What Are the 5 As of Schizophrenia?

Reviewed on 4/8/2022
What Are the 5 As of Schizophrenia
The 5 As of schizophrenia refer to negative symptoms: affective flattening, alogia, anhedonia, asociality, and avolition.

Schizophrenia is a brain disorder that affects how a person thinks, behaves, and feels. People who have schizophrenia can lose touch with reality and see or hear things that aren't there, believe things that aren't true, and/or not display emotions. 

There are three types of symptoms of schizophrenia:

  • Positive symptoms
    • Abnormal experiences or behaviors that occur because of schizophrenia which are psychotic manifestations 
    • Hallucinations: seeing, hearing, smelling, feeling, or tasting things that aren't there
    • Delusions
      • Irrational fears
      • Paranoia 
      • Believing things that are not true
    • Disorganized thinking or speech 
  • Negative symptoms 
    • Normal behaviors that stop because of schizophrenia
    • The 5 As of schizophrenia refer to negative symptoms:
      • Affective flattening
        • Lack of emotional display or not showing facial expressions (“flat affect”)
      • Alogia
        • Impaired thinking that affects speech
      • Anhedonia
        • No interest in being with others or doing things that used to be pleasurable
      • Asociality
        • Decreased interest in relationships with others
        • Decreased social interactions
      • Avolition
        • Reduced or lack of motivation 
        • Difficulty planning, starting, and sustaining activities
  • Cognitive symptoms 
    • Symptoms that affect thinking and memory, causing difficulty:
      • Making sense of new information
      • Solving problems
      • Learning and remembering
      • Focusing or paying attention
      • Making decisions
      • Understanding speech or other types of communication

Patients who have schizophrenia may also experience emotional symptoms such as anxiety and/or depression.

What Causes Schizophrenia?

It is not entirely understood what causes schizophrenia but it is thought to be due to a combination of factors: 

  • Genetics
    • Schizophrenia may run in families 
  • Environment, combined with genetic predisposition
    • Stressful surroundings
    • Exposure to viruses 
    • Prenatal nutritional problems
    • Poverty
  • Brain structure and function
    • Differences in brain structure, function, and interactions among neurotransmitters in the brain may contribute to the development of schizophrenia in some patients

What Is the Treatment for Schizophrenia?

Schizophrenia is treated with medications combined with counseling and support.

Antipsychotics are the primary type of medication used to treat schizophrenia, and patients usually have to take these drugs for the rest of their lives. Antipsychotics often cause uncomfortable side effects and as a result, many patients stop taking them. Never stop taking a prescribed medication without first talking to your doctor. It may be possible to change the dosage or regimen, or switch to a different medication to find one that works best for you and also minimize side effects. It often takes several attempts with different medications to find the right one for each individual patient. 

Counseling and other support for schizophrenia includes: 

  • Cognitive behavioral therapy (CBT)
  • Cognitive remediation interventions to help address the negative and cognitive symptoms of schizophrenia
  • Supported employment
  • Behavioral skills training
  • Family education and support programs
  • Coordinated specialty care (CSC), which is recovery-oriented treatment programs for people with first episode psychosis, an early stage of schizophrenia
  • Assertive Community Treatment (ACT) for individuals with schizophrenia who are at risk for repeated hospitalizations or homelessness


Schizophrenia is the most disabling mental illness. See Answer

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Reviewed on 4/8/2022
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