524 CHAPTER 12
Alogia: Poverty of Speech
People with schizophrenia who have alogia, or poverty of speech, may respond
slowly or minimally to questions and generally speak less than do most other peo-
ple. A person with alogia will take a while to muster the mental effort necessary
to respond to a question. Even choosing among words can be challenging. For ex-
ample, if asked how he or she liked a television show that just ended, a person with
alogia might nod once very briefl y. If pushed to explain why the show was enjoy-
able, he or she might take 5–10 seconds to think and then just say “Funny.”Avolition: Diffi culty Initiating or Following Through
In movies portraying people with schizophrenia, hospitalized patients are often
shown sitting in chairs apparently doing nothing all day, not even talking to
others. This portrayal suggests avolition, the term for diffi culty in initiating or
following through with activities. For example, Hester Genain would often sit for
hours, seemingly staring into space, and had diffi culty beginning her chores.
The sets of positive and negative symptoms in DSM-IV-TR grew out of decades
of clinical observations of patients with schizophrenia; these symptoms can gener-
ally be observed or can be inferred by a trained individual. However, research has
revealed that cognitive defi cits—which are not part of the DSM-IV-TR criteria—
also play a crucial role in schizophrenia. Let’s examine these defi cits.Cognitive Defi cits: The Specifi cs
Research has revealed the important role that cognitive defi cits (also called neurocog-
nitive deficits) play in the course and prognosis of schizophrenia (Barch, 2005;
Green, 2001). In this section, we examine specifi c defi cits in attention, memory, and
executive functioning that arise in most people with schizophrenia (Keefe, Eesley, &
Poe, 2005; Wilk et al., 2005).Defi cits in Attention
Cognitive defi cits include diffi culties in sustaining and focusing attention, which can
involve distinguishing relevant from irrelevant stimuli (Gur et al., 2007). One indi-
vidual with schizophrenia recounted: “If I am talking to someone they only need
to cross their legs or scratch their heads and I am distracted and forget what I was
saying” (Torrey, 2001, p. 29).Defi cits in Working Memory
Another area of cognitive functioning adversely affected in people with schizophrenia
isworking memory, which consists of short-term memory and a set of executive pro-
cesses that operate on information in short-term memory (for example, by ordering it
in new ways). Working memory organizes and transforms incoming information so
that it will be available to be remembered later and also is involved in reasoning and
related mental activities (Baddeley, 1986). For example, if you are trying to remember
items you need to buy at the store, you will probably use working memory to organize
the items into easy-to-recall categories. People with schizophrenia do not organize
information effectively, which indicates that their working memories are impaired;
they may not remember something they were told or shown once or even a few times.
However, when presented with information on multiple occasions, people with
schizophrenia are able to store the information in long-term memory. Once the
information is successfully stored, they will remember it as well as people who do
not have schizophrenia (Chan et al., 2000; Green, 2001). Defi cits in working mem-
ory may also lead to disruptions in reasoning—and hence to disorganized speech
(Melinder & Barch, 2003).Defi cits in Executive Functioning
The problems with working memory apparently arise because people with schizo-
phrenia often have diffi culty with executive functions, which are mental processes
involved in planning, organizing, problem solving, abstract thinking, and exercising
good judgment (Cornblatt et al., 1997; Erlenmeyer-Kimling et al., 2000; Kim et al.,People with schizophrenia may exhibit fl at
affect—an extremely limited range of emotional
expression—which can make them appear
emotionally unresponsive. However, these people
report experiencing emotions to the same degree
as others do.Michael Newman/PhotoEdit
Alogia
A negative symptom of schizophrenia marked
by speaking less than most other people and
responding slowly or minimally to questions.Avolition
A negative symptom of schizophrenia marked
by diffi culty in initiating or following through
with activities.Executive functions
Mental processes involved in planning,
organizing, problem solving, abstract
thinking, and exercising good judgment.