Negative Symptoms — MRCPsych Paper B MCQ

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EasyRehabilitationNegative SymptomsMRCPsych Paper B

A 42-year-old man with schizophrenia has been stable on aripiprazole for 2 years and has no current hallucinations or delusions. On a rehabilitation ward, he shows little spontaneous activity, rarely initiates social contact and has markedly reduced facial and vocal emotional expression. He denies low mood and is alert during assessment. Which symptom domain is predominant?

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Correct answer: E — Negative symptoms

The correct answer is E, negative symptoms. Little spontaneous activity indicates avolition, reduced initiation of social contact indicates asociality or social withdrawal, and reduced emotional expression indicates blunted affect. These are characteristic negative symptoms of schizophrenia. Positive symptoms include hallucinations, delusions and thought disorder, which are absent. Cognitive symptoms would involve deficits such as impaired attention, memory or executive functioning. Affective symptoms would require evidence of a mood syndrome; he denies low mood, and reduced outward expression alone is blunted affect rather than depression. Catatonia involves features such as stupor, mutism, posturing, negativism or excitement, none of which are described. Secondary causes of apparent negative symptoms should still be considered clinically.

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), Context section. 2014; last reviewed 29 July 2025. https://www.nice.org.uk/guidance/cg178/chapter/Context