Which of the following best describes the 'deficit syndrome' in schizophrenia and its significance?

• A Persistent positive symptoms refractory to multiple antipsychotics
• B Cognitive decline secondary to chronic antipsychotic use
• C Primary, enduring negative symptoms (affective flattening, alogia, avolition) independent of depression or medication ✓
• D Periodic exacerbations of psychosis despite maintained treatment

Explanation

The deficit syndrome (Carpenter et al.) refers to primary, enduring negative symptoms — flat affect, alogia, avolition, anhedonia, and asociality — that are intrinsic to the illness and not secondary to positive symptoms, depression, medication side effects (e.g., drug-induced parkinsonism), or psychosocial deprivation. It is characterised by worse premorbid functioning, poorer response to antipsychotics, and a worse prognosis compared to non-deficit schizophrenia. This distinction guides treatment decisions (adding antidepressants or psychosocial interventions).

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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