body image and refusal to eat 4. Inattention and hyperactivity–impulsivity
1. A-1, B-3, C-2, D-4
2. A-3, B-2, C-1, D-4
3. A-3, B-1, C-2, D-4
4. A-3, B-1, C-4, D-2
Show answer
Answer: C — A-3, B-1, C-2, D-4
Anorexia nervosa is a distorted body image with refusal to eat; bulimia nervosa is bingeing followed by purging; binge eating is out-of-control eating without purging; and ADHD is marked by inattention and hyperactivity–impulsivity. The usual slip swaps bulimia and binge eating — the difference is that purging follows the binge only in bulimia.
In which disorder are both mania and depression alternately present, sometimes interrupted by periods of normal mood — the condition earlier called manic-depressive disorder?
1. Major depressive disorder
2. Generalised anxiety disorder
3. Schizophrenia
4. Bipolar I disorder
Show answer
Answer: D — Bipolar I disorder
Bipolar I disorder involves alternating episodes of mania and depression and was earlier known as manic-depressive disorder. Major depressive disorder is the trap: it shares the depressive episodes but has no manic ones, and manic episodes rarely appear on their own.
Assertion (A): Major depressive disorder involves a period of depressed mood and/or loss of interest in most activities, together with other symptoms. Reason (R): Women are more likely than men to report depressive disorders.
1. Both A and R are true, and R is the correct explanation of A
2. Both A and R are true, but R is not the correct explanation of A
3. A is true, but R is false
4. A is false, but R is true
Show answer
Answer: B — Both A and R are true, but R is not the correct explanation of A
A is the book's description of major depressive disorder, and R is one of the risk factors it lists under gender. But a difference in who reports the disorder more often does not explain what the disorder is, so R, though true, is not the explanation of A — a risk factor is not a definition.
Among the psychomotor symptoms of schizophrenia, the state in which a person remains motionless and silent for long periods is called:
1. Catatonic stupor
2. Catatonic posturing
3. Inappropriate affect
4. Perseveration
Show answer
Answer: A — Catatonic stupor
Catatonic stupor is remaining motionless and silent for long stretches. Catatonic posturing is the near-miss: it means holding awkward, bizarre positions for long periods. Perseveration is a thought disorder — the repetition of the same thoughts — not a motor symptom.
Consider the statements. I. Positive symptoms of schizophrenia are excesses of thought, emotion and behaviour. II. Neologisms are new words invented by the person. III. Flat affect is a positive symptom. IV. In delusions of reference, people attach special personal meaning to others' actions or to events. Which are correct?
1. I and II only
2. II, III and IV only
3. I, II and IV only
4. I, II, III and IV
Show answer
Answer: C — I, II and IV only
I, II and IV are correct statements about positive symptoms, neologisms and delusions of reference. III is false: flat affect is a lack of emotional expression and so a negative symptom; it is inappropriate affect that counts as positive. Stopping at I and II drops the accurate definition of delusions of reference.