Schizophrenia is often described in terms of positive (or productive) and negative (or deficit) symptoms.
Positive symptoms include:
- auditory hallucinations,
- and thought disorder, and are typically regarded as manifestations of psychosis.
Negative Symptoms are so-named because they are considered to be the loss or absence of normal traits or abilities, and include features such:
- as flat or blunted affect and emotion,
- the poverty of speech (alogia),
- and lack of motivation (avolition). Despite the appearance of blunted affect, recent studies indicate that there is often a normal or even heightened level of emotionality in Schizophrenia especially in response to stressful or negative events.
- A third symptom grouping, the disorganization syndrome, is commonly described and includes chaotic speech, thought, and behavior. There is evidence for a number of other symptom classifications.
- Cognitive symptoms – these affect the person’s thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
- Emotional symptoms – these are usually negative symptoms, such as blunted emotions.
Delusions of persecution
The belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).
Delusions of Reference
A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically to them.
Delusions of Grandeur
The belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).
Delusions of Control
The belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”) and thought withdrawal (“The CIA is robbing me of my thoughts.”).
Hallucinations are sounds or other sensations experienced as real when they exist only in the person’s mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.
Signs and symptoms of paranoid schizophrenia
- Disorganized speech
- Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
- Common signs of disorganized speech in schizophrenia include Loose associations — Rapidly shifting from topic to topic, with no connection between one thought and the next.Neologisms — Made-up words or phrases that only have to mean to the patient.Perseveration — Repetition of words and statements; saying the same thing over and over.Clang — Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head.”).
Signs and symptoms of disorganized schizophrenia
- Disorganized schizophrenia generally appears at an earlier age than other types of schizophrenia. Its onset is gradual, rather than abrupt, with the person gradually retreating into his or her fantasies. The distinguishing characteristics of this subtype are disorganized speech, disorganized behavior, and blunted or inappropriate emotions. People with disorganized schizophrenia also have trouble taking care of themselves and may be unable to perform simple tasks such as bathing or feeding themselves.
- The symptoms of disorganized schizophrenia include:
- Impaired communication skills
- Incomprehensible or illogical speech
- Emotional indifference
- Inappropriate reactions (e.g. laughing at a funeral)
- Infantile behavior (baby talk, giggling)
- Peculiar facial expressions and mannerisms
- People with disorganized schizophrenia sometimes suffer from hallucinations and delusions, but unlike the paranoid subtype, their fantasies aren’t consistent or organized.
Signs and symptoms of catatonic schizophrenia
The hallmark of catatonic schizophrenia is a disturbance in movement: either a decrease in motor activity, reflecting a stuporous state, or an increase in motor activity, reflecting an excited state.
Stuporous motor signs
The stuporous state reflects a dramatic reduction in activity. The person often ceases all voluntary movement and speech and may be extremely resistant to any change in his or her position, even to the point of holding an awkward, uncomfortable position for hours.
- Thought disorder – the person may jump from one subject to another for no logical reason. The speaker may be hard to follow or erratic.
Excited motor signs
Sometimes, people with catatonic schizophrenia pass suddenly from a state of stupor to a state of extreme excitement. During this frenzied episode, they may shout, talk rapidly, pace back and forth, or act out in violence either toward themselves or others.
People with catatonic schizophrenia can be highly suggestible. They may automatically obey commands, imitate the actions of others, or mimic what others say.
Other symptoms may include:
- Lack of motivation (avolition) – the patient loses their drive. Everyday actions, such as washing and cooking, are neglected.
- Poor expression of emotions – responses to happy or sad occasions may be lacking, or inappropriate.
- Social withdrawal – when a patient with schizophrenia withdraws socially, it is often because they believe somebody is going to harm them.
- Unawareness of illness – as the hallucinations and delusions seem so real for patients, many of them may not believe they are ill. They may refuse to take medication for fear of side effects, or for fear that the medication may be poison, for example.
- Cognitive difficulties – the patient’s ability to concentrate, recall things, plan ahead, and to organize their lives are affected. Communication becomes more difficult.