Self-portrait of a person with Schizophrenia, representing that individual's perception of the distorted experience of reality in the disorder
Individuals with Schizophrenia may experience hallucinations (most reported are hearing voices), delusions (often bizarre or persecutory in nature), and disorganized thinking and speech. The latter may range from loss of train of thought, to sentences only loosely connected in meaning, to incoherence known as word salad in severe cases. Social withdrawal, sloppiness of dress and hygiene, and loss of motivation and judgment are all common in Schizophrenia. There is often an observable pattern of emotional difficulty, for example lack of responsiveness. Impairment in social cognition is associated with Schizophrenia, as are symptoms of paranoia; social isolation commonly occurs. Difficulties in working and long-term memory, attention, executive functioning, and speed of processing also commonly occur. In one uncommon subtype, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation, all signs of catatonia. About 30% to 50% of people with Schizophrenia do not have insight; in other words, they do not accept their condition or its treatment. Treatment may have some effect on insight. People with Schizophrenia often find facial emotion perception to be difficult.

Positive and negative
Schizophrenia is often described in terms of positive and negative (or deficit) symptoms. Positive symptoms are those that most individuals do not normally experience but are present in people with Schizophrenia. They can include delusions, disordered thoughts and speech, and tactile, auditory, visual, olfactory and gustatory hallucinations, typically regarded as manifestations of psychosis. Hallucinations are also typically related to the content of the delusional theme. Positive symptoms generally respond well to medication.
Negative symptoms are deficits of normal emotional responses or of other thought processes, and respond less well to medication. They commonly include flat or blunted affect and emotion, poverty of speech (alogia), inability to experience pleasure (anhedonia), lack of desire to form relationships (asociality), and lack of motivation (avolition). Research suggests that negative symptoms contribute more to poor quality of life, functional disability, and the burden on others than do positive symptoms. People with prominent negative symptoms often have a history of poor adjustment before the onset of illness, and response to medication is often limited.

Some Details:
Schizophrenia symptoms range from mild to severe. The symptoms of Schizophrenia fall into three broad categories: Positive Symptoms, Negative Symptoms, and Cognitive Symptoms. These are:
I. Positive Symptoms refer to a distortion of a person's normal thinking and functioning. They are "psychotic" behaviors. People with these symptoms are sometimes unable to tell what's real from what is imagined. Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often "lose touch" with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. Positive symptoms include:

A)HALLUCINATIONS are false sensory perceptions which are not based on real external stimuli,hallucinations are either recurrent or persistent and experienced in a state of full wakefulness or alertness.

Types of Hallucinations:

1. Auditory - e.g. hearing voices, music, etc.
- Most common
- may be threatening (commanding self-harm)

2. Visual - Seeing something that is not there e.g.: a person or small animal
- Often accompanies auditory hallucinations

3. Tactile - perception that something is happening to the outside of the body
- e.g.: bugs are crawling over body (often with cocaine psychosis)

4. Somatic - perception that something is happening inside one’s body
- e.g.: worms eating one’s intestines

5. Olfactory - perception of a smell
- Usually indicates an organic condition e.g.: temporal lobe epilepsy

B)Delusions

A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in Schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies.The person believes delusions even after other people prove that the beliefs are not true or logical. They are implausiblePatient is typically preoccupied by themPatients are resistant to contradictory arguments or facts proving their delusions wrong.

Types of Delusions:

1. Paranoid delusions: -Most common
- Belief of being watched or tormented by people they know or authorities. E.g. A Beautiful Mind – Prof. Nash contacted the FBI about conspiracies to take over the world

2. Grandiose delusions: - belief that one is a special person or entity or has special powers.


3. Delusions of reference: - believe that random events or comments are directed at them- e.g.: television broadcast is referring to them, or news announcer is talking to him/her.

4. Delusions of control: - belief that one’s thoughts are being controlled by outside forces – thought insertion or thought extraction

5. Somatic delusions: - false belief involving functioning of the body

C)FORMAL THOUGHT DISORDERS:

Ways of thinking that are not usual or helpful. People with thought disorders may have trouble organizing their thoughts. Sometimes a person will stop talking in the middle of a thought. And some people make up words that have no meaning. Thought disorders are unusual or dysfunctional ways of thinking such as:

1. Poverty of content – thought that gives little information because of vagueness, empty repetitions or obscure phrases.

2. Loosening of associations / derailment - gradual or sudden deviation in train of thought. Slip from one topic to another, unrelated topic.

3. Tangentially - inability to have goal-directed associations of thought; speaker never gets to desired point to desired goal /

4. Perseveration - persisting response to a previous stimulus after a new stimulus has been presented.

5. Word salad - incoherent mixture of words and phrases

D)MOVEMENT DISORDERS: may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may stop moving or talking for a while, a rare condition called "Catatonia.".Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for Schizophrenia was not available.

E) Disorganized speech
Fragmented thinking is characteristic of Schizophrenia. Externally, it can be observed in the way a person speaks. People with Schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in Schizophrenia include:
 

Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next. Neologisms – Made-up words or phrases that only have meaning to the patient. Perseveration – Repetition of words and statements; saying the same thing over and over. Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").

F) DISORGANIZED BEHAVIOR
Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as:
 

A decline in overall daily functioning Unpredictable or inappropriate emotional responses Behaviors that appear bizarre and have no purpose Lack of inhibition and impulse control

II-Negative Symptoms
The so-called “negative” symptoms of Schizophrenia refer to the absence of normal behaviors or decreased functions found in healthy individuals. Common negative symptoms of Schizophrenia include:

Lack of emotional expression – Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
Lack of interest or enthusiasm – Problems with motivation; lack of self-care.
Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.
Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone.

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Physically immobile - the patient cannot speak or move. They may stare and hold their body in a fixed position. They appear to be unaware of their surroundings (catatonic stupor).
Waxy flexibility - this is part of physical immobility. If the patient's arm, for example, is moved by someone else into a certain position, it remains in that position for possibly hours.
Excessive mobility - the patient moves excitedly with what appears to have no specific or useful purpose. This may include pacing around energetically, walking in circles, making loud and unusual utterances.
Uncooperative - the patient may resist any attempt to move them. They may say absolutely nothing (not speak) and not respond to instructions.
Strange movements - the patient's posture may be unusual or inappropriate. There may be bizarre mannerisms and grimacing.
Unusual behavior - the patient may repeat words, follow a ritual/routine with obsession. He/she may be obsessed with lining things up in a specific way.
Echolalia (mimicking utterances) and/or Echopraxia(mimicking movements) - the patient may repeat something someone else has just said. There may be repetition of a movement or gesture made by another person.
Apart from the above, which are examples of catatonic Schizophrenia symptoms, the patients may also have the following signs and symptoms of Schizophrenia:

Thought disorder - the person may jump from one subject to another for no logical reason. The speaker may be hard to follow. The patient's speech might be muddled and incoherent. In some cases the patient may believe that somebody is messing with his/her mind.
Lack of motivation (avolition) - the patient loses his/her drive. Everyday automatic actions, such as washing and cooking are abandoned. It is important that those close to the patient understand that this loss of drive is due to the illness, and has nothing to do with slothfulness.
Poor expression of emotions - responses to happy or sad occasions may be lacking, or inappropriate.
Social withdrawal - when a patient with Schizophrenia withdraws socially it is often because he/she believes somebody is going to harm them. Other reasons could be a fear of interacting with other humans because of poor social skills.
Unaware of illness - as the hallucinations and delusions seem so real for the patients, many of them may not believe they are ill. They may refuse to take medications which could help them enormously for fear of side-effects, for example.
medical help on their own. When their symptoms appear to have subsided, it is common for them to believe they are fine and do not need treatment. Seeking medical help is frequently initiated by a family member or good friend.

III-Cognitive Symptoms are not easy to see, but they can make it hard for people to have a job or take care of themselves. Cognitive Symptoms include:

 

Trouble using information to make decisions Problems using information immediately after learning it Trouble paying attention.

Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following:
• Poor "executive functioning" (the ability to understand information and use it to make decisions)
• Trouble focusing or paying attention
• Problems with "working memory" (the ability to use information immediately after learning it).
Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.
Teens can get Schizophrenia, but it may be hard to see at first. This is because the symptoms may look like problems many teenagers have. A teen developing Schizophrenia may:

 

Start getting bad grades in school Change friends Have trouble sleeping Be irritable or moody.