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What are the signs and symptoms of schizophrenia?

At Priory, we understand that it can be very difficult to cope with schizophrenia, and the symptoms that are associated with this condition, including experiencing hallucinations and delusions, can be distressing for the sufferer.

Overall, schizophrenia can cause dramatic changes in the way that people think, feel and act on a daily basis. The signs and symptoms of schizophrenia can vary from person to person; they can start suddenly for some people, or develop gradually, and may come and go over a long period of time.

Schizophrenia symptoms can be categorised into ‘positive’ symptoms (things that start to happen) and ‘negative’ symptoms (things that stop happening). These include:

Positive symptoms of schizophrenia

  • Hallucinations – people with schizophrenia may experience hallucinations that cause them to see, hear or feel things that aren’t real. The most common type of hallucinations that are associated with schizophrenia are auditory hallucinations, whereby individuals hear voices in their head that no-one else can hear. The voices may tell you what to do, act as a running commentary on your thoughts and actions (e.g. saying things like “he’s opening the door”), or say threatening things to you. Often, there’s more than one voice and the conversation tends to be very personal in nature, demonstrating an intimate knowledge of your beliefs and habits. The voices may also talk to each other about you
  • Delusions – these are strong beliefs that an individual holds even when they are presented with evidence to the contrary. In schizophrenia, delusions may centre upon paranoia, whereby you may become convinced that you’re being spied on, persecuted, or controlled in some way, or they may cause you to hold grandiose beliefs such as thinking that you’re a famous actor, a monarch, or that you have superpowers
  • Disorganised thoughts and speech – people with schizophrenia may find it difficult to organise their thoughts and speech. Your thoughts may seem jumbled and random and when you talk, your words may not make sense. In addition, this confusion may mean that you’re unable to comprehend what other people are saying and you may appear to be distracted and ‘zoned out’ to others. People with schizophrenia may also have trouble concentrating and may jump from one idea to another
  • Changes in behaviour – your behaviour may become gradually more unpredictable. For example, you may start behaving inappropriately in certain situations or find that you become agitated for no apparent reason, which may even cause you to shout and swear
  • Abnormal patterns of movement – schizophrenia can cause people to develop abnormal patterns of movement. You may find yourself repeating the same actions over and over again or seem to be ‘jumpy’ and ‘twitchy’ all the time. At the other end of the spectrum, people with schizophrenia may stay still for hours on end, sometimes in what can seem to be very uncomfortable positions – something known as ‘catatonia’ or a ‘catatonic state’

Negative symptoms of schizophrenia

  • Lack of emotion – an individual with schizophrenia may seem to be emotionless, detached, and unable to display any feelings. When you speak, your voice can sound flat and monotonous. This lack of emotional responsiveness is known as ‘flat affect’
  • Social withdrawal – someone with this condition may stop making plans with friends and family, and stop socialising with anyone. This can lead to you becoming withdrawn, isolated and struggling to leave the house, as well as having an adverse effect on personal relationships
  • Struggling to look after themselves – schizophrenia can make it hard for you to engage in ordinary, day-to-day tasks and responsibilities such as washing yourself, getting dressed, or eating
  • Lack of motivation, ambition and commitment – individuals with schizophrenia may have trouble finishing tasks that they’ve started, or even getting started at all. You may lose interest in activities and people that were once important to you. If you are employed, you might find it difficult to turn up for work on time, or even at all, and may have a reduced desire to do well in your career. This may lead to job loss, financial difficulties and even homelessness

It’s important to recognise that the earlier schizophrenia is diagnosed and treated, the greater your chances of being able to effectively manage your condition and reduce the associated symptoms.

This page was clinically reviewed by Dr Michael Phelan (MBBS, BSc, FRCPsych) in January 2021.

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