symptoms
Typical Symptoms
Introduction
A basic understanding of schizophrenia’s symptoms is not as difficult as it may seem. To receive the diagnosis of schizophrenia, patients must be experiencing some combination of “positive symptoms” (abnormal behaviors or thoughts that are present) and “negative symptoms” (normal behaviors that are absent). The specific symptoms may vary with the subtype of schizophrenia, between individual patients, and even in the same patient over time. Many symptoms disappear when patients receive effective treatment or are in a period of remission.
The DSM-IV (TR)1 outlines the features necessary to make the diagnosis of schizophrenia:
A. Characteristic Symptoms
Two 2 or more of the following symptoms which are present much of the time
for a one month period:
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Delusions: fixed false beliefs. -
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Hallucinations: seeing, hearing, smelling, tasting, or feeling things that are not real.
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Disorganized Speech: incoherent (rambling or disconnected) speech or derailment (ideas spontaneously change to unrelated ideas).
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Disorganized behavior or catatonia: Catatonia3 can be catatonic excitement (frenzied purposeless activity) or what appears to be stupor, where the individual is mute, unresponsive and rigid.
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Negative Symptoms: affective flattening is little or no facial expression. Alogia is poverty of speech or poverty of the content of speech. In other words, the patient doesn’t talk very much or not at all, or he talks a lot, but doesn’t say much. Avolition simply means difficulty starting and continuing activity to accomplish some goal.
B. Social/Occupational Dysfunction4
This means that there has been a decline in the person’s ability to function at
work, in relating to others, or in their self-care (hygiene). Examples might be
that “John” isn’t finishing assignments at work or in school, he stopped getting
together with the guys to watch football, or he’s not taking a shower regularly.
C. Duration: signs of the illness have been there all the time for at least 6 months
D. The symptoms are not part of another illness (Schizoaffective Disorder, Manic-
Depressive Disorder, or Depression with psychosis).
E. The disturbance is not due to Autism or another Pervasive Developmental
Disorder.
1 The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (text revision) Copyright 2000 American Psychiatric Association
2 Only one characteristic symptom is required if it consists of a bizarre delusion, voices that are continuously commenting on the person’s thoughts or behavior, or there are two or more voices (auditory hallucinations) talking to one another.
3 True catatonia is more common in Bipolar Affective Disorder (Manic-Depressive Disorder). Its presence should at least prompt physicians to consider that or related diagnoses.
4 Social or occupational dysfunction in children or adolescents may mean that they fail to achieve what is expected of them in terms of normal development in these areas.
(Sources: The author’s knowledge base, unless otherwise noted.)
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