Obvious positive symptoms of schizophrenia—such as hallucinations and delusions—typically prompt treatment, but positive symptoms may be absent or clouded by the rationalizations and minimization often seen in paranoia. Negative symptoms can also escape detection because of their subtlety.
Andreasen and Olson’s criteria for negative symptoms1 provide the basis for the Schedule for the Assessment of Negative Symptoms (SANS) that includes the five As: avolition/apathy, alogia, affective flattening, anhedonia/asociality, and attentional impairment.
Many remember Bleuler’s four As of schizophrenia—autism, loosening of associations, affective disturbances, and ambivalence—but may have a harder time remembering the SANS’ five As. I find the pseudo-acronym PLANT (for the vegetative changes manifested with negative symptoms) helpful for recalling all five As (Table).
Table
Use PLANT pseudo-acronym to recall vegetative symptoms
| Symptom | Meaning | Examples |
|---|---|---|
| aPathy/avolition | Lack of drive | Poor grooming |
| Anergia | ||
| Impersistence | ||
| aLogia | Marked impairment in thought processing and/or content | Poverty of speech |
| Poverty of content | ||
| Thought blocking | ||
| Latency of response | ||
| Poor abstracting | ||
| Affective disturbances | Altered expressiveness | Poor eye contact |
| Aprosodic speech | ||
| Lack of expression | ||
| Poverty of gestures | ||
| aNhedonia/ asociality | Loss of interests and pleasures | Little interest in sex |
| Lack of closeness | ||
| Few friends | ||
| Poor capacity for rapport | ||
| aTtentional impairment | Inattentiveness | Poor concentration |
| Stereotyped thought |