Schizophrenia is a chronic mental health disorder that affects how a person thinks, feels, and behaves. The symptoms of schizophrenia can be very distressing and have a profound impact on a person’s life.
What are the positive symptoms of schizophrenia?
The positive symptoms of schizophrenia refer to experiences that people with schizophrenia have that are not experienced by most other people. The main positive symptoms are:
- Hallucinations – hearing, seeing, smelling or feeling things that are not there. Auditory hallucinations, like hearing voices, are most common.
- Delusions – fixed, false beliefs not shared by others that the person holds even when there is evidence to the contrary. Common delusions include paranoia, grandiose delusions, delusions of control, and delusions of reference.
- Disorganized thinking – incoherent or illogical thought patterns.
- Disorganized speech – pattern of speaking that is disorganized and difficult to follow.
- Disorganized or abnormal motor behavior – includes repetitive behaviors, agitation, inappropriate childlike behavior.
These symptoms often lead to significant disruption in the person’s life including problems with relationships, work or self-care. The person may also appear confused, fearful or withdrawn.
Examples of How the Positive Symptoms May Feel
- Hallucinations: “I hear voices when no one else is around. The voices are loud and clear and tell me what to do or criticize me.”
- Delusions: “I think the FBI has implanted a computer chip in my brain to track me.”
- Disorganized thinking: “My thoughts are all jumbled up and don’t make much sense, even to me.”
- Disorganized speech: “People tell me they have a hard time following my train of thought when we talk.”
- Disorganized behavior: “I feel constantly restless and anxious. I pace around or rock back and forth without any real reason.”
What are the negative symptoms of schizophrenia?
The negative symptoms refer to a loss or decrease in normal functions and feelings. Common negative symptoms include:
- Lack of motivation or interest in life activities
- Social withdrawal or isolation
- Limited emotional expression – reduced gestures, vocal intonation
- Difficulty experiencing pleasure from normal activities (anhedonia)
- Slowed thinking and reaction time
- Poor hygiene and self-care
Negative symptoms often appear before positive symptoms and may be harder to recognize. They can be mistaken for depression or other health conditions. However, negative symptoms severely diminish a person’s quality of life.
Examples of How the Negative Symptoms May Feel
- Lack of motivation: “I don’t have the energy or interest to go to work or see my friends anymore.”
- Social withdrawal: “I’ve become very isolated and spend most of my time alone at home.”
- Limited emotional expression: “People say I seem emotionless, even about major events in my life.”
- Anhedonia: “Things that used to give me joy, like my hobbies, now leave me feeling flat.”
- Slowed thinking/reaction: “It takes me a long time to process questions and respond when someone talks to me.”
- Poor hygiene: “I don’t care about bathing or washing my clothes like I used to.”
What are the cognitive symptoms of schizophrenia?
In addition to positive and negative symptoms, many people with schizophrenia experience cognitive difficulties that affect their ability to function. Common cognitive symptoms include:
- Problems with memory and concentration
- Disorganized thinking and speech
- Poor problem-solving skills and abstract thinking
- Difficulty integrating information and processing stimuli
These cognitive deficits make it very hard for a person to manage their illness, interact socially, or perform well at work or school. The cognitive symptoms are often present before the onset of noticeable positive or negative symptoms.
Examples of How the Cognitive Symptoms May Feel
- Memory problems: “I can’t seem to remember simple things like names, dates or phone numbers anymore.”
- Concentration problems: “I struggle to stay focused on conversations or reading material.”
- Disorganized thinking: “My thoughts are racing all the time and I jump from one thing to the next.”
- Poor problem-solving: “Answering questions or making decisions is really difficult for me now.”
- Difficulty processing information: “When there’s a lot of noise or activity around me, I get overwhelmed very easily.”
What are the mood symptoms of schizophrenia?
Many people with schizophrenia also experience intense mood disturbances or mental health co-morbidities that exacerbate their illness, including:
- Severe depression
- Mania or bipolar-like episodes
- High anxiety
- Panic attacks
- Social phobias
- Suicidal thoughts
- Substance abuse disorders
These mood disturbances and co-morbid disorders often go hand in hand with schizophrenia. They can worsen positive symptoms like delusions and hallucinations, while also diminishing functioning and quality of life.
Examples of How the Mood Symptoms May Feel
- Depression: “I feel hopeless and cry all the time. I don’t want to get out of bed.”
- Mania: “My thoughts are racing and I feel like I have endless energy. I don’t feel like sleeping.”
- Anxiety: “I have constant, severe feelings of nervousness and panic.”
- Social phobia: “I feel incredibly self-conscious and anxious around other people.”
- Suicidal thoughts: “The voices keep telling me I’m worthless. Death seems like the only way to escape this.”
- Substance abuse: “Getting drunk or high is the only thing that helps quiet the voices.”
What triggers schizophrenia symptoms?
Schizophrenia symptoms are different for each person but are often triggered or exacerbated by factors like:
- High stress
- Drug or alcohol abuse
- Major life changes or traumatic events
- Isolation or lack of social support
- Stopping medication
- Physical illnesses or changes in brain chemistry
- External stimuli like loud noises or flashing lights
During periods of high stress or arousal, the symptoms may flare up. Having treatment strategies and support systems to help manage these symptom triggers can be very valuable for the person.
Examples of Triggers
- “Whenever I feel really stressed at work, the voices get much louder.”
- “Using drugs again after being clean caused me to have a bad psychotic episode.”
- “My hallucinations got much worse for a while after my mom passed away.”
- “When I isolate myself at home alone for too long, I start feeling more paranoid.”
- “Forgetting to take my meds caused my concentration problems to come back.”
- “Loud noise exacerbates my auditory hallucinations.”
How does schizophrenia typically develop over time?
Schizophrenia typically develops slowly, going through different phases:
- Prodromal phase: Subtle, negative symptoms like withdrawal from others, reduced concentration and interest in life may appear first and slowly worsen over months or years.
- Active phase: Positive symptoms like hallucinations, delusions, disorganized speech, and behavior emerge and are most severe during acute psychotic episodes.
- Residual phase: Positive symptoms improve with treatment but negative symptoms, cognitive deficits, and functional impairments often persist long-term.
Some people have long periods of relatively stable, milder symptoms between acute episodes. Others may experience a continuous decline in functioning. Supportive treatment soon after initial symptoms appear leads to better long-term outcomes.
| Phase | Common Symptoms | Timeframe |
|---|---|---|
| Prodromal phase | Social withdrawal, loss of interest, concentration problems | Months to years |
| Active phase | Hallucinations, delusions, disorganized speech and behavior | Days to months of acute episodes |
| Residual phase | Negative and cognitive symptoms persist, less positive symptoms | Years |
What are common misconceptions about how schizophrenia feels?
There are many misconceptions that contribute to the stigma around schizophrenia. It’s important to understand the facts:
- Myth: People with schizophrenia are violent or dangerous.
- Fact: They are no more violent than the general population. Their symptoms can sometimes lead to unpredictable behavior when untreated, but they are far more likely to be victims of violence.
- Myth: Schizophrenia means having a split personality.
- Fact: That describes dissociative identity disorder. Schizophrenia is about losing touch with reality, not developing split or multiple personalities.
- Myth: Schizophrenia is untreatable.
- Fact: While there is no cure, many people with schizophrenia can achieve long-term remission of symptoms and good quality of life with comprehensive treatment and support.
- Myth: People with schizophrenia cannot function or work.
- Fact: With effective therapies and accommodations, many can manage symptoms well enough to maintain relationships and employment.
What treatments help manage schizophrenia symptoms?
There are a variety of treatments that can ease schizophrenia symptoms, prevent relapses and improve quality of life. These include:
- Medications – Antipsychotic drugs help reduce hallucinations, delusions, disordered thinking and behavior. Other medications can treat co-morbid conditions like depression.
- Psychosocial Treatments – Therapy, social skills training, and support groups help patients manage symptoms, develop coping strategies, and improve functioning.
- Coordinated Specialty Care – Early intervention programs involving team-based care optimize outcomes. Key elements include case management, family education, psychotherapy, employment support, and medication management.
- Self-Care – Lifestyle approaches involving stress management, social interaction, sleep hygiene, avoiding drugs and alcohol, etc. help maintain stability.
Treatment needs to be personalized and address each individual’s spectrum of symptoms. Monitoring and adjusting treatment plans over time maximizes outcomes.
Conclusion
Schizophrenia has a profound effect on a person’s thoughts, emotions, perceptions, behaviors and quality of life. Hallucinations, delusions, disorganized thinking/speech, apathy, social withdrawal and other symptoms significantly disrupt life functioning. Symptoms and their severity vary by individual but often follow a pattern of progression over phases. While schizophrenia cannot be cured, a range of treatments help many people achieve stable remission and good quality of life. Increased understanding, access to care, lifestyle modifications and social support also enable those with schizophrenia to better manage their illness.