Schizophrenia is a debilitating disorder that manifests unusual features, which can often be scary and stigmatized by society. There is a detailed enumeration of this disorder's subtle signs and symptoms in various classification systems of psychological disorders. The defining feature of this disorder is psychotic symptoms. Before understanding the signs and symptoms of the disorder, it is imperative to acknowledge that psychosis-like symptoms and bizarre experiences are not always abnormal and thus may occur in the general population as well. The threshold for abnormality is decided by the duration, severity, and impairment caused by the disorder.
The derailment, modification, or assumption of a new parallel reality seen in psychosis can be seen in Schizophrenia as well. Generally, Schizophrenic symptoms are classified into positive and negative symptoms based on an individual's excess or deficit of different modalities. These symptoms are then further divided into subtypes indicating impairment in different spheres of life. These are discussed in the upcoming sections:
Positive symptoms are exaggeration and excess of cognition, behavior, emotions, and physiology, implying a modality's presence or increment. Many positive symptoms have been observed in schizophrenic patients, some of which are discussed below.
Delusions: Delusions are erroneous and untrue beliefs and cognitions that do not hold evidence and thus contradict reality. Patients maintain such beliefs despite the presence of contradictions in their environments. There can be many kinds of delusion.
Delusion of grandeur: This implies a false belief that one is special, has superpowers, and is a special person. Thus, a patient may believe he has the superpower to manipulate the future and thus holds the responsibility to help the world.
Delusion of persecution: A person suffering this delusion may believe being targeted, plotted against, and harmed/followed/poisoned. For example, a person may become paranoid and claim that some assassins are plotting against her.
Somatic delusion: It indicates a false belief of disease, abnormal or changed body. A person may thus claim that some paradise insects have entered his body and infected his lungs. The person may also show problems in breathing due to this strongly held belief.
Delusion of control: This refers to the belief that one's thoughts are inserted, withdrawn, or broadcasted by someone else. A patient with this delusion may claim that her husband is planting suicidal thoughts into her mind.
Several other kinds of delusion exist, like the delusion of jealousy, nihilistic delusion, religious delusion, erotomanic delusion, etc.
Hallucination: These positive symptoms manifest in the form of false sensations and experiences without any such external stimuli. These can be observed in any sensory modality and are therefore classified as follows:
Auditory: In these hallucinations, one hears a sound which could be commanding, running commentary, or conversation. A person claiming to hear a critical commentary on everything he does may suffer from this hallucination.
Visual: These are false perceptions of sight of things, light, color, or organism. A patient talking to a friend who is not visible to others may be suffering from it.
Olfactory: These pertain to the false perception of a smell. An example could be a patient reporting smelling something rotten or spoiled when none exists.
Gustatory: These are false perceptions of taste, for example, when a patient claims to taste medicine even if he does not eat one continuously.
Tactile: These are related to the false perception of something happening on or in the body. For example, a patient may report a crawling snake on his chest.
Disorganized speech: These symptoms are manifested in the form of impairment in speech, which is often indicative of dysfunctional thinking. Its manifestation is as follows:
Derailment: Here, the patient loses association and, very frequently and abruptly jumps from one topic to another. The speech of such a patient may look like this. "I love ice cream. Yes, the table is good; however, paper is not good for drawing…."
Neologism: This implies the use of new and made-up words that do not exist in a language. Thus a patient may say, "crotmenlamist is tasty."
Echolalia: This implies automatic repetition of the vocalization of another person. So when a patient manifesting this disorder is asked, "what about the weather?" he would reply. "What about the weather?"
Blocking: It refers to when the patient abruptly stops speaking and, after a while, may indicate a lack of memory. Thus a patient may say "I was going to" and get silent.
Mutism: This implies refusal or inability to speak. Such a patient may remain mute even after being prompted to speak.
Disorganized behavior: Impairment in behavior is seen in the form of inappropriate behavior (for example laughing in a sad situation), extreme activity (e.g., excess emotional reaction or agitation), peculiar body movement, postures, and gestures (e.g., bizarre sitting posture). These may also manifest in an extremely high motor activity like moving quickly, swinging arms widely, or talking rapidly.
Negative symptoms imply the absence or deficit of a modality like cognition, emotion, behavior, and physiological activities. These have also been classified into several types, which have been enumerated below:
Apathy: This imply the absence of suppression of emotions. A patient indicating apathy may not feel an emotional reaction to an incident like the death of a loved one or while seeing other people sad.
Avolition: This indicates a lack of motivation, absence of interest, inability to persist in routine activities, and spending much time doing nothing.
Alogia: This indicates a reduction of speech, and the patient may respond to inquiry in one or two words only. For example, when asked what all he did, the patient may answer "many."
Anhedonia: This implies a total loss or prominent reduction in pleasure from previously pleasurable activities. For example, ice cream may not elicit a positive mood in a person who used to love ice cream.
Asociality: This implies impaired social relationships and skills, which may be evident through lack of interest in other people, lack of desire for close relationships, and lack of close relationships like friends.
Affective blunting: This refers to the complete loss of affective response to environmental cues. Such a person may not show facial expression or body language and act like a robot.
Beyond the classification of positive and negative symptoms, some other signs of Schizophrenia have also been identified. These include social withdrawal, depressive symptoms, increased suspiciousness, lack of personal hygiene, expressionlessness, lack of emotional expression, insomnia or oversleeping, forgetfulness, irrational and odd statements, and extreme reactions to criticism. Doubtlessly, Schizophrenia is a very chronic psychological disorder with a very subtle manifestation, diagnosis of which is difficult. Nevertheless, adequate knowledge of these is important for clinicians and common people to identify and help those suffering from this debilitating disorder.
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