Schizophrenia (cont.)
What are symptoms of schizophrenia?
The symptoms of schizophrenia fall into three broad categories:
- Positive symptoms are
unusual thoughts or perceptions, including hallucinations, delusions,
thought
disorder, and disorders of movement.
- 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 recognize 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 recognize 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 behaviors 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 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 behavior, 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 tumors), and feeling
things like invisible fingers touching their bodies when no one is near.
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 behavior 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 famous
historical figures. 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, in which the person has
difficulty organizing his or her thoughts or connecting them logically. Speech
may be garbled or hard to understand. Another form is "thought blocking," in
which the person stops abruptly in the middle of a thought. When asked why, the
person may say that it felt as if the thought had been taken out of his or her
head. Finally, the individual might make up unintelligible words, or
"neologisms."
Disorders of Movement. People with schizophrenia can be clumsy and
uncoordinated. They may also exhibit involuntary movements and may grimace or
exhibit 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. It 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 behavioral states. These include the following:
- 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 activities. Because it is not as obvious that negative symptoms are
part of a psychiatric illness, people with schizophrenia are often perceived as
lazy and unwilling to better their lives.
Cognitive symptoms
Cognitive symptoms are subtle and are often detected only
when neuropsychological tests are performed. They include the following:
- 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. They can
cause great emotional distress.
Next: When does it start and who gets it? »
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