Symptoms 

The symptoms of schizophrenia are divided into two groups; “positive” and “negative”.

It is important to realise that not all the symptoms of schizophrenia are always present in each patient. Any combination of the signs listed below can occur, which makes each case individual and often difficult to diagnose.

Positive Symptoms

The stereotypical characteristics of schizophrenia are part of this group.

Hallucinations

• Auditory hallucinations are common in schizophrenia. These often take the form of voices that sound utterly real, and may issue commands or offer advice or criticism. The voices can address the patient directly, or engage in conversation. They can be pleasant, but are often abusive, rude and upsetting.
• Auditory hallucinations can affect behaviour. Patients will often act upon commands regardless of the consequences and despite a previous adherence to the general rules of social function. However, the voices heard in schizophrenia can also be muted or ignored, or induce less obvious behavioural symptoms such as depression.

Other sensory hallucinations are less common in schizophrenia, but not entirely unheard of.

Delusions

Beliefs that are maintained with complete conviction despite an obvious lack of evidence are termed delusions.

• These may often arise in patients due to a misunderstanding of a situation, and can cause bewildering behaviour and a disregard of usual social awareness. Patients often struggle to discuss their delusions, and place more importance on their certainty about a situation over the opinions of others.
• Delusions are often based upon hallucinations. Patients may interpret the voices they hear as evidence of being monitored; the government is often held accountable for ‘spying’ on them.
• These often develop into paranoid delusions, based upon feelings of harassment or persecution. Paranoid delusions can be concerning everyday situations, from misunderstandings in personal relationships to changes in routine.
• They can also concern unusual situations, such as development of personal conspiracies or the belief that lifestyle is being influenced by secret technology. These delusions can affect many people, most often those closest to the patient as they may be perceived as the persecutors.
• Connections between unrelated aspects of life are common positive symptoms of schizophrenia. Patient often see hidden meanings in regular occurrences, such as methods of private communication like the number of people walking by or the colours of cars passing in the street.
• Feelings of being controlled are also common. Patients may describe the sensation of having thoughts taken away from them, or that their thoughts have been placed inside them by a separate entity. This may stretch to a conviction of complete control and the belief that someone or something is directing individual movements. Explanations can range from alien control and the use of technology to spiritual enlightenment or witchcraft.

Thought Disorder

Concentration may become difficult for patients.

• Everyday activities such as reading, studying, watching television or any other extended activity can become harder to focus upon.
• Thoughts are often unrelated and transient, with little consistency or connection. Communication of ideas can be a cause of frustration for patients with schizophrenia.

Disorganised Speech

• A regular consequence of Thought Disorder is a disorganisation of speech. Words and sentences may be as erratic as the thoughts that guide them, and can develop into verbal incoherence or nonsense.

Negative Symptoms

These symptoms are more difficult to recognise, and are based around an apparent lack of motivation or enthusiasm (termed avolition).

• Patients may appear to have no energy, or no interest in pursuing usual social activities. Everyday routines such as hygiene and cleanliness may become difficult to maintain, and concentrating on even small tasks can seem onerous.
• Social situations may also be avoided, and the patient can develop a desire for solitude based upon a feeling of being unable to communicate with others.

From the symptoms described above, it is clear that schizophrenia can cause dramatic and troublesome changes to lifestyle.

• This is at no time more obvious than when the patient is in a social situation. Family and friends will find many of the symptoms of schizophrenia hard to understand and deal with. This can have a profound effect on patients and heighten a sense of persecution, as well as contribute to communication problems.
• The consequent decrease in ability to function in a normal social manner is one of the many reasons that patients are also highly susceptible to depression; indeed, around 1 in 7 people with continuing symptoms will develop a depressive mood or state of mind. This is a serious aspect of the disorder that is linked to the relatively high rates of suicide among patients.

The video below gives a brief overview of personal accounts from patients suffering from schizophrenia and highlights many of the symptoms described above.

Hallucination image courtesy of Flickr at https://www.flickr.com/photos/modashell/3071828160/sizes/l/

Paranoia image courtesy of Flickr at https://www.flickr.com/photos/sweetjellyrolls/2217363840/sizes/l/

VideonCourtesy of YouTube at https://uk.youtube.com/watch?v=f4R6jln_eZg