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Re: Depression vs. 'negative' psychotic symptoms » Tomatheus

Posted by ed_uk2010 on February 13, 2015, at 16:03:53

In reply to Re: Depression vs. 'negative' psychotic symptoms » Chinaboy, posted by Tomatheus on February 13, 2015, at 13:21:04

>the difficulties that I have with getting out of bed when I want to...

Do you have anything to get out of bed for? Work, hobbies? Amotivation is common when there is little to get motivated about under the circumstances.

>whether the problems that I have with energy and concentration are part and parcel of my negative symptoms or part of something else (e.g., depression).

Would you say you mood is negative, or normal (you feel quite reasonable emotionally, most of the time, once out of bed)?

Flat affect implies you feel almost nothing eg. if a close family member died, you wouldn't feel bad, you would be emotionally blank. In depression, positive feelings are reduced but a lot of negativity is retained, and distress is still experienced when unpleasant personal events occur.

>Depression and mood disorders vs schizophrenia - type of negative symptoms.

Impairment of personal care is often much more severe in schizophrenia eg. loss of interest in washing, showering, brushing teeth etc. It is very common, for example, for a person with severe negative symptoms of schizophrenia to go for weeks without brushing their teeth. If questioned about this, there would (if a reply was received), be little sign that the person was bothered by this. This degree of deficit is rare in mood disorders except during the most severe depression. Negative sx in schizoaffective disorder are usually mild compared with schizophrenia, and overlap to a greater extent with depressive symptoms. In depression, a person may feel fatigued and less inclined to look after themselves, but would generally feel uncomfortable if they hadn't washed for days and say... had to go to see their pdoc. In the setting of severe psychotic negative symptoms, the appreciation and embarrassment about this situation would be lost - normal feelings are replaced by an indifferent blankness. In these severe situations, there is a difference, and the course of symptoms over time often follows a different course.

I'm not sure it's possible to tell the difference between mild negative sx of psychosis and depression in all cases because the problems overlap. It is possible to tell the difference in certain circumstances eg. when affect is totally flat in a pt with a history of psychosis, or when severe depressed mood is obviously present. When mild, it may not be useful to try and distinguish....

>poverty of speech, or writing (if alone, eg. writing on p-babble!)

Occurs in both. In depression, the remaining speech will often be negative. In negative sx predominant psychotic illness, speech is less likely to be negative, and much more likely to be vague, unusual in content and difficult to comprehend. In depression, speech may be slow or negative but is normally entirely understandable.

What counts as goal-directed behaviour?

Posting on here does, in my opinion. Your writing is exceptionally coherent, which can be the case in chronic depression, and when mild negative psychotic symptoms at present, but not in severe negative psychotic illness.

You replies will be helpful, but I do get the impression your symptoms represent:

1. Chronic depressive illness, somewhat resembling a bad case of dysthymia (this would be suggested by chronic low mood and loss of enjoyment while retaining some negative emotions towards yourself, your situation etc),

or 2. Moderate, post-psychotic, residual negative symptoms (this would be suggested by a loss of positive *and* negative feelings eg. not feeling any distress about something unpleasant which affects you personally... or by the persistence of some psychotic symptoms I'm not aware of).
I think it's rather unusual for pronounced negative sx to occur in schizoaffective disorder in the absence of any recent depression or psychosis. Chronic fatigue may have many causes, on the other hand, both medical and psychiatric.

or 3. some mixture of the above, with more of the depression.

Negative symptoms of psychosis normally involve at least some disorganisation of speech/writing and/or expression of odd/bizarre ideas. Neither is at all evident in your posts! Not even occasionally! Do you have any feelings of paranoia at all, or voices/hallucinations?

Impaired attention and fatigue are too non-specific to be helpful in diagnosis. Most forms of illness cause these symptoms!

Unfortunately, symptoms are often exacerbated by a person's circumstances. If you have been unable to work or go out much due to chronic ill-health, it's not surprising that increased amotivation has developed, whatever your condition.

Take care.

 

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