A third category of cognitive symptoms is also included in some descriptions of the disease. These are subtle differences in cognitive ability that are normally only discovered after neuropsychological tests are given.
Symptoms are further divided by type, including motor, behavioral, and mood disturbances.
The primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social supports.
Any behavior not seen in people without the disorder that correlates with a loss of contact with reality; a disorder of commission.
Defining Psychosis and Schizophrenia
Schizophrenia is a psychological disorder characterized by major disturbances in thought, perception, emotion, and behavior. About 1% of the population experiences schizophrenia in their lifetime, and usually the disorder is first diagnosed during early adulthood (early to mid-20s). Most people with schizophrenia experience significant difficulties in many day-to-day activities, such as holding a job, paying bills, caring for oneself (grooming and hygiene), and maintaining relationships with others. Schizophrenia is considered a disorder of psychosis, or one in which the person’s thoughts, perceptions, and behaviors are impaired to the point where they are not able to function normally in life. In informal terms, one who suffers from a psychotic disorder (that is, has a psychosis) is disconnected from the world in which most of us live.
Symptoms of Schizophrenia
Schizophrenia has a wide range of symptoms, and not all symptoms may be present in all forms of schizophrenia. The signs and symptoms of schizophrenia are usually divided into two categories: positive and negative. A third category of cognitive symptoms is also included in some descriptions of the disease. Both positive and negative symptoms are further characterized as motor, behavioral, and mood disturbances.
Positive symptoms are disorders of commission, meaning they are something that individuals do or think. Examples include hallucinations, delusions, and bizarre or disorganized behavior. Positive symptoms can also be described as behavior that indicates a loss of contact with the external reality experienced by non-psychotic individuals. An example of a positive motor disturbance would be catatonic excitement, which is uncontrolled and aimless motor activity. Positive symptoms tend to be the easiest to recognize.
Hallucinations, one of the most noted symptoms, involve perceiving a sensory stimuli that no one else is able to perceive. Most frequently, people with schizophrenia hear voices that tell them what to do, warn of danger, or talk to each other about the individual. Delusions are also commonly experienced; they include false beliefs that are not of the culture of the individual and are unchanging even after being proven incorrect.
Negative symptoms are disorders of omission, meaning they are things that the individual does not do. Examples include alogia (lack of speech), flat affect (lack of emotional response), anhedonia (inability to experience pleasure), asociality (lack of interest in social contact), avolition (lack of motivation), and apathy (lack of interest). Some individuals will experience a catatonic stupor, or a state in which they are immobile and mute, yet conscious. They may exhibit waxy flexibility, where another person can move the patient's limbs into postures and the patient will retain these postures, like a wax doll. In some cases, negative symptoms can be misinterpreted as depression or laziness.
Cognitive symptoms are the most harmful to the livelihood of the individual, as they prevent the individual from participating effectively in the workplace or in society. Cognitive symptoms are subtle differences in cognitive ability that are normally only discovered after neuropsychological tests are given. These include poor ability to absorb and act upon information (executive functioning), lack of attention, and an inability to utilize working memory.
Motor disturbances include disorders of mobility, activity, and volition. People with schizophrenia can exhibit too little (negative) or too much (positive) movement. In addition to catatonic stupor and catatonic excitement, examples of motor disturbances include stereotypy (repeated, non-goal directed movement such as rocking), mannerisms (normal, goal-directed activities that appear to have social significance, but are either odd in appearance or out of context, such as repeatedly running one's hand through one's hair or grimacing), mitgehen (moving a limb in response to slight pressure, despite being told to resist the pressure), ecopraxia (the imitation of the movements of another person), and automatic obedience (carrying out simple commands in a robot-like fashion).
Disorders of behavior may involve deterioration of social functioning, such as social withdrawal, self-neglect, or neglect of environment. Behavioral disorders may also involve behaviors that are considered socially inappropriate, such as talking to oneself in public, obscene language, or inappropriate exposure. Substance abuse is another disorder of behavior; patients may abuse cigarettes, alcohol, or other substances. Substance abuse is associated with poor treatment compliance, and may be a form of self-medication.
Disorders of mood and affect include affective flattening, which is a reduced intensity of emotional expression and responsiveness that leaves patients indifferent and apathetic. Typically, one sees unchanging facial expression, decreased spontaneous movements, a lack of expressive gestures, poor eye contact, lack of vocal inflections, and slowed speech. Anhedonia, or the inability to experience pleasure, is also common, as is emotional emptiness. Patients may also exhibit inappropriate affect, such as laughing at a funeral.
The primary treatment of schizophrenia is antipsychotic medications, often in combination with psychological and social supports. Hospitalization may occur for severe psychotic episodes either voluntarily or (if mental health legislation allows it) involuntarily. Community support services—such as drop-in centers, visits by members of a community mental-health team, supported employment, and support groups—are common. Some evidence indicates that regular exercise has a positive effect on the physical and mental health of those with schizophrenia. A number of psychosocialinterventions may be useful in the treatment of schizophrenia, including family therapy, skills training, and psychosocial interventions for substance abuse. Family therapy or education, which addresses the whole family system of an individual, may reduce relapses and hospitalizations.