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Symptoms of Schizophrenia

People with schizophrenia may have perceptions of reality that are strikingly different from the reality seen and shared by others around them. Living in a world distorted by hallucinations and delusions, people with this condition may feel frightened, angry, anxious, depressed, or confused.
Symptoms of schizophrenia usually start in adolescence or early adulthood. They often appear slowly and become more pronounced, disturbing, and bizarre over time. The first signs of schizophrenia often appear as confusing—or even shocking—changes in behavior. To fit the diagnostic criteria, symptoms of the illness must be present for at least six months, and there must be deterioration from the patient’s previous level of functioning.
The sudden onset of severe psychotic symptoms is referred to as an acute phase of schizophrenia. Psychosis, a common condition in schizophrenia, is a state of mental impairment marked by hallucinations. Less obvious symptoms (such as social isolation and/or withdrawal, unusual speech, bizarre thinking, or strange behavior) may precede, coincide, or follow the psychotic symptoms.
People with schizophrenia may behave differently at unpredictable times. This unusual behavior usually occurs as a result of the unusual realities they are experiencing. People with this condition may seem distant, detached, or preoccupied. They may be very restless and/or hypervigilant and unable to sit or stand still, or sit as rigidly as a stone (catatonia) without moving or speaking for hours.
Common symptoms of schizophrenia include:
  • Hallucinations —Hallucinations involve seeing, hearing, touching, tasting, or smelling things that are not there. Hearing voices that other people do not hear is the most common type of hallucination observed in schizophrenia. Voices may describe the patient’s activities, carry on a conversation, warn of impending dangers, or even issue orders to the person (called command hallucinations).
  • Delusions —Delusions are false personal beliefs that are not based in reality. Delusions may take on different themes. For example, patients suffering from paranoid-type symptoms often have false and irrational beliefs that they are being cheated, harassed, poisoned, or conspired against. These patients may believe that they, a family member, a friend, or someone close to them are the focus of this persecution. In addition, they may believe that they are a famous or important figure. Sometimes the delusions experienced by people with schizophrenia are quite bizarre. For instance, they may believe that a neighbor is controlling their behavior with magnetic waves, that people on television are directing special messages to them, or that their thoughts are being broadcast aloud to others.
  • Disorganized thinking —Schizophrenia often affects a person’s ability to “think straight.” Thoughts may come and go rapidly. The person may not be able to concentrate on one thought for very long and may be easily distracted or unable to focus attention on any one subject or theme for very long. A person with schizophrenia may not be able to sort out what is relevant and irrelevant to a situation. He may be unable to connect thoughts into logical sequences, as their thoughts are often disorganized and fragmented.
  • Disorganized speech —People with schizophrenia often lack logical or continuity of thought, which makes carrying a conversation difficult if not impossible. This can lead to misunderstandings, fear, and eventually contribute to social isolation.
  • Catatonic behavior —Schizophrenia can include catatonic behavior, which is marked by slow or absent movement. Those experiencing catatonia can remain motionless for hours, demonstrate peculiar posturing, perform rhythmic gestures, or pace for an extended period of time.
  • Emotional flatness —People with schizophrenia often show little or no emotional expressiveness. They may show no signs of normal emotion, speak in a monotonous voice, lack facial expressions, and/or appear extremely disinterested.
  • Inappropriate laughter —Inappropriate emotions are common in people with schizophrenia. They may inappropriately laugh or act silly in response to situations and events not considered humorous by others.
  • Poor hygiene and self-care —A person with schizophrenia may not bathe, wash, or take care of his appearance.
  • Social isolation —A person with this condition may avoid contact with others and withdraw socially. If forced into situations that require interaction, he may do so inappropriately or in a bizarre manner.
Some people have only one psychotic episode. Others have many episodes during a lifetime, but lead relatively normal lives between these periods. A person with chronic schizophrenia, with a continuous or recurring pattern of illness, often does not fully recover normal functioning. This person typically requires long-term treatment, including medicine to control the symptoms.
People with schizophrenia do not always act abnormally. Indeed, some people with the illness can appear completely normal even while they experience hallucinations or delusions. A person’s behavior may change over time—often becoming strange or bizarre if medication is stopped, then returning closer to normal when receiving and complying with appropriate treatment.

References

Carson RC, Butcher JN, et al. Abnormal Psychology and Modern Life. 11th ed. Boston, MA: Allyn and Bacon; 2000.

DelBello M, Grcevich S. Phenomenology and epidemiology of childhood psychiatric disorders that may necessitate treatment with atypical antipsychotics. J Clin Psychiatry. 2004;65(suppl 6):12-19.

Keshavan MS, Roberts M, et al. Guidelines for clinical treatment of early course schizophrenia. Curr Psychiatry Rep. 2006;8:329-334.

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov.

Schizophrenia. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 4, 2010. Accessed September 6, 2010.

Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Mosby Elsevier; 2008.

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