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There are three major categories of symptoms associated with schizophrenia:

• Positive symptoms
• Negative symptoms
• Cognitive symptoms

Positive Symptoms

Positive symptoms are also known as psychotic symptoms. They are typically characterized by a loss of contact with reality. Positive symptoms may be intermittent, sometimes appearing severe and easily observable while at other times barely noticeable. Approximately 25-40% of patients will experience persistent psychotic symptoms of varying levels of intensity despite good medical management of schizophrenia. Positive symptoms include:

• Hallucinations - person hears voices, sees people or objects, smells, or feels sensations (described as invisibles fingers touching their bodies) that no one else is experiencing. The most common hallucination experienced in schizophrenia is hearing a voice or voices that either:

  • orders them to behave in a certain way
  • warns them of danger
  • comments on their behavior
  • talk to each other about the patient

• Delusions - these are false personal beliefs that do not change even when other people disprove them as either groundless or illogical. Schizophrenia may involve delusions that are quite severe, including:

  • others control their behavior
  • people on the radio or television are sending them special messages
  • the patient sees himself as a great historical figure such as Jesus or Napoleon (delusions of grandeur)
  • paranoid feelings (delusions of persecution) that others are cheating or poisoning them, or spying or plotting against them or their loved ones

• Thought Disorder - this involves disorganized thought processes such as:

  • disorganized thinking
  • garbled speech
  • stopping in the middle of a thought and cannot continue (blocking)
  • unintelligible words (neologisms)

• Disorders of Movement

  • clumsy, uncoordinated movement
  • grimacing
  • involuntary movements
  • repetitive motion
  • catatonia - state of immobility and unresponsiveness or bizarre motor behavior

These 4 types of positive symptoms are also the basis of what is described above as "Types of Schizophrenia". The fifth subtype noted in that section, residual, consists of symptoms that remain after a psychotic episode.

Negative Symptoms

Negative symptoms involve a reduction or absence of normal emotional and behavioral states, including:

• Flat affect - poor facial expression, monotonous speaking voice
• Reduced ability to plan or initiate activity
• Apathy - no follow-through on plans; no interest or involvement in anything
• Lack of pleasure in everyday life (anhedonia)
• Infrequent speech

In addition, there is a tendency of patients with negative symptoms of schizophrenia to neglect personal hygiene. They also may need help in carrying out everyday activities such as dressing or buying food. As a result, they may be perceived by others as being lazy or depressed or not willing to better their lives. Negative symptoms tend to fluctuate less over time than psychotic symptoms. They are more pervasive and are associated with poor psychosocial functioning.

Cognitive Symptoms

Cognitive impairment is a core feature of schizophrenia and occurs in approximately 75-85% of patients. In most patients, cognitive impairment precedes the onset of other symptoms and persists even after effective treatment for other symptoms. Onset of cognitive symptoms may be subtle and may not be detected until they are picked up on psychological or neuropsychological testing. These symptoms include:

• Poor attention