Types of symptoms

The symptoms of schizophrenia are generally divided into three categories: positive, negative, and cognitive symptoms. Schizophrenia is a complex, long-term medical illness that distorts the senses, making it very difficult for the individual to distinguish what is real from what is not real. Symptoms are not always present, and the illness can involve repeated episodes throughout the individual’s lifetime. People with the illness will have various symptoms to varying degrees.

• Positive Symptoms

  In schizophrenia, positive symptoms represent experiences not shared by others. These can include hallucinations, where individuals see or hear things that aren't present, and delusions, which are false beliefs resistant to reasoning. Understanding and addressing these symptoms are crucial aspects of schizophrenia support. Positive symptoms include:

  

  • Hallucinations

    Hearing, seeing, or, less commonly, tasting, smelling, or feeling things that are not there. However, the hallucination is very real to the person experiencing it.

  • Delusions

    False beliefs that don’t change even when the person who holds them is presented with new ideas or facts. People who have delusions may also have problems concentrating, confused thinking, or the sense that their thoughts are blocked.

  • Grandiosity

    Belief that you can control other people’s minds, are a well-known historical or media figure, or are an important and influential person (e.g., writer, musician, inventor, politician, police, military personnel, religious figure, etc.).

  • Paranoia

    An unfounded or excessive suspicion of the motives of others. People believe that others can read their thoughts or are plotting against them.

• Negative Symptoms

  Negative symptoms of schizophrenia involve a decrease or absence of certain abilities or emotions that are typically present. This may manifest as reduced motivation, social withdrawal, or challenges in expressing emotions. Recognizing and addressing negative symptoms is important for comprehensive schizophrenia support. Negative symptoms include:

  

  • Anosognosia

    A very severe lack of awareness. This is not simply denial of illness but a lack of awareness of the illness. The individual cannot understand that they are ill. Anosognosia occurs in more than 50 percent of people who are diagnosed with schizophrenia and can have a severe impact on an individual’s prognosis and outcome.

    The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) says that anosognosia is “the most common predictor of non-adherence to treatment. It has been found to predict higher relapse rates, increased number of involuntary treatments, poorer psychosocial functioning, aggression, and a poorer course of illness”.

    Anosognosia also occurs in other mental illnesses, including bipolar disorder, although it is more common in severe mental illnesses like schizophrenia. It also occurs in people with brain injury and other brain-based diseases like Huntington’s and Parkinson’s.

  • Alogia

    Difficulty with speaking. In some people, this means a reduced amount of speech and reduced verbal fluency (the ease with which words are chosen). People with alogia struggle to give brief answers to questions, for example.

  • Avolition (Apathy)

    Associated with social withdrawal. The individual lacks energy, spontaneity, and initiative. There is a loss of drive and interest. It’s very difficult to begin a new task or to finish any assignment.

  • Anhedonia (Asociality)

    Few recreational interests/activities; impaired personal and sexual relationships; uncommunicative, detached, distant.

  • Inattention

    Impaired concentration; social inattentiveness; inattentiveness during conversation; poor rapport.

  • Catatonia

    In this state, the person becomes unreactive to their environment. They could become resistant to instruction, maintain a rigid, fixed and/or inappropriate posture, or completely lack verbal or physical responses. They could also move slowly, repeat rhythmic gestures,and or make ritualistic movements. Catatonia can also look like excessive movement like grimacing, staring, being mute, or echoing what others say.

  • Emotional Flattening

    Marked by diminished emotional responsiveness, including having few expressive gestures; changes in facial expression; stilted, forced, or artificial gestures; poor eye contact; lack of vocal inflection; decreased spontaneous movements.

• Cognitive Symptoms

  Cognitive symptoms refer to difficulties with the thinking skills needed to process information, gain new knowledge, learn, and solve problems. They impact the skills that allow people to function in daily life, including attention, learning and memory, reasoning and decision-making, and social cognition. Cognitive symptoms include:

  

  • Disorganized perceptions

    Trouble making sense of everyday sights, sounds, and feelings. Perceptions may be distorted, so ordinary things become distracting or frightening. The individual may experience extra sensitivity to background noises, colours, and shapes.

  • Disorganized Thinking and Speech

    Trouble understanding language, communicating in coherent sentences, or carrying on a conversation. The person may switch from one topic to another quickly. Their thoughts may seem sped up or slowed down.

  • Disorganized Behaviour

    Loss of short-term memory and organizational skills make planning, prioritizing, and decision-making tasks difficult, if not impossible.

  • Cognitive Deficits

    People living with schizophrenia and other psychotic disorders often develop profound and disabling cognitive deficits. Even more than positive or negative symptoms, cognitive deficits can impair daily functioning and are a major factor in chronic disability and unemployment. However, some programs can help improve cognitive abilities alongside medication, offering hope for better functioning and a higher quality of life.

    Dealing with Cognitive Dysfunction Associated with Psychiatric Disabilities – A handbook for families and friends of individuals with psychiatric disorders – published by the New York State Office of Mental Health

    The Consequences of Mental Illness That Nobody Talks About – published in HuffPost news, written by Susan Inman, BCSS Board Director, and author of After Her Brain Broke: Helping My Daughter Recover Her Sanity.