Signs and Symptoms of Schizophrenia

Schizophrenia is a chronic psychiatric disorder that affects how a person thinks, feels, and behaves. It is usually an episodic condition, where the severity of symptoms go up and down. 

Many factors have been linked to schizophrenia, including genetics and environmental factors, but it is not yet known exactly what causes it. Worldwide, it is estimated that around 1% of adults live with schizophrenia.

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Symptoms usually start to develop during young adulthood, between late adolescence, around 16 years old, and early thirties. Schizophrenia tends to emerge slightly earlier in men than in women.

Symptoms are typically progressive, meaning that, if left untreated, they will get worse over time. Effective treatments are available and there exist a variety of different options. With a comprehensive treatment plan, symptoms can be managed well.

A diagnosis of schizophrenia will be made clinically by a mental health practitioner using the "Diagnostic and Statistical Manual of Mental Disorders" (DSM–5). According to DSM-5, a diagnosis of schizophrenia requires two, or more, of the following symptoms to be exhibited for a significant portion of time during a one-month period:

  • Delusions
  • Hallucinations
  • Disorganized speech (e.g if someone frequently derails from their train of thought or is incoherent)
  • Grossly disorganized or catatonic behavior
  • Diminished emotional expression or avolition, also called negative symptoms

At least one of the symptoms involved in the diagnosis must be among the first three—delusions, hallucinations, or disorganized speech. As well as the significant portion of time that two or more symptoms are present over a one-month period, symptoms must also have been continuously present for at least six months.

It is also a requirement that symptoms are not caused by the effects of substance abuse, medication, or are due to another medical condition, and that there are significant problems with functioning in areas such as self-care, relationships, and/or at work. 

The symptoms of schizophrenia are broadly separated into either positive symptoms, negative symptoms, or cognitive symptoms.

You may have heard of terms such as paranoid schizophrenia, disorganised schizophrenia and catatonic schizophrenia. These are no longer classified as schizophrenia subtypes and have been dropped from the DSM-5.

Positive Symptoms

Positive symptoms are characterized by altered perceptions, including changes in vision, hearing, smell, touch, and taste. While they are referred to as positive, the term is not used to describe 'good' symptoms but rather the development of symptoms that a person without schizophrenia would not experience.

The main symptoms are:

  • Hallucinations: Experiences of things that are not real. For example, seeing or hearing things, such as voices, that are not there. While these types of hallucinations are the most common, a person can hallucinate a touch, taste or smell as well. 
  • Delusions: Firmly held beliefs that are not supported by objective facts. People with delusions can have distortions of self-experience (ipseity disturbance) where their grip on what they are aware of is destabilized. For example, they may display paranoia, the fear that others are out to get them, or believe those on television or radio are talking directly to them. 
  • Disorganized thoughts and speech: Ways of thinking or speaking that seem odd or illogical. This can involve stopping talking in the middle of a sentence or thought (also called thought blocking) or speaking incoherently, including making up words that have no meaning (also referred to as “word salad”).

Antipsychotic medications are effective treatments for positive symptoms. While they cannot cure schizophrenia, they can help relieve symptoms and improve quality of life.

Negative Symptoms

Negative symptoms are characterized by social withdrawal as well as difficulty with functioning normally and showing emotions. They are not referred to as negative because they are 'bad' but rather because they refer to the absence of normal emotional responses or thought processes.

The main symptoms are:

  • Alogia: A reduction in the amount a person speaks and a loss of spontaneity in the conversations they hold
  • Anhedonia: A reduced ability to experience pleasant emotions
  • Asociality: Decreased interest in, or motivation for, forming close relationships with others. Rather than referring to a person’s behavior, asociality refers mainly to how much someone values and desires social interaction and close social bonds. 
  • Avolition: A decrease in a person’s desire and interest in goal-directed activities
  • Blunted affect: A reduction in a person’s expression of emotion, including showing no facial expressions, such as smiles or frowns, or talking in a flat voice

These five symptoms can be broadly described as relating to either apathy or diminished expression. Apathy is characterized by anhedonia, asociality, and avolition, while diminished expression is characterized by alogia and blunted affect.

Negative symptoms may be primary or secondary symptoms. If they are primary they relate directly to the diagnosis of schizophrenia. If they are secondary they may have been caused as a side effect of antipsychotics or be a product of substance abuse or social deprivation. These secondary causes are easier to treat.

While antipsychotic medication can help manage positive symptoms, it has little effect on negative symptoms.

Cognitive Symptoms

Almost all patients with schizophrenia demonstrate some cognitive deficits, meaning they experience challenges in the way they think and understand the world around them. For example, someone experiencing cognitive symptoms might have difficulty processing information or trouble paying attention.

These symptoms are typically among the earliest signs of schizophrenia, often preceding the onset of the first severe episode, but they can be difficult to detect. While they are core features of schizophrenia, they are not considered core symptoms in the same way that positive and negative symptoms are.

Examples of cognitive symptoms include: 

  • Neurocognitive impairment: Such as issues with memory, attention and verbal learning as well as substantial difficulties in reasoning, planning, abstract thinking and problem solving
  • Impaired sensory perception: Such as impaired discrimination of tone, the inability to perceive visual illusions, and visual backward masking
  • Social cognition: Such as difficulties in correctly processing information from social clues. For example, a person with schizophrenia may struggle with accurately identifying and responding to facial expressions.

While medications can do very little to improve cognitive deficits in schizophrenia, there is growing evidence that cognitive remediation training (CRT), a behaviorally-based treatment, is effective.

Symptoms in Teens and Adolescents

While schizophrenia usually develops from late adolescence, in rare cases it can occur in younger children. It is estimated that approximately 1 in 10,000 may have childhood-onset schizophrenia (COS), where the illness is diagnosed prior to the age of 13.

The symptoms of schizophrenia in teens and adolescents are often hard to spot because many of the features of the condition are common during normal childhood development. Warning signs of early-onset schizophrenia (EOS) and childhood-onset schizophrenia (COS) include:

  • Introversion
  • Depression
  • Aggression
  • Suicidal ideation
  • Manic-like behaviors

Complications

Individuals with schizophrenia and other psychotic disorders are over-represented in the homeless population. It is not uncommon for people with schizophrenia to have substance use disorder. Nearly half of patients with schizophrenia exhibit either alcohol or illicit drug dependence during their lifetime. 

Substance abuse, in general, is linked to poor outcomes in terms of recovery. It can also increase the risk of suicide, trauma, and homelessness as well as the risk of developing other mental illnesses. For those affected, a comprehensive plan that includes treatment for substance abuse disorder is important.

Substance abuse has also been linked to the increased risk of committing violent crime among people with schizophrenia, who are thought to be four to six times more likely than the general population to commit violent crime.

This does not mean that a person with schizophrenia will be violent. There is considerable uncertainty over the link between schizophrenia itself and increased risk of violent behavior.

From a medical standpoint, schizophrenia has been linked with an increased risk of developing metabolic syndrome. This is a group of conditions, which include obesity, hypertension, and insulin resistance, that increase the risk of type 2 diabetes and cardiovascular disease. 

People with schizophrenia have a life expectancy 20% lower than the general population. The main reason behind this is due to physical illness.

A Word From Verywell

Schizophrenia usually develops slowly, with warning signs and cognitive deficits developing before the first severe episode. The early warning signs include:

  • Social withdrawal
  • Decline in self-care or personal hygiene
  • New difficulty in thinking clearly or concentrating
  • A worrying drop in grades or job performance
  • Suspiciousness of or uneasiness around other people
  • Difficulty telling reality from fantasy

These changes, by themselves, are not concerning. However, if you, or someone you love, experience a number of these changes in behavior then you should contact a mental health professional. Early diagnosis and treatment of schizophrenia increase the chance of successful recovery. 

If you or your loved one is thinking or talking about harming themselves, then contact someone who can help right away. You can call the toll-free, 24-hour National Suicide Prevention Lifeline (Lifeline) (800-237-8255).

If you require immediate emergency care then call 911 for emergency services or go to the nearest emergency room.

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