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What are the Symptoms of Schizophrenia?

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Updated May 16, 2014

Woman clutching her head in mental anguish
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Question: What are the Symptoms of Schizophrenia?
Answer: The symptoms of schizophrenia seem peculiar to people who observe them. However, when people are experiencing schizophrenic symptoms they have little or no insight that their perceptions or behaviors are strange. The lack of insight can make schizophrenia very frustrating and frightening for loved ones.

Psychosis

Schizophrenia is classified as a psychotic disorder. People with schizophrenia have symptoms of psychosis, an abnormal state of consciousness in which the higher functions of the mind are disrupted. In psychosis, some combination of a person's perceptions, thought processes, beliefs, and emotions appear to become disconnected from reality. These symptoms may come and go, and the person may seem normal at times.

Most of the symptoms of schizophrenia are symptoms of psychosis, but it is possible to have psychotic symptoms without having schizophrenia. Symptoms of schizophrenia are categorized as one of three types: positive (psychotic) symptoms, negative symptoms, and cognitive symptoms.

Positive Symptoms of Schizophrenia

Positive symptoms of schizophrenia are behaviors and experiences that the ill person has that healthy people do not. Positive symptoms are also referred to as psychotic symptoms, although the word psychotic is used in many other ways as well. Positive symptoms include:
  • Delusions
    Delusions are false beliefs that don’t make sense in the context of a person’s culture. Although everyone has wrong beliefs from time to time, psychotic delusions also have an abnormal obsessive quality. People with psychotic delusions can’t be convinced that their beliefs aren’t real.

  • Hallucinations
    Hallucinations are false sensory experiences that have no basis in the external world. Psychotic hallucinations occur when the person is fully awake and not under the influence of alcohol or illicit drugs. Auditory hallucinations (hearing voices) and visual hallucinations (seeing things) are the most common, but a person can hallucinate a touch (for example, bugs crawling on the skin), taste or smell.

  • Disorganized speech
    Also known as loose association. In psychotically disorganized speech, words are not linked together based on the normal rules of language, but are strung together based on sounds, rhyme, puns, or free associations. Although everyone makes speech errors, especially when they’re tired or stressed, psychotically disorganized speech is obviously abnormal, and is difficult or impossible to understand.

  • Disorganized or catatonic behavior
    Psychotically disorganized behaviors are not goal-directed, and don’t make sense in context. For example, taking one’s clothes off to take a bath is sensible. Taking one’s clothes off on a public bus is an example of a disorganized behavior. Laughing at inappropriate times or for no reason is a disorganized behavior. Adopting strange postures or freezing are catatonic behaviors.

Negative Symptoms of Schizophrenia

Negative symptoms of schizophrenia describe normal traits that are absent or reduced in the person who is ill. Negative symptoms include:
  • Flattened affect
    Patients with flattened affect appear very emotionless, or have a very limited range of emotions. They show little response to emotional or disturbing situations or images.

  • Anhedonia
    Patients may fail to experience or express pleasure in things that they once found enjoyable.

  • Reduced speech.

  • Lack of initiative
    Also called avolition.

Cognitive Symptoms of Schizophrenia

Cognitive symptoms of schizophrenia have to do with the way a person thinks. Although cognitive symptoms are not used to diagnose schizophrenia, some are fairly common with the illness.
  • Difficulty maintaining attention
    The inability to maintain focused attention makes people with schizophrenia seem spacey or “out of it.”

  • Memory problems
    Schizophrenia often effects working memory, which is the kind of memory you use to keep things in your head for active processing, like the digits of a phone number you’re about to dial.

  • Difficulty planning and structuring activities
    Caused by reduced executive control. Executive control is the mental process that allows us to identify the steps needed to complete a task and then execute them in a proper order. Executive control also allows us to suppress our response to distractions in order to get something done.

  • Lack of insight
    People with schizophrenia have a specific cognitive blindspot that prevents them from understanding that they are ill. This means that loved ones and caregivers should remain as vigilant as possible to help the patient maintain the routines of treatment in order to control symptoms.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 2000.

Morrison, J. DSM-IV Made Easy: the Clinician’s Guide to Diagnosis. New York: The Guilford Press, 2006.

Schizophrenia: a detailed booklet that describes symptoms, causes, and treatments, with information on getting help and coping. National Institutes of Mental Health. (2006) http://www.nimh.nih.gov/health/publications/schizophrenia/summary.shtml

Torrey, E.F. Surviving Schizophrenia: a Manual for Families, Patients and Providers, 5th Edition. New York: HarperCollins Publishers, 2006.

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