Symptoms - Schizophrenia

Schizophrenia is a severe long-term mental health condition.

Schizophrenia is a type of psychosis. This means that sometimes you cannot distinguish your thoughts and ideas from reality.

It may develop slowly from when someone is a young person. The first signs can be hard to identify as they can be mistaken for how young people normally behave. For example, becoming socially withdrawn and unresponsive, or changing sleeping patterns.

People often have episodes of schizophrenia when their symptoms are severe. This is acute schizophrenia.

They can then go through periods with few or no symptoms. Thoughts can still be confused or muddled, even when there are no obvious external symptoms.

Positive and negative symptoms

The symptoms of schizophrenia are usually grouped into:

• positive symptoms - any change in behaviour or thoughts, such as hallucinations or delusions
• negative symptoms - where people seem to withdraw from the world around them, take no interest in everyday social interactions and often seem emotionless and flat

Positive symptoms of schizophrenia

Positive symptoms are the same as those of psychosis and include:

Hallucinations

Hallucinations are when you see, hear, smell, taste or feel things that do not exist. The most common hallucination is hearing voices.

Hallucinations are very real to the person having them. This is even though people around them cannot hear the voices or experience the sensations.

Brain-scanning has shown there are changes in the speech area of the brain when someone with schizophrenia hears voices. This means their brain may mistake thoughts for real voices.

Some people describe the voices they hear as friendly and pleasant. More often they're rude, critical, abusive or annoying.

The voices might:

• describe activities taking place
• discuss the person's thoughts and behaviour
• give instructions or talk directly to the person

Voices may come from different places or 1 place in particular, such as the TV.

Delusions

A delusion is a belief that is based on a mistaken, strange or unrealistic view. It may affect the way the person behaves.

Delusions can begin suddenly, or may develop over weeks or months.

You may develop a delusional idea to explain a hallucination you're having. For example, if you hear a voice describing your actions, you may think someone is monitoring you.

You may experience a paranoid delusion. This is when you believe you're being persecuted or harassed. You may believe you're being chased, followed, watched, plotted against or poisoned - for example, by a family member or friend.

You may believe people on TV or in newspaper articles are communicating messages to you. Or you may believe there are hidden messages in everyday events or coincidences.

Confused thoughts (thought disorder)

People who experience psychosis often have trouble keeping track of their thoughts and conversations.

Psychosis describes a collection of different symptoms including hallucinations, delusions and confused thinking. Psychotic symptoms are associated with a range of mental health conditions, including schizophrenia.

Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme.

People sometimes describe their thoughts as 'misty' or 'hazy' when this is happening. Thoughts and speech may become jumbled or confused. This makes conversation hard for other people to understand.

Changes in behaviour and thoughts

A person's behaviour may become more disorganised and unpredictable. Their appearance or dress may seem unusual to others.

People with schizophrenia may behave inappropriately. They may become very agitated, and shout or swear for no reason.

They may believe that their thoughts:

• are not their own
• are being controlled by someone else
• have been planted in their mind by someone else
• are disappearing, as though someone is removing them from their mind

Some people feel their body is being taken over. They may feel someone else is directing their movements and actions.

Negative symptoms of schizophrenia

Negative symptoms of schizophrenia often appear several years before the first acute episode.

These initial negative symptoms are the 'prodromal period' of schizophrenia.

They usually appear gradually and slowly get worse.

They include the person becoming more socially withdrawn. They may also lose interest in their appearance or personal hygiene.

It can be difficult to tell if the symptoms are part of the development of schizophrenia. They could be caused by something else.

Negative symptoms include:

• losing interest and motivation in life and activities, including relationships and sex
• lack of concentration
• not wanting to leave the house
• changes in sleeping patterns
• feeling uncomfortable with people
• being less likely to start conversations or feeling there's nothing to say

The negative symptoms of schizophrenia often lead to problems with friends and family. Symptoms can sometimes be mistaken for deliberate laziness or rudeness.

Schizophrenia and psychosis

Schizophrenia is often described by doctors as a type of psychosis. An episode of psychosis (psychotic episode) is a symptom of schizophrenia.

A first acute episode of psychosis can be very difficult to cope with. It can be difficult for the person who is ill and for their family and friends.

There can be a big change in their behaviour. They might become upset, anxious, confused, angry or suspicious of those around them.

They may not think they need help. It can be hard to persuade them to visit a GP.