ABSTRACT
Emotional dysfunction and schizophrenia have long been uncomfortable bedfellows. It was Bleuler who first argued that problems of affect lie at the heart of schizophrenia and that the symptoms we all focus on, the hallucinations and delusions, are merely ‘accessory’ and common to many forms of disorder. This view gave way to the now familiar distinction between affective and non-affective psychosis and to Jaspers’ hierarchical approach to diagnosis wherein affective symptoms are ‘trumped’ by the presence of schizophrenia in terms of diagnosis and treatment. Yet emotional dysfunction is pervasive in non-affective psychosis! Sometimes (and unhelpfully) referred to as ‘comorbidity’, this includes: depression, usually accompanied by hopelessness and suicidal thinking; social anxiety, usually accompanied by social avoidance and problems forming relationships; and traumatic (post-traumatic stress disorder; PTSD) symptoms. There is also the distress (fear, anger, shame) attached to the experience of psychotic symptoms themselves. Emotional dysfunction, in common with the core symptoms and disabilities, develops rapidly and aggressively during the prodrome and early phase (Table 7.1).1
