The symptoms of schizophrenia can be broadly divided into three types – positive, negative and cognitive. The terms positive and negative might seem confusing in relation to schizophrenia. In Surviving Schizophrenia: A Family Manual, Dr. E. Fuller Torrey explains that the adjective “positive” denotes those symptoms which are present and should be absent, and “negative” denotes those that are absent but should be present. Positive symptoms range from hallucinations to auditory delusions. Negative symptoms refer to loss of ability to communicate and participate in daily life. Cognitive symptoms, as the term seems to suggest, indicate deficiencies in cognitive functions, such as the ability to analyze and organize, caused by schizophrenia.
Generally, positive symptoms are more visible than the other symptoms of schizophrenia. Hallucinations, delusions, and disorders in thought and movement, fall under this category.
A hallucination is an experience (seeing, hearing, tasting, touching, feeling) perceived as real by the hallucinator but which does not have a basis in any external stimulus. The most common schizophrenic hallucinations are auditory – “voices” that instruct the patient to do something, comments or threatens the patient etc. Other examples of hallucinations include seeing things or people that do not exist or feeling as if unseen fingers are touching them.
A delusion can range from a delusion of grandeur to a delusion of persecution. Generally, the delusion is an irrational belief that the patient will not let go of, even if it is proved to be wrong. Believing oneself to be a famous historical figure, or imagining that there is a conspiracy to kill the patient are examples of the two kinds of delusions.
Schizophrenia affects the thought process; therefore, disorganized thinking is an important symptom of this illness. Sometimes the patient will have trouble connecting different thoughts coherently. This leads to distortions in speech. Another symptom of thought disorder is “thought blocking” where the person stops does not finish the thought he/she is articulating. If questioned, they will reply that the thought has been plucked out of their brain.
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The movements and body language of a person with schizophrenia can seem awkward and uncoordinated. They may also show involuntary movements, repeated movements, facial contortions and in very rare cases, catatonia or extreme rigidity of limbs.
A person suffering from schizophrenia will have very little energy and this will manifest itself as lack of motivation. They may not seem very interested in daily life. For instance, they may ignore basic norms of hygiene. Often, this is misunderstood to be laziness.
Flat/blunted affect is another negative symptom of schizophrenia. This indicates a “flattening” of emotions. It would seem as if the schizophrenia patient does not have emotions because their facial expressions and body language does not show any emotion. But this is not true. The individual can feel deep emotions but is not capable of showing it outwardly.
Depression and social withdrawal are other typical negative symptoms of schizophrenia. People with schizophrenia may have less than normal ability to take pleasure in daily life and interact with others.
While positive and negative symptoms of schizophrenia may be more obvious, the neurocognitive symptoms are subtler and might require medical testing to confirm. In general, the schizophrenia patient may have less ability to take in and analyze information. Their attention spans, decision-making abilities, problem-solving abilities and working memories may be comparatively diminished.
When talking about the different symptoms of schizophrenia, it is worthwhile to demystify the idea that schizophrenia causes patients to become violent. Most people with schizophrenia are not prone to violence and only a small minority of people who commit violent acts are schizophrenic.