The first signs of schizophrenia often appear as confusing, or even shocking, changes in behavior. Coping with the symptoms can be especially challenging for family members who remember how vital and present a person was before illness. The symptoms of schizophrenia are categorized into three groups: positive, negative, and disorganized. Positive symptoms refer to the presence of symptoms, such as hallucinations and delusions that should not be there. Negative symptoms indicate the absence of characteristics that are present in normal individuals: emotional expression, pleasure and normal speech patterns. Disorganized symptoms refer to difficulty in communicating with others, interpreting surroundings and feelings, and to their slow movements and repetitive gestures.
The sudden onset of severe psychotic symptoms is referred to as an "acute" phase of schizophrenia. "Psychosis" is a state of mental impairment marked by hallucinations, which are disturbances of sensory perception, and delusions, which result from an inability to separate real from unreal experiences. Other symptoms including social isolation or withdrawal, unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms.
Some people have only one such psychotic episode; others have many episodes over a lifetime, but lead relatively normal lives during the interim periods. "Chronic" schizophrenia refers to recurring patterns of illness from which a person often does not fully recover and typically requires long-term treatment to control symptoms.
Symptoms may include the presence of two or more of the following for at least one week:
Distorted Perceptions of Reality: Perceptions of reality that are strikingly different from the reality shared by others, which may leave sufferers feeling frightened, anxious, and confused. Due to these misperceptions, people with schizophrenia may experience sporadic bouts of seeming distant, detached, preoccupied, sitting rigidly for hours. Other times they may move about constantly, appearing wide-awake, vigilant, and alert.
Hallucinations and Illusions: Disturbances of perception that occur without connection to an appropriate source. They can be visual, tactile, gustatory, olfactory, and auditory. Voices may describe the patient's activities, carry on a conversation, warn of imminent dangers, or even give orders to the individual. Illusions occur when a sensory stimulus is present but incorrectly interpreted by the individual. For example, the sounds of crashing waves may be interpreted as gunfire.
Delusions: False personal beliefs that are unrelated to reason. Delusions may take on different themes. In a paranoid situation, a person may have delusions of persecution and think they are being cheated, harassed, conspired against, or poisoned. They also might have delusions of grandeur, in which they may believe they are famous or an important figure. A delusion might mean believing that a neighbor is controlling their behavior with magnetic waves or that people on television are directing special messages to them.
Thought Disorder Schizophrenia often affects a person's ability to think straight, and an inability to concentrate or focus attention.
People with schizophrenia may not be able to sort out what is relevant or not relevant to a situation. An inability to connect thoughts into logical sequences can make conversation very difficult and may encourage social isolation. If people cannot make sense of what an individual is saying, they are likely to become uncomfortable.
Emotional Expression
People with schizophrenia often show a "blunted" or "flat" affect which is a severe reduction in emotional expressiveness. Other symptoms may include a lack of normal emotion, speaking in monotone, diminished facial expressions, an extremely apathetic appearance, social withdrawal, and having nothing to say. Motivation can be greatly decreased, resulting in a person spending entire days with no activity, even neglecting hygiene.
