Psychotic spectrum

Examiners love the psychotic spectrum because two words unlock most of the questions: positive and negative. "Positive" doesn't mean good — it means symptoms added to normal experience. "Negative" means normal functions taken away.

Positive symptoms are the dramatic ones you can point to: hallucinations (perceptions without a stimulus — auditory voices are the classic in schizophrenia), delusions (fixed false beliefs held despite contrary evidence — persecutory, grandiose, referential), and disorganization (disorganized speech such as loose associations or word salad, and grossly disorganized or catatonic behavior). Think of positive symptoms as distortions or excesses of normal function.

Negative symptoms are the quiet, easily-missed ones — losses or deficits. Learn the classic set: flat/blunted affect (diminished emotional expression), avolition (lack of goal-directed motivation), alogia (poverty of speech), anhedonia (reduced pleasure), and asociality (social withdrawal). A mnemonic: the 5 A's. Negative symptoms tend to be more chronic, more disabling, and less responsive to medication than positive ones.

Now the course basics — these numbers are tested verbatim. Schizophrenia requires continuous signs for at least 6 months, including at least 1 month of active-phase positive symptoms (less if treated). Shorter durations get different labels: schizophreniform disorder = the same active symptoms lasting 1 to 6 months; brief psychotic disorder = symptoms lasting less than 1 month with full return to baseline. Order them by duration and you can't miss.

Clinical Pearl: Positive = added (hallucinations, delusions, disorganization); Negative = subtracted (flat affect, avolition, alogia). For course, memorize the ladder by duration: brief psychotic <1 month -> schizophreniform 1-6 months -> schizophrenia >=6 months.