A nurse is caring for a client who is diagnosed with schizophrenia. Which of the following manifestations should the nurse identify as a negative symptom?

A. Paranoia is a positive symptom of schizophrenia, characterized by excessive distrust and suspicion. Positive symptoms involve an excess or distortion of normal functions, such as hallucinations or delusions. Paranoia reflects an altered perception of reality rather than a diminished emotional or cognitive function. B. Distorted beliefs, including delusions, are considered positive symptoms of schizophrenia. These beliefs are false, fixed, and not based on reality, often involving grandiosity, persecution, or somatic concerns. Positive symptoms represent an exaggeration of normal thought processes rather than a reduction in function. C. Confusion is often associated with cognitive impairment in schizophrenia but is not classified as a negative symptom. Cognitive symptoms include deficits in memory, attention, and executive function, whereas negative symptoms involve the absence of normal emotional or behavioral responses. Confusion is more related to disorganized thinking rather than a loss of function. D. Lack of emotions, or affective flattening, is a negative symptom of schizophrenia. Negative symptoms involve a reduction in normal functions, such as diminished emotional expression, social withdrawal, and decreased motivation. These symptoms contribute significantly to functional impairment and are often more resistant to treatment than positive symptoms.