Changes in thinking and behaviour are the most obvious symptoms of schizophrenia. People experience schizophrenia and its symptoms in different ways.
The earlier the symptoms are identified and treatment is started, the better the outlook.
The symptoms of schizophrenia are usually classified into one of two categories: positive or negative.
- Positive symptoms represent a change in behaviour or thoughts, such as hallucinations or delusions.
- Negative symptoms represent a withdrawal or lack of function that you would usually expect to see in a healthy person. For example, people with schizophrenia often appear emotionless, flat and apathetic.
The illness may develop slowly. The first signs of schizophrenia, such as becoming socially withdrawn and unresponsive or experiencing changes in sleeping patterns, can be hard to identify. Because the first symptoms often develop during adolescence, the changes can be mistaken for an adolescent 'phase'.
People often have episodes of acute schizophrenia, during which their positive symptoms are particularly severe, followed by periods where they experience few or no positive symptoms.
Positive symptoms of schizophrenia
A hallucination occurs when a person experiences a sensation when there is nothing or nobody there to account for it. A hallucination can involve any of the senses, but the most common is hearing voices.
Although other people cannot hear the voices or experience the sensations, they seem real to the person experiencing them. Research using brain-scanning equipment has shown that there are changes in the speech area of the brain in people with schizophrenia when they hear voices. These studies show that the experience of hearing voices is a real one, as if the brain mistakes thoughts for real voices.
Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive or just annoying. The voices might describe activities taking place, discuss the hearer's thoughts and behaviour, give instructions or talk directly to the person. Voices may come from different places or they may come from one place in particular, such as the television.
A delusion is a belief that is held with complete conviction, even though it is based on a mistaken, strange or unrealistic view. It may affect the way people behave. Delusions can begin suddenly or may develop over a period of weeks or months.
Some people develop a delusional idea to explain a hallucination they are having. For example, if they have heard voices describing their actions, they may have a delusion that a secret agent is monitoring their actions. Someone experiencing a paranoid delusion may believe that they are being harassed or persecuted. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend.
Some people who experience delusions find different meanings in everyday events or occurrences. They may believe that people on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing in the street.
Confused thoughts (thought disorder)
People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme. People sometimes describe their thoughts as 'misty' or 'hazy' when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand.
Changes in behaviour and thoughts
Behaviour may become more disorganised and unpredictable, and appearance or dress may seem unusual to other people. People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason.
Some people feel that their thoughts are being controlled by someone else, that their thoughts are not theirs, or that the thoughts have been planted in their mind by someone else. Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind. Some people feel that their body is being taken over and someone else is directing their movements and action
Negative symptoms of schizophrenia
The negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia.
Symptoms during the prodromal period usually begin gradually and then slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene.
It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else. Negative symptoms experienced by people living with schizophrenia include:
- losing interest and motivation in life and activities, including relationships and sex
- lack of concentration, not wanting to leave the house and changes in sleeping patterns
- being less likely to initiate conversations and feeling uncomfortable with people, or feeling that there is nothing to say
The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes be mistaken for deliberate laziness or rudeness.