In schizophrenia, "positive symptoms" refer to:
A: Symptoms associated with a good prognosis
B: Experiences or behaviours added to normal functioning, such as hallucinations and delusions
C: Emotionally positive symptoms such as grandiosity
D: Symptoms that respond well to antipsychotic medication
Correct: Experiences or behaviours added to normal functioning, such as hallucinations and delusions
The positive/negative distinction, introduced by Tim Crow, classifies symptoms according to whether they represent an excess or distortion of normal function (positive) or a diminution of normal function (negative). Positive symptoms include hallucinations, delusions, disorganised thinking, and abnormal motor behaviour. The term "positive" refers to something being added, not to valence or prognosis.
Which of the following is a negative symptom of schizophrenia?
A: Auditory hallucinations
B: Persecutory delusions
C: Avolition (lack of motivation)
D: Thought insertion
Correct: Avolition (lack of motivation)
Negative symptoms represent a diminishment of normal function and include: avolition (lack of motivation to pursue goals), alogia (poverty of speech), anhedonia (inability to experience pleasure), affective flattening (reduced emotional expression), and asociality (reduced social drive). Negative symptoms are often more persistent than positive symptoms, more resistant to antipsychotic treatment, and more strongly predictive of functional outcome.
The original dopamine hypothesis of schizophrenia proposed that psychotic symptoms arise from:
A: Reduced dopamine activity in the mesolimbic pathway
B: Excess dopamine activity, particularly in the mesolimbic pathway
C: Reduced serotonin activity in the prefrontal cortex
D: Glutamate receptor hypofunction throughout the cortex
Correct: Excess dopamine activity, particularly in the mesolimbic pathway
The original (Version 1) dopamine hypothesis, developed in the 1960s-70s, proposed that positive symptoms result from hyperactivity of dopamine transmission in the mesolimbic pathway. Evidence came from two directions: drugs that increase dopamine activity (e.g., amphetamine) can induce psychosis, and all effective antipsychotics block D2 receptors. The revised hypothesis adds that negative symptoms and cognitive deficits may reflect dopamine hypofunction in the mesocortical (prefrontal) pathway.
Atypical (second-generation) antipsychotics are distinguished from typical antipsychotics primarily by their lower risk of extrapyramidal side effects and their additional antagonism of serotonin receptors.
Answer: True
Typical (first-generation) antipsychotics (e.g., haloperidol, chlorpromazine) are predominantly D2 antagonists and carry significant risk of extrapyramidal side effects (EPS), including Parkinsonism, akathisia, and tardive dyskinesia. Atypical (second-generation) antipsychotics (e.g., clozapine, olanzapine, risperidone) have a broader receptor profile including 5-HT2A antagonism, which is thought to contribute to reduced EPS risk. Clozapine, reserved for treatment-resistant schizophrenia, is the only antipsychotic with clear superior efficacy but requires regular blood monitoring due to risk of agranulocytosis.
The neurodevelopmental hypothesis of schizophrenia proposes that:
A: Schizophrenia is caused by acute brain damage in early adulthood
B: Genetic and environmental factors disrupt early brain development, with symptoms emerging at or after puberty
C: Schizophrenia is primarily a degenerative condition beginning in middle age
D: Childhood trauma directly causes psychotic symptoms in genetically susceptible individuals
Correct: Genetic and environmental factors disrupt early brain development, with symptoms emerging at or after puberty
The neurodevelopmental hypothesis proposes that schizophrenia is rooted in early disruptions to brain development — possibly during foetal development or early childhood — due to genetic risk factors and environmental insults (e.g., obstetric complications, prenatal infection, cannabis use). These early disturbances do not produce symptoms immediately; rather, they interact with the maturational changes of adolescence and early adulthood to trigger psychosis, explaining the typical age of onset in late teens to late twenties.
Cognitive Behavioural Therapy for psychosis (CBTp) is most strongly supported by evidence for which outcome?
A: Complete elimination of positive symptoms
B: Reducing the distress and functional impact associated with psychotic symptoms
C: Reversing negative symptoms
D: Replacing antipsychotic medication
Correct: Reducing the distress and functional impact associated with psychotic symptoms
CBTp does not typically eliminate psychotic symptoms, but evidence supports its effectiveness in reducing the distress, conviction, and functional interference associated with delusions and hallucinations. It also improves depression, social functioning, and insight. NICE guidelines recommend CBTp as an adjunct to pharmacological treatment for all people with psychosis. It does not replace antipsychotics.
People with schizophrenia are significantly more likely to be victims of violence than perpetrators.
Answer: True
Despite widespread public stigma associating schizophrenia with dangerousness, the evidence consistently shows that people with schizophrenia and other psychotic disorders are far more likely to be victims of violent crime than to commit it. The modest elevation in risk of violence perpetration associated with psychosis is largely accounted for by comorbid substance misuse and adverse social circumstances. Challenging this stigma is an important component of public mental health education.
Psychosis & Schizophrenia
In schizophrenia, "positive symptoms" refer to:
About this quiz
Schizophrenia is one of the most complex and stigmatised mental disorders, affecting approximately 1% of the population worldwide. Characterised by a fragmentation of thought, perception, and emotion, it presents profound challenges for patients, families, and clinicians.
This quiz covers the positive and negative symptom distinction, the neurodevelopmental and dopamine hypotheses, and the pharmacological and psychosocial treatments that form the basis of modern care.