Schizophrenia symptoms usually start between the ages of 16 and 30. These are the core symptoms (American Psychiatric Association, 2013, p. 99):
- Delusions: False fixed beliefs.
- Hallucinations: Perceiving things not existing.
- Disorganized speech: Frequent derailment or incoherence.
- Disorganized or catatonic behavior: Bizarre movements and often body kept rigid and immobile.
- Negative symptoms: Diminished emotional expression and lack of motivation.
What is Schizophrenia?
Schizophrenia is a chronic and serious mental illness that affects a person’s thinking, expression of emotions, behavior, perception of reality, and relationships. It is a type of mental illness known as “psychosis”. In psychosis, one cannot distinguish between what is real and what is imagined – delusions or hallucinations that have no connection to reality. At times, they may lose touch with reality, manifesting as a sudden change in personality and behavior, which is referred to as a psychotic episode. Contrary to popular belief, schizophrenia is not the same as split or multiple personality.
Schizophrenia affects 1 in 100 people worldwide, and 1 in 200 people in the United States. Thus, it is not as common as some of the major mental illnesses, but its symptoms can be severely disabling. The symptoms can develop so slowly over the years that the person may not even know until it is full-blown. However, in some cases, it can strike suddenly and develop quickly.
What are the Symptoms of Schizophrenia?
Early Symptoms of Schizophrenia
The condition usually shows up in men in their late teens or early 20s. In women, it mostly appears in their late 20s and early 30s. Symptoms can be present for days, weeks, or even years before full psychosis, which is the prodromal period. It can be difficult to spot it because there’s often no clear trigger. Usually, only subtle behavioral changes may be seen, especially in teens (Sadock, et al., 2017, pp. 1415-1456).
The early symptoms include:
- Decline in academic performance
- Social withdrawal
- Decreased concentration
- Outbursts of temper
- Difficulty sleeping
Positive Symptoms of Schizophrenia
In this context, positive does not mean good. It refers to thoughts or actions not based on reality. Hallucinations and delusions are called psychotic symptoms. The obvious and dramatic psychotic symptoms are synonymous with schizophrenia for the general public and for many clinicians. For most people, they are what is fascinating and frightening about schizophrenia.
- Delusions: These are “fixed false beliefs” that are not based in reality and the person continues to hold on to them even when shown the facts. For example, these can include the beliefs that they are God or the devil (delusions of grandeur), that other people can hear their thoughts (thought broadcasting) or that people are putting thoughts into their head (thought insertion) or plotting against them (delusions of persecution or paranoid delusions). Delusions of reference in which neutral stimuli or events or people take on a particular significance in reference to the person. More than 70% of people with schizophrenia will have delusions. Delusions are not experiences that happen only to the mentally ill.
- Hallucinations: Hallucinations are said to be present when you see, hear, feel, taste or smell things that are not there in reality. Hallucinations do not confirm or exclude schizophrenia versus any other psychiatric diagnosis, and the finding of frequent hallucinations in the general public (up to 15% of them) suggests that the presence of hallucinations does not by itself confirm psychiatric illness.
- Hearing voices (auditory hallucinations) is the most common one, present in more than 70% of people with schizophrenia. The content of auditory hallucinations is generally derogatory or threatening and often patients will hear expletives, threats, demeaning personal comments, and accusations of vile thoughts or behaviors. They can last from waking until bedtime or can come in irregular periods of seconds or minutes a few times a month. Sometimes, the voices may issue commands which might be obeyed.
- Seeing things that aren’t there (visual hallucinations, in about 40-50% of patients)
- Smelling strange odors (olfactory hallucinations)
- Having a funny taste in your mouth (gustatory hallucinations)
- Feeling sensations on your skin even though nothing is touching your body (tactile hallucinations).
- Disorganized Speech: It typically arises from abnormal thought processes. Here the person can’t think clearly or respond as expected. They are also referred to as “thought disorder” or “loosening of associations”. Examples include:
- Talking in incomplete sentences or suddenly going off-topic when speaking (tangential speech), thus impairing communication
- Thought blocking – suddenly stopping speaking and forgetting the original topic
- Neologisms – the invention and use of new words
- Perseveration – repeating words or sentences (echolalia)
- Pressured speech – very rapid speech, sometimes to the point of meaninglessness and incoherence (word salad)
- Disorganized behavior or Catatonia:They may sometimes mimic the motor behaviors of others, which is referred to as Rocking when sitting or standing is common, as is patients hugging themselves, wringing their hands, or toying with their clothing, or hair, or small objects around them. Their body may become rigid and immobile for a very long time (catatonia).
Negative Symptoms of Schizophrenia
Negative symptoms mean the absence of normal behaviors. The severity of negative symptoms predicts short-term and long-term disability better than the severity of other symptoms of schizophrenia. Negative symptoms do not exist only in schizophrenia or only in psychiatric illness. They are seen in 5 to 10 percent of the population who do not meet criteria for a psychiatric illness.
The negative symptoms include:
- Flattening or blunting of affect: Lack or reduced expression of emotions either in face or voice tone. Emotional responses to happy or sad occasions may be lacking, or inappropriate.
- Social withdrawal: Withdrawal from family, friends, and social activities, often because they believe somebody is going to harm them
- Physical anergia: Less energy
- Alogia: Speaking less / poverty of speech content
- Avolition (Lack of motivation): difficulty beginning and sustaining goal-directed activities, leading them to be inactive and neglecting even daily living activities like bathing and grooming
- Anhedonia: Loss of pleasure or interest in life
- Inattentiveness: during social interactions or during testing
Cognitive Symptoms of Schizophrenia
Cognitive symptoms refer to difficulties with concentration and memory. They will have:
- Poor executive functioning: Trouble understanding information and using it to make decisions
- Trouble with focusing or paying attention
- Decline in working memory: Trouble using information immediately after learning it
- Lack of insight or awareness of their disorder (i.e., anosognosia): Trouble recognizing that they have any of these problems. They may argue that there is nothing wrong with them.
Most people with schizophrenia will experience significant depression and anxiety during the course of their illness, which are sort of co-morbidities. Depression can be confused with negative symptoms and vice versa, though there is no similarity between negative symptoms and depression in schizophrenia. Social phobia, panic attacks and panic disorder, and generalized anxiety disorder are common in schizophrenia.
Agitation, irritability or frank hostility, uncooperativeness, and impulsivity can be present in schizophrenia. In the mind of the general public schizophrenia is sometimes synonymous with violence, but people with schizophrenia are far more likely to be the victims of violence than the perpetrators. However, the presence of a diagnosis of schizophrenia increases the risks of committing violence or being arrested.
Not every person with schizophrenia will have all of the above symptoms. Each person will have a different set of symptoms. Currently, there are no radiological, laboratory, or psychometric tests for the disorder, and the diagnosis rests largely upon clinical features.
According to the DSM-5 (American Psychiatric Association, 2013, p. 99), a diagnosis of schizophrenia requires that:
- A person has two or more of the five core symptoms, one of which must be hallucinations, delusions, or disorganized speech, for at least one month.
- Level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is below the level prior to the symptoms.
- Continuous signs of the disturbance last for at least 6 months.
- Other mental illnesses with psychotic symptoms have been ruled out.
- The disturbance is not caused by substance abuse.
- It is not caused by the presence of another medical condition such as autism or a communication disorder.
Diagnosing Schizophrenia in Children
- The main features of schizophrenia are the same in children, but it is more difficult to make the diagnosis. Delusions and hallucinations may be less pronounced than in adults, and visual hallucinations are more common and should be distinguished from normal fantasy play.
- Disorganized speech and disorganized behavior can occur in other childhood disorders like autism and ADHD; hence these symptoms should not be attributed to schizophrenia without proper consideration of those childhood disorders.
- Childhood-onset cases have poorer outcomes, with gradual onset and prominent negative symptoms.
- Children who later receive the diagnosis of schizophrenia are more likely to have experienced nonspecific emotional-behavioral disturbances and psychopathology, intellectual and language alterations, and subtle motor delays (American Psychiatric Association, 2013, pp. 102-103).
If reading through the above symptoms and diagnosis does not allow you to make an assessment of whether you or a loved one has schizophrenia, then take this 2-minute Schizophrenia Test to ascertain. After taking the test if you suspect a problem, then see a psychiatrist as soon as possible. Do not delay, and do not be afraid of being diagnosed with it nor consider it a label you are stuck with because with early diagnosis and treatment many people make a complete recovery, and in most of those that do not it can be managed effectively.
Recovery from Schizophrenia
Being diagnosed with schizophrenia does not mean you have to suffer lifelong from it. In fact, the prognosis of schizophrenia is not as bad as it is made out to be, with the “rule of quarters” (Living With Schizophrenia, n.d.) suggesting the outcomes after 10 years from diagnosis:
- About 25% of people will recover completely and go on to have no further problems in their life.
- A further 25% will improve substantially with treatment and will go on to recover almost all of their former level of functioning with very few relapses.
- Another 25% of people will improve somewhat but will still need considerable levels of support to function normally and to tide over relapses, which will occur at several intervals in their life.
- In the remaining 25%, the outlook is not so good. Of these, 15% will have little or no improvement, leading to repeated hospital stays over a prolonged part of their adult life, whilst the final 10% will commit suicide.
Note that there is no known prevention for schizophrenia.
- American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing.
- Living With Schizophrenia, n.d. Can you recover from schizophrenia?. [Online]
Available at: https://www.livingwithschizophreniauk.org/information-sheets/can-you-recover-from-schizophrenia/ [Accessed 22 August 2019].
- Sadock, B. J., Sadock, V. A. & Ruiz, P., 2017. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer.