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Signs and Symptoms of Schizophrenia

Schizophrenia is a devastating brain disorder that affects approximately 2.2 million American adults, or 1.1 percent of the population age 18 and older. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings.

Schizophrenia interferes with a person's ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or early twenties. People with schizophrenia often suffer psychotic symptoms, such as delusions and hallucinations.

Hallucinations are perceptions that occur without connection to an appropriate source. Although hallucinations can occur in any sensory form-auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory (smell)-hearing voices that other people do not hear is the most common type of hallucination in schizophrenia. Voices may describe the patient's activities, carry on a conversation, warn of impending dangers, or even issue orders to the individual suffering from schizophrenia. Illusions, on the other hand, occur when a sensory stimulus is present but is incorrectly interpreted by the person with schizophrenia.

Delusions are false personal beliefs held by the person with schizophrenia, but have no basis in reality. Delusions may take on different themes. For example, patients with schizophrenia suffering from paranoid-type symptoms-roughly one-third of people with schizophrenia-often have delusions of persecution, or false and irrational beliefs that they are being cheated, harassed, poisoned, or conspired against. These people with schizophrenia may believe that they, or a member of the family or someone close to them, are the focus of this persecution.

In addition, delusions of grandeur, in which a person with schizophrenia may believe he/she is a famous or important figure, may occur in schizophrenia. Sometimes the delusions experienced by people with schizophrenia are quite bizarre; for instance, believing that a neighbor is controlling their behavior with magnetic waves; that people on television are directing special messages to them; or that their thoughts are being broadcast out loud to others.

Schizophrenia often affects a person's ability to "think straight." Thoughts may come and go rapidly; the person with schizophrenia may not be able to concentrate on one thought for very long and may be easily distracted, unable to focus attention.

Less obvious symptoms of schizophrenia, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms for a person with schizophrenia. Some people with schizophrenia have only one such psychotic episode, while other people with schizophrenia may have many episodes during a lifetime, yet lead relatively normal lives during the interim periods.

The sudden onset of severe psychotic symptoms of schizophrenia is referred to as an "acute" phase of schizophrenia. The individual with "chronic" schizophrenia, or a continuous or recurring pattern of illness, often does not fully recover normal functioning and typically requires long-term treatment for schizophrenia, generally including medication, to control the symptoms of schizophrenia.

The first outward signs of schizophrenia often appear as confused thinking or speech, and behavior that doesn't make sense. Changes in behavior may include such things as trouble communicating in coherent sentences or carrying on conversations with others; slower movement; repeat rhythmic gestures or movements such as walking in circles or pacing; difficulty making sense of everyday sights, sounds and feelings.

Outward symptoms of schizophrenia can include emotional flatness or lack of expression; inability to start and follow through with activities; speech that is brief and lacks content; lack of pleasure or interest in life. These symptoms of schizophrenia refer to a lack of certain characteristics that should be there but are notably absent in the person with schizophrenia.

People with schizophrenia often show "blunted" or "flat" affect. This refers to a severe reduction in emotional expressiveness. A person with schizophrenia may not show the signs of normal emotion, perhaps may speak in a monotonous voice, have diminished facial expressions, and/or appear extremely apathetic. The person with schizophrenia may withdraw socially, avoiding contact with others.

People with schizophrenia may not be able to sort out what is relevant and what is not relevant to a situation. The person with schizophrenia may be unable to connect thoughts into logical sequences, and their sentences may become disorganized and fragmented. This lack of logical continuity of thought in a person with schizophrenia, termed "thought disorder," can make conversation very difficult and may contribute to social isolation. If people cannot make sense of what an individual is saying, they are likely to become uncomfortable and tend to leave that person alone.

Schizophrenia is also associated with changes in cognition. These changes affect the ability to remember and to plan for achieving goals, so that the social life of a person with schizophrenia is sorely affected as well. Also, attention and motivation are diminished in the person with schizophrenia, so that "normal" expectations in a relationship, such as physical affection, effective listening skills, etc., can be nonexistent in a person with schizophrenia .

In some severe cases, a person with schizophrenia can spend entire days doing nothing at all, even neglecting basic hygiene. These problems with emotional expression and motivation, which may be extremely troubling to family members and friends, are symptoms of schizophrenia-not character flaws or personal weaknesses (a common misconception regarding people with schizophrenia).

At times, it is difficult to tell one mental disorder from another. Since schizophrenia also affects mood, for instance, some people with symptoms of schizophrenia exhibit prolonged extremes of elated or depressed mood, and it is important to determine whether such a patient has schizophrenia or actually has bipolar disorder or major depressive disorder. A person who has symptoms of both schizophrenia and bipolar disorder is sometimes diagnosed as having a "schizoaffective disorder."

In determining whether a person has schizophrenia, it is important to rule out other medical illnesses as well, as sometimes people suffer severe mental symptoms or even psychosis due to undiagnosed medical conditions. Because of this, a medical history should be taken and a physical examination and laboratory tests should be done to rule out other possible causes of the symptoms before concluding that someone has schizophrenia.

Lastly, since commonly abused drugs may cause symptoms resembling schizophrenia, a drug screen from blood or urine samples from the person should be done at a hospital or physicians' office to test for the presence of these drugs before a definitive diagnosis of schizophrenia is made.

About the Author

Michele Soloway has dealt with bipolar disorder from a very young age. Her grandmother, mother, herself, and her teenage son all have the disorder. She also lost her sister to suicide because of bipolar disorder. Michele has a blog for bipolar survivors at http://bipolarsurvivor.blogspot.com, and is also a contributing writer to www.bipolarcentral.com.

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Being the Ultimate Perfectionist

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I am the ultimate perfectionist.  Yes, me.  I even got a fortune cookie one time that said, "You have a yearning for perfection," do you believe that?"  Even Confucius knows it!

But it's a real battle for me.  I expect things from myself that I would never expect from anyone else, and it really messes with my bipolar disorder, because, well, no one's perfect, and no one can live with that kind of stress.

So I was talking to someone about it lately, and they told me, "It's ok to strive for perfection, as long as you don't expect to arrive at perfection."

It's ok to make mistakes.  That's what I've been learning.  If you don't learn that, you'll be bound up in fear (another thing that's bad for our bipolar disorder). 

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