Positive and negative symptoms in schizophrenia. A critical reappraisal.

We reexamined the validity of subdividing schizophrenia into categorical subtypes using the predominance of positive and negative symptoms as the characteristic defining features. Using diagnostic criteria proposed in 1982, we again found that the negative subtype may be characterized by a variety of hypothesized correlates of structural brain abnormality, including poor premorbid adjustment, early age at onset, lower educational achievement, poor performance on cognitive testing, and poor response to treatment; a preponderance were also male and unemployed. The patients with negative symptoms did not have a significantly larger ventricular-brain ratio than did those with mixed or positive symptoms, however. As an alternative approach, patients were also classified by ventricle size (large and small); this classification had less predictive validity, with the use of hypothesized indexes of structural brain abnormality, than did the classification based on phenomenology.