Symptoms of schizophrenia

Disease burdens

For the patient

Schizophrenia is a disease of brain function which affects about 1% of the population.1 Symptoms vary between individuals, and can affect sufferers’ thoughts, feelings and actions. In general, symptoms take the following forms:1

  • Separation from reality

  • Delusions

  • Hallucinations

  • Emotional dysregulation

  • Disorganized behaviour

Schizophrenia typically progresses in cycles of symptoms and remission. Patients often suffer impaired social relationships leading to isolation; impaired mental function; inability to function at work, and poor health, all contributing to a reduced quality of life (QoL).1 Many patients attempt suicide – an estimated 25-50%, and 10% achieve it2, so it is vital that schizophrenia patients receive appropriate and timely treatments.

For caregivers

The impact of schizophrenia goes beyond the individual with the disease. Caregivers, who are often family members, also suffer consequences of a dependent with schizophrenia:1

  • Parents: 41% of schizophrenia patients live with their parents

  • Brothers and sisters: 12% of schizophrenia patients are cared for by their siblings

  • Spouses/partners: 7% of patients are cared for by their spouses/partners

The types of burden suffered by carers include:1

  • Work overload

  • Poor sleep

  • Little free time for leisure activities and socialising

  • Financial pressures

  • Environmental burden: stigmatization and social isolation by neighbours and others

Many schizophrenia patients need 24/7 care, so it is not surprising that reduced QoL for the patient is associated with reduced QoL for the caregiver.1

Positive and negative symptoms

Symptoms of schizophrenia are usually divided into two categories: positive and negative.

Positive symptoms

These are additional thoughts and behaviours that the person did not exhibit prior to developing schizophrenia, such as hallucinations and delusions. These are symptoms that only the patient can describe to the HCP. Positive symptoms include:3

  • Hallucinations

    Hallucinations can be visual (often people or abstract images), auditory (usually voices), tactile, or olfactory (involving smell or taste). The patient imagines things that are not real, but they have no way of distinguishing them from reality.

  • Delusions

    Delusions are firmly held beliefs that are not correct and have no basis in reality. They can manifest in many ways including:

    • Colour symbolism: they associate particular colours with messages from God or another higher power

    • Religious delusions: Up to 50% of schizophrenia will have religious delusions at some time, often involving thoughts that they have been chosen by God to be a saint or prophet, or that they are Jesus Christ

    • Paranoia: one of the most common delusions in schizophrenia patients, often involving thoughts of being watched or listened-to by family, neighbours or work colleagues using hidden devices; sometimes the culprit is thought to be a government agency or even aliens

    • Ideas of reference: people with schizophrenia believe that they are responsible for events, in the news for example, that have happened elsewhere; alternatively, they may believe that they are receiving hidden coded messages from words or statements, or even car number plates for example

    • Thought disorder: this manifests as breaks in their train of thought, or their thoughts becoming confused and disordered; often schizophrenia patients will stop midway through a sentence because they cannot think of the words needed to express their thoughts

    • Thought control: the person believes that their thoughts are being stolen or broadcast to the world, or that thoughts have been inserted into their mind

    • Grandiose delusions: the person believes they are special, with special powers such as the ability to fly or control the weather; they may also believe that they are the reincarnation of a famous person or a historical figure

Negative symptoms

These are thoughts and behaviours that the patient no longer exhibits, but were once beneficial before the patient developed schizophrenia. These tend to be noticed by the carers of schizophrenia patients, rather than by the patients themselves3. Negative symptoms include:3

  • Apathy

    The person with schizophrenia loses motivation to continue with things that used to be important to them, such as their work, school or college studies, and participating in sports or social activities.

  • Social withdrawal

    This is often the first symptom of schizophrenia. The person may start spending extended periods of time in their room, only coming out at unusual times in order to eat alone. They often neglect the needs and feelings of their family and close friends.

  • Blunted or incongruous emotional responses

    The person’s speech may be flat and lack inflection, and their facial expressions may not change. When told an important piece of information, the person may not respond at all, or their response might be the opposite to what would be considered appropriate – termed emotional incongruity.

  • Changes in body clock

    People with schizophrenia sometimes show an altered or completely reversed sleep/awake pattern, staying awake at night and sleeping through the day.

References

  1. Millier A, Schmidt U, Angermeyer MC, Chauhan D, Murthy V, Toumi M, et al. Humanistic burden in schizophrenia: a literature review. J Psychiatr Res 2014; 54: 85-93.
  2. Stahl SM, 2008. Essential Psychopharmacology Online. Available at: http://stahlonline.cambridge.org/essential_4th_chapter.jsf?page=chapter4_introduction.htm&name=Chapter%204&title=Symp tom%20dimensions%20in%20%20schizophrenia#c02598-4-18 (accessed March 2018).
  3. Living with schizophrenia UK. Available at: https://www.livingwithschizophreniauk.org/symptoms-of-schizophrenia/ (accessed March 2018).

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