What are the symptoms of schizophrenia?
The symptoms of schizophrenia fall into three broad categories:
- Positive symptoms are unusual thoughts or perceptions that include hallucinations, delusions and thought disorder.
- Negative symptoms represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are harder to recognise as part of the disorder and can be mistaken for laziness or depression.
- Cognitive symptoms (or cognitive deficits) are problems with attention, certain types of memory, and the executive functions that allow us to plan and organize. Cognitive deficits can also be difficult to recognise as part of the disorder but are the most disabling in terms of leading a normal life.
Positive symptoms
Positive symptoms are easy-to-spot behaviours not seen in healthy people and usually involve a loss of contact with reality. They include hallucinations, delusions, thought disorder, and disorders of movement. Positive symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether or not the individual is receiving treatment.
Hallucinations. A hallucination is something a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. "Voices" are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices that may comment on their behaviour, order them to do things, warn them of impending danger, or talk to each other (usually about the patient). They may hear these voices for a long time before family and friends notice that something is wrong. Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects (although this can also be a symptom of certain brain tumours), or feeling things like invisible fingers touching their bodies when no one is close by.
Delusions. Delusions are false personal beliefs that are not part of the person's culture and do not change, even when other people present proof that the beliefs are not true or logical. People with schizophrenia can have delusions that are quite bizarre, such as believing that neighbors can control their behaviour with magnetic waves, people on television are directing special messages to them, or radio stations are broadcasting their thoughts aloud to others. They may also have delusions of grandeur and think they are a famous historical figure. People with paranoid schizophrenia can believe that others are deliberately cheating, harassing, poisoning, spying upon, or plotting against them or the people they care about. These beliefs are called delusions of persecution.
Thought Disorder. People with schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking where the person may have difficulty organizing his thoughts or connecting them logically. Speech may be garbled or hard to understand. Another form is "thought blocking" where the person stops abruptly in the middle of a thought. When asked sometimes the person says it felt as if the thought had been taken out of his head. Finally, the individual might make up unintelligible words, so-called "neologisms."
Disorders of Movement. People with schizophrenia can be clumsy and uncoordinated. They may also show involuntary movements and may show grimacing or unusual mannerisms. They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness that was more common when treatment for schizophrenia was not available; fortunately, it is now rare.
Negative symptoms
The term "negative symptoms" refers to reductions in normal emotional and behavioural states. These include:
- flat affect (immobile facial expression, monotonous voice),
- lack of pleasure in everyday life,
- diminished ability to initiate and sustain planned activity, and
- speaking infrequently, even when forced to interact.
People with schizophrenia often neglect basic hygiene and need help with everyday living activities. Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived by others as lazy and not willing to better their lives.
Cognitive symptoms
Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include:
- poor executive functioning (the ability to absorb and interpret information and make decisions based on that information),
- inability to sustain attention, and
- problems with working memory (the ability to keep recently learned information in mind and use it right away).
Cognitive impairments often interfere with the patient's ability to lead a normal life and earn a living, and can cause great emotional distress.
