Positive and Negative Symptoms in Psychosis: Description, Research, and Future Directions

By Philip D. Harvey; Elaine E. Walker | Go to book overview

CEREBRAL STRUCTURE AND SYMPTOMATOLOGY

Mantosh J. Dewan, M.D.

Psychiatric symptoms have been attributed to a conflicted mind ( Freud, 1900) , problems in living ( Szasz, 1961) or, more recently, a "broken brain" ( Andreasen, 1984). With the advent of advanced, non-invasive imaging technologies like computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), a longstanding interest in identifying the specifics of the broken brain has been renewed ( Weinberger, Wagner and Wyatt, 1983; Andreasen et al., 1986; Kling, Metter, Riege and Kuhl, 1986). Besides serving a heuristic purpose, these studies are important for their potential to subdivide the "group of schizophrenias" ( Bleuler, 1911/ 1950) into discrete, clinically viable syndromes.

Another avenue of investigation has been the application of the negative/positive symptom distinction to differentiate among schizophrenic patients, although the use of numerous different descriptors has rendered these studies difficult to compare to each other. To address this issue, recent attempts have been made to describe and validate operationalized criteria for positive and negative symptoms ( Andreasen, 1982a; Andreasen and Olsen, 1982; Krawiecka, Goldberg and Vaughn, 1977), and the innovative application of these criteria has spawned a number of sophisticated studies in this area ( Johnstone, et al., 1978; Andresasen, Olsen, Dennert, and Smith, 1982; Owens et al., 1985).

For almost a century now, it has been postulated that psychiatric symptomatology, and particulary the negative syndrome, may be related to the "broken brain". Kraepelin ( 1919) notion that chronic, deteriorated patients with dementia praecox may have a neuropathological basis for their disease earned the support of both Bleuler ( 1911/ 1950) and Freud ( 1964). More recently, Crow ( 1980a;b) has posited a division of schizophrenia into two subtypes, with Type II schizophrenics being distinguished by having a structural brain abnormality and predominantly negative

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