Schizophrenia: Symptoms

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Schizophrenia Symptoms

• 03/30/05

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Schizophrenia is a PSYCHOTIC DISORDER (i.e., a
severe mental disorder in which thinking and
emotion are so impaired that the individual is
seriously out of contact with reality).
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Schizophrenia actually refers to a group of
disorders. There is not one essential symptom
that must be present for a diagnosis. Instead,
patients experience different combinations of the
main symptoms of schizophrenia.
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Two categories of symptoms in schizophrenia

• Positive symptoms
• Negative symptoms

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Positive Symptoms

• Distortions or excesses of normal functioning
  (e.g., delusions, hallucinations, disorganized
  speech/thought disturbances, motor disturbances)
• Positive symptoms are generally more responsive
  to treatment than negative symptoms

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Delusions

• False beliefs that are firmly and consistently
  held despite disconfirming evidence or logic
• Individuals with mania or delusional depression
  may also experience delusions. However, the
  delusions of patients with schizophrenia are
  often more bizarre (highly implausible).

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Types of delusions

• Delusions of persecution belief that one is the
  target of others mistreatment, evil plots,
  and/or murderous intent (most common)
• Delusions of reference belief that all
  happenings revolve around oneself, and/or one is
  always the center of attention

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Types of delusions

• Delusions of grandeur belief that one is a
  famous or powerful person from the past or
  present
• Delusions of control belief that some external
  force is trying to take control of ones thoughts
  (thought insertion), body, or behavior

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Example of delusions of controlThought
insertion Believing that thoughts that are not
your own have been placed in your mind by an
external sourceA 29-year-old housewife said, I
look out of the window and I think the garden
looks nice and the grass looks cool, but the
thoughts of Eamonn Andrews come into my mind.
There are no other thoughts there, only his He
treats my mind like a screen and flashes his
thoughts on it like you flash a picture.
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Types of delusions

• Thought broadcasting belief that ones thoughts
  are being broadcast or transmitted to others
• Thought withdrawal belief that ones thoughts
  are being removed from ones mind

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Thought broadcasting Believing that your
thoughts are broadcast or transmitted, so that
others know what you are thinkingA 21-year-old
student found that As I think, my thoughts leave
my head on a type of mental ticker-tape. Everyone
around has only to pass the tape through their
mind and they know my thoughts.
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Hallucinations

• Sensory experiences in the absence of any
  stimulation from the environment
• Any sensory modality may be involved auditory
  (hearing) visual (seeing) olfactory (smelling)
  tactile (feeling) gustatory (tasting)
• Auditory hallucinations are most common

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Common auditory hallucinations in schizophrenia

• Hearing own thoughts spoken by another voice
• Hearing voices that are arguing
• Hearing voices commenting on ones own behavior

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Disorganized Speech / Thought Disturbances

• Problems in organizing ideas and speaking so that
  a listener can understand
• Loose Associations (cognitive slippage)
  continual shifting from topic to topic without
  any apparent or logical connection between
  thoughts
• Neologisms new, seemingly meaningless words that
  are formed by combining words

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Example of loose associationsMy thoughts get
all jumbled up. I start thinking or talking about
something but I never get there. Instead, I
wander off in the wrong direction and get caught
up with all sorts of different things thaty may
be connected with things I want to say but in a
way I cant explian. People lisetning to me get
more lost than I do My trouble is that Ive got
too many thoughts. You might think about
something, lets say that ashtray and just think,
oh yes, thats for putting my cigarette in, but I
would think of it and then I would think of a
dozen different things connected with it at the
same time.
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Disorganized Motor Disturbances

• Extreme activity levels (unusually high or low),
  peculiar body movements or postures (e.g.,
  catatonic schizophrenia), strange gestures and
  grimaces

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Negative Symptoms

• Behavioral deficits that endure beyond an acute
  episode of schizophrenia
• More negative symptoms are associated with a
  poorer prognosis
• Some negative symptoms might be secondary to
  medications and/or institutionalization

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Types of negative symptoms

• Anhedonia inability to feel pleasure lack of
  interest or enjoyment in activities or
  relationships
• Avolition inability or lack of energy to engage
  in routine (e.g., personal hygiene) and/or
  goal-directed (e.g., work, school) activities

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Types of negative symptoms

• Alogia lack of meaningful speech, which may take
  several forms, including poverty of speech
  (reduced amount of speech) or poverty of content
  of speech (little information is conveyed vague,
  repetitive)
• Asociality impairments in social relationships
  few friends, poor social skills, little interest
  in being with other people

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Types of negative symptoms

• Flat affect no stimulus can elicit an emotional
  response. Patient may stare vacantly, with
  lifeless eyes and expressionless face. Voice may
  be toneless. Flat affect refers only to outward
  expression, not necessarily internal experience.

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Schizophrenia Subtypes

• Paranoid Type preoccupation with one or more
  delusions or frequent auditory hallucinations
• Disorganized Type disorganized speech,
  disorganized behavior, and flat or inappropriate
  affect
• Catatonic Type motoric immobility or excessive
  motor activity, extreme negativism or mutism,
  peculiar voluntary movement, echolalia or
  echopraxia
• Undifferentiated Type none of the above
• Residual Type Absence of prominent delusions,
  hallucinations, disorganized speech/behavior but
  odd beliefs/behavior or negative symptoms