Symptoms and Complications
Schizophrenia can have a gradual or sudden onset. But for most people, mild symptoms are followed by more severe ones. Symptoms of schizophrenia can vary widely in severity, can come and go, or be persistent. For those who experience mild symptoms initially, the first signs may be withdrawal from friends or social activities, poor school performance, caring less about personal appearance, and perceiving things differently.
The symptoms of schizophrenia usually fall into one of several groups:
- Positive symptoms are symptoms associated with excess or distortion of normal function. Positive symptoms include delusions, hallucinations, and disorganized thoughts and behaviors.
- Delusions are false beliefs (e.g., being followed, reading or watching something and thinking the message is directed at them personally, thinking people can read their mind or control their thoughts).
- Hallucinations are hearing, seeing, feeling, smelling, or tasting things that are not actually there. Hearing voices (auditory) is the most common type of hallucinations with schizophrenia.
- Disorganized thinking can result in switching topics quickly when talking or not making sense when talking. Disorganization can also cause inappropriate behavior (e.g., agitation, poor hygiene, and disturbances in feelings (e.g., may feel devoid of emotion, or may experience sudden, inappropriate bursts of feeling, or may find it difficult to express feelings).
- Negative symptoms refer to a decrease or loss of normal function. This can include lack of eye contact, lack of emotional response, decreased talking, decreased pleasure, reduced motivation, and decreased interest in social activities and relationships. People with schizophrenia may find it difficult to carry out daily activities such as going to work or shopping.
- Cognitive impairment can include difficulty concentrating and solving problems.
- Emotional symptoms such as depression or inappropriate behavior can also occur with schizophrenia.
Because schizophrenia presents a variety of symptoms, the illness is classified according to which symptoms are most prevalent in a particular individual.
- Paranoid schizophrenia is associated with mainly hallucinations and delusions.
- Disorganized schizophrenia is associated primarily with not thinking clearly, incoherent speech, and unusual behavior.
- Catatonic schizophrenia, which is extremely rare, results in mobility being impaired, excessive, or unusual.
- Undifferentiated schizophrenia is a mixture of symptoms from the various types of schizophrenia.
- Residual schizophrenia occurs after active symptoms have resolved, in which a person may experience a mild decrease or loss of normal function for long periods of time.
During the acute phase of the disease, psychotic symptoms get worse and influence the ability to function normally. Stabilization refers to a period when symptoms are being treated and controlled by medications. There may not be any obvious psychotic symptoms during this phase, but some people still have problems coping with day-to-day situations.
10% of people with schizophrenia commit suicide. People most at risk for suicide are those who have paranoid schizophrenia, especially if they were functioning well prior to having schizophrenia.