Signs and symptoms
Schizophrenia is a syndrome, which means it is characterized by groups of symptoms which may also overlap with symptoms of other psychiatric conditions. It may also be mimicked by organic psychiatric disorders or may be substance-induced or -associated. Thus, the clinical diagnosis rests upon the symptom pattern. However, there is a range of signs and symptoms that are commonly associated with a diagnosis of schizophrenia. These symptoms can be categorized as positive, negative, and general, more unspecific symptoms, along with cognitive symptoms that involve both social and neuropsychological dysfunction (Kahn et al., 2013).
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Positive symptoms of schizophrenia are extensively documented and often considered the most recognizable and prominent symptoms.
a. Delusional perceptions - are true perceptions, to which a person attributes a false meaning (e.g., a perfectly normal event such as the traffic lights turning red may be interpreted by the patient as meaning that e.g., Martians are about to land).
b. Hallucinations, in particular auditory hallucinations of commanding, commenting, or dialoging type. Hallucinations may also include other auditory, visual, olfactory, gustatory, or tactile sensations lacking a physical source of the perception.
c. Delusions – beliefs that are impossible or contradicted by reality, i.e., a fixed belief in something that is not backed by reality or may even be imposible. This can include e.g., the belief to be chased, followed, watched, poisoned, etc. Delusions can be categorized into 3 different categories. Persecutory delusions involve the idea that others are plotting against the individual, leading to a general distrust in people. Delusion of reference refers to the belief that everyday events are intentionally targeted at the individual. Somatic delusions involve the conviction that the person has a physical condition that contradicts medical advice. Delusions of grandeur are characterized by an inflated belief in the individual's power, abilities, or fame.
While delusions are listed among the core symptoms of schizophrenia they actually represent a secondary, failed response of the mind to address underlying perceptual alterations.
Positive symptoms can lead to intense discomfort for individuals. The intensity of positive symptoms can have a notable impact on a person's daily functioning, overall quality of life, and may also be linked to cognitive impairments.
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Negative symptoms of schizophrenia indicate a lack of typical behaviors and functions. These symptoms encompass:
a limited display of facial emotions,
decreased frequency and variety of gestures and vocal changes,
reduced eye contact,
lack of speech (alogia),
decreased social interaction,
diminished motivation (avolition),
poor hygiene, and
diminished pleasure (anhedonia). Anhedonia often presents as a lack of interest in recreational activities, difficulty experiencing closeness, and decreased interest in sexual activity.
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Studies investigating cognitive functioning in individuals with schizophrenia have identified abnormalities in various cognitive processes that hinder their daily functioning.
Social dysfunction has been found, involving poor emotion processing and theory of mind,
Lack of insight or awareness of having a mental disorder,
Problems with attention,
Problems with executive functioning,
Problems with learning,
Problems with decision making and memory.