Self-portrait of a person with Schizophrenia,
representing that individual's perception of the
distorted experience of reality in the disorder
Individuals with Schizophrenia may experience
hallucinations (most reported are hearing voices),
delusions (often bizarre or persecutory in nature),
and disorganized thinking and speech. The latter may
range from loss of train of thought, to sentences
only loosely connected in meaning, to incoherence
known as word salad in severe cases. Social
withdrawal, sloppiness of dress and hygiene, and
loss of motivation and judgment are all common in
Schizophrenia. There is often an observable pattern
of emotional difficulty, for example lack of
responsiveness. Impairment in social cognition is
associated with Schizophrenia, as are symptoms of
paranoia; social isolation commonly occurs.
Difficulties in working and long-term memory,
attention, executive functioning, and speed of
processing also commonly occur. In one uncommon
subtype, the person may be largely mute, remain
motionless in bizarre postures, or exhibit
purposeless agitation, all signs of catatonia. About
30% to 50% of people with Schizophrenia do not have
insight; in other words, they do not accept their
condition or its treatment. Treatment may have some
effect on insight. People with Schizophrenia often
find facial emotion perception to be difficult.
Positive and negative
Schizophrenia is often described in terms of
positive and negative (or deficit) symptoms.
Positive symptoms are those that most individuals do
not normally experience but are present in people
with Schizophrenia. They can include delusions,
disordered thoughts and speech, and tactile,
auditory, visual, olfactory and gustatory
hallucinations, typically regarded as manifestations
of psychosis. Hallucinations are also typically
related to the content of the delusional theme.
Positive symptoms generally respond well to
Negative symptoms are deficits of normal emotional
responses or of other thought processes, and respond
less well to medication. They commonly include flat
or blunted affect and emotion, poverty of speech (alogia),
inability to experience pleasure (anhedonia), lack
of desire to form relationships (asociality), and
lack of motivation (avolition). Research suggests
that negative symptoms contribute more to poor
quality of life, functional disability, and the
burden on others than do positive symptoms. People
with prominent negative symptoms often have a
history of poor adjustment before the onset of
illness, and response to medication is often
Schizophrenia symptoms range from mild to severe.
The symptoms of Schizophrenia fall into three broad
categories: Positive Symptoms, Negative Symptoms,
and Cognitive Symptoms. These are:
I. Positive Symptoms refer to a distortion of a
person's normal thinking and functioning. They are
"psychotic" behaviors. People with these symptoms
are sometimes unable to tell what's real from what
is imagined. Positive symptoms are psychotic
behaviors not seen in healthy people. People with
positive symptoms often "lose touch" with reality.
These symptoms can come and go. Sometimes they are
severe and at other times hardly noticeable,
depending on whether the individual is receiving
treatment. Positive symptoms include:
are false sensory perceptions which
are not based on real external
stimuli,hallucinations are either recurrent or
persistent and experienced in a state of full
wakefulness or alertness.
Types of Hallucinations:
1. Auditory - e.g. hearing voices, music, etc.
- Most common
- may be threatening (commanding self-harm)
2. Visual - Seeing something that is not there e.g.:
a person or small animal
- Often accompanies auditory hallucinations
3. Tactile - perception that something is happening
to the outside of the body
- e.g.: bugs are crawling over body (often with
4. Somatic - perception that something is happening
inside one’s body
- e.g.: worms eating one’s intestines
5. Olfactory - perception of a smell
- Usually indicates an organic condition e.g.:
temporal lobe epilepsy
A delusion is a firmly-held idea that a
person has despite clear and obvious evidence that
it isn’t true. Delusions are extremely common in
Schizophrenia, occurring in more than 90% of those
who have the disorder. Often, these delusions
involve illogical or bizarre ideas or fantasies.The
person believes delusions even after other people
prove that the beliefs are not true or logical. They
are implausiblePatient is typically preoccupied by
themPatients are resistant to contradictory
arguments or facts proving their delusions wrong.
Types of Delusions:
Paranoid delusions: -Most common
- Belief of being watched or tormented by people
they know or authorities. E.g. A Beautiful Mind –
Prof. Nash contacted the FBI about conspiracies to
take over the world
Grandiose delusions: -
belief that one is a
special person or entity or has special powers.
Delusions of reference: -
believe that random
events or comments are directed at them- e.g.:
television broadcast is referring to them, or news
announcer is talking to him/her.
Delusions of control: -
belief that one’s
thoughts are being controlled by outside forces –
thought insertion or thought extraction
Somatic delusions: -
false belief involving functioning of the body
C)FORMAL THOUGHT DISORDERS:
Ways of thinking that
are not usual or helpful. People with thought
disorders may have trouble organizing their
thoughts. Sometimes a person will stop talking in
the middle of a thought. And some people make up
words that have no meaning. Thought disorders are
unusual or dysfunctional ways of thinking such as:
1. Poverty of content
– thought that gives little
information because of vagueness, empty repetitions
or obscure phrases.
Loosening of associations / derailment
or sudden deviation in train of thought. Slip from
one topic to another, unrelated topic.
- inability to have goal-directed
associations of thought; speaker never gets to
desired point to desired goal /
- persisting response to a previous
stimulus after a new stimulus has been presented.
- incoherent mixture of words and phrases
may appear as agitated body
movements. A person with a movement disorder may
repeat certain motions over and over. In the other
extreme, a person may stop moving or talking for a
while, a rare condition called "Catatonia.".Movement
disorders may appear as agitated body movements. A
person with a movement disorder may repeat certain
motions over and over. In the other extreme, a
person may become catatonic. Catatonia is a state in
which a person does not move and does not respond to
others. Catatonia is rare today, but it was more
common when treatment for Schizophrenia was not
E) 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
Loose associations – Rapidly shifting from topic
to topic, with no connection between one thought and
Neologisms – Made-up words or phrases that only
have meaning 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
F) DISORGANIZED BEHAVIOR
Schizophrenia disrupts goal-directed activity,
causing impairments in a person’s ability to take
care of him or herself, work, and interact with
others. Disorganized behavior appears as:
A decline in overall daily functioning
Unpredictable or inappropriate emotional responses
Behaviors that appear bizarre and have no purpose
Lack of inhibition and impulse control
The so-called “negative” symptoms
of Schizophrenia refer to the absence of normal
behaviors or decreased functions found in healthy
individuals. Common negative symptoms of
Lack of emotional expression
– Inexpressive face,
including a flat voice, lack of eye contact, and
blank or restricted facial expressions.
Lack of interest or enthusiasm
– Problems with
motivation; lack of self-care.
Seeming lack of interest in the world
unawareness of the environment; social withdrawal.
Speech difficulties and abnormalities
to carry a conversation; short and sometimes
disconnected replies to questions; speaking in
A symptom is something the patient senses and
describes, while a sign is something other people,
such as the doctor notice. For example, drowsiness
may be a symptom while dilated pupils may be a sign.
- the patient cannot speak or
move. They may stare and hold their body in a fixed
position. They appear to be unaware of their
surroundings (catatonic stupor).
- this is part of physical
immobility. If the patient's arm, for example, is
moved by someone else into a certain position, it
remains in that position for possibly hours.
- the patient moves excitedly
with what appears to have no specific or useful
purpose. This may include pacing around
energetically, walking in circles, making loud and
- the patient may resist any attempt
to move them. They may say absolutely nothing (not
speak) and not respond to instructions.
- the patient's posture may be
unusual or inappropriate. There may be bizarre
mannerisms and grimacing.
Unusual behavior -
the patient may repeat words,
follow a ritual/routine with obsession. He/she may
be obsessed with lining things up in a specific way.
Echolalia (mimicking utterances) and/or Echopraxia(mimicking movements)
- the patient may
repeat something someone else has just said. There
may be repetition of a movement or gesture made by
Apart from the above, which are examples of
catatonic Schizophrenia symptoms, the patients may
also have the following signs and symptoms of
- the person may jump from one
subject to another for no logical reason. The
speaker may be hard to follow. The patient's speech
might be muddled and incoherent. In some cases the
patient may believe that somebody is messing with
Lack of motivation (avolition)
- the patient loses
his/her drive. Everyday automatic actions, such as
washing and cooking are abandoned. It is important
that those close to the patient understand that this
loss of drive is due to the illness, and has nothing
to do with slothfulness.
Poor expression of emotions
- responses to happy
or sad occasions may be lacking, or inappropriate.
- when a patient with
Schizophrenia withdraws socially it is often because
he/she believes somebody is going to harm them.
Other reasons could be a fear of interacting with
other humans because of poor social skills.
Unaware of illness
- as the hallucinations and
delusions seem so real for the patients, many of
them may not believe they are ill. They may refuse
to take medications which could help them enormously
for fear of side-effects, for example.
medical help on their own. When their symptoms
appear to have subsided, it is common for them to
believe they are fine and do not need treatment.
Seeking medical help is frequently initiated by a
family member or good friend.
are not easy to see, but they
can make it hard for people to have a job or take
care of themselves. Cognitive Symptoms include:
Trouble using information to make decisions
Problems using information immediately after
Trouble paying attention.
Cognitive symptoms are subtle. Like negative
symptoms, cognitive symptoms may be difficult to
recognize as part of the disorder. Often, they are
detected only when other tests are performed.
Cognitive symptoms include the following:
• Poor "executive functioning" (the ability to
understand information and use it to make decisions)
• Trouble focusing or paying attention
• Problems with "working memory" (the ability to use
information immediately after learning it).
Cognitive symptoms often make it hard to lead a
normal life and earn a living. They can cause great
Teens can get Schizophrenia, but it may be hard to
see at first. This is because the symptoms may look
like problems many teenagers have. A teen developing
Start getting bad grades in school
Have trouble sleeping
Be irritable or moody.