Abnormalities of mood of some description are common. This is most often a flat or empty affect, especially in patients with an insidious onset and pronounced lack of will. There is not usually a pronounced and pervasive depression or elation of mood (if so, consideration of a primary mood disorder would be appropriate as an alternative diagnosis). Irritability and fear may also be present, as in response to delusions or hallucinations. The mood may be incongruous, for example, inexplicably cheerful, sometimes seeming to vary according to the content of auditory hallucinations.

Extreme mood changes of elation, depression, or rage may occur. Sustained depressive symptoms are found in at least 50 per cent of patients on follow-up, and are probably part of the schizophrenic process, although they may also represent side-effects of antipsychotic drug treatment, or a response to the realization of having such a serious disease.

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