Schizophrenia is a complex mental disorder with a range of symptoms that can severely impact daily life. It's characterized by positive symptoms like hallucinations and delusions, negative symptoms like reduced emotional expression, and cognitive impairments affecting attention and memory.

Diagnosing schizophrenia involves identifying specific symptoms and ruling out other conditions. The disorder has several subtypes, each with unique features. Understanding these symptoms and subtypes is crucial for proper diagnosis and treatment of this challenging mental health condition.

Symptoms of Schizophrenia

Symptoms of schizophrenia

• Positive symptoms involve an excess or distortion of normal functions
  • Hallucinations are sensory experiences that occur in the absence of an external stimulus and can affect any of the five senses (auditory hallucinations are the most common, such as hearing voices)
  • Delusions are fixed, false beliefs that are not based on reality and are held despite contradictory evidence (persecutory delusions involve the belief of being persecuted or conspired against, grandiose delusions involve the belief of having special powers or importance, and referential delusions involve the belief that certain gestures, comments, or events are directed at oneself)
  • Disorganized speech is characterized by loose associations, tangential thinking, or incoherence, making it difficult for others to understand the individual's thought process
  • Grossly disorganized or catatonic behavior involves either unpredictable agitation and purposeless movement or a marked decrease in reactivity to the environment (catatonia)
• Negative symptoms involve a diminution or loss of normal functions
  • Affective flattening is the reduced intensity and range of emotional expression, both in facial expressions and vocal intonation
  • Alogia refers to a poverty of speech, characterized by brief, laconic, and empty responses to questions
  • Avolition is a lack of motivation or initiative to pursue goal-directed activities, leading to a reduction in the amount and quality of activities
  • Anhedonia is the inability to experience pleasure from activities that were once enjoyable (hobbies, social interactions, or sexual activity)
  • Asociality is a lack of interest in social interactions and a preference for solitary activities, leading to social withdrawal and isolation
• Cognitive symptoms involve impairments in various aspects of cognitive functioning
  • Impaired attention and concentration make it difficult for individuals to focus on tasks, follow conversations, or remember important information
  • Difficulty with executive functioning affects the ability to plan, organize, and solve problems, leading to challenges in daily life and work settings
  • Memory deficits, particularly in working memory and verbal memory, can hinder the individual's ability to retain and manipulate information in the short term and learn new information
  • Impaired processing speed results in a slowness of thought and a reduced ability to process and respond to information in a timely manner

Impact of schizophrenia

• Social functioning is significantly impacted, as individuals struggle to maintain relationships, withdraw from social interactions, and display impaired social skills and communication, leading to isolation and loneliness
• Occupational functioning is often impaired, with individuals experiencing difficulty maintaining employment, reduced work performance and productivity, and frequent job changes or unemployment, which can lead to financial instability
• Daily living skills, such as self-care, personal hygiene, managing finances, and household tasks, may be compromised, resulting in a dependence on others for support and assistance
• Emotional well-being is negatively affected, with an increased risk of depression and anxiety, lower self-esteem and self-efficacy, and the added burden of stigma and discrimination associated with the disorder
• Physical health is often poorer compared to the general population, with higher rates of smoking and substance abuse, an increased risk of metabolic disorders (obesity and diabetes), and a reduced life expectancy

Subtypes and Diagnosis of Schizophrenia

Subtypes of schizophrenia

• Paranoid schizophrenia is characterized by a predominance of delusions (often persecutory) and hallucinations, while cognitive functioning and affect remain relatively intact compared to other subtypes
• Disorganized schizophrenia features prominent disorganized speech and behavior, along with flat or inappropriate affect and impaired cognitive functioning, making it difficult for individuals to communicate effectively and function in daily life
• Catatonic schizophrenia involves marked psychomotor disturbances, such as:
  1. Catatonic stupor, characterized by immobility and unresponsiveness to external stimuli
  2. Catatonic excitement, involving excessive and purposeless motor activity
  3. Posturing or catalepsy, in which the individual maintains a rigid, awkward posture for extended periods
  4. Negativism, characterized by resistance to instructions or attempts to be moved
  5. Echolalia, which is the repetition of words or phrases spoken by others
  6. Echopraxia, involving the repetition of movements made by others

Diagnostic criteria for schizophrenia

• The presence of at least two of the following symptoms for a significant portion of time during a 1-month period (at least one of these must be delusions, hallucinations, or disorganized speech):
  1. Delusions
  2. Hallucinations
  3. Disorganized speech
  4. Grossly disorganized or catatonic behavior
  5. Negative symptoms
• Impairment in one or more major areas of functioning (work, interpersonal relations, or self-care) must be present since the onset of the disturbance
• Continuous signs of the disturbance must persist for at least 6 months, including at least 1 month of active-phase symptoms and may include periods of prodromal or residual symptoms
• Schizoaffective disorder and depressive or bipolar disorder with psychotic features must be ruled out as the primary diagnosis
• The disturbance must not be attributable to the physiological effects of a substance (drugs or medications) or another medical condition (brain tumor or neurological disorder)
• If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are present for at least 1 month