Schizophrenia is a challenging brain disorder that often makes it difficult to distinguish between what is real and unreal, to think clearly, manage emotions, relate to others, and function normally. It affects the way a person behaves, thinks, and sees the world.
The most common form is paranoid schizophrenia, or schizophrenia with paranoia as it's often called. People with paranoid schizophrenia have an altered perception of reality. They may see or hear things that don't exist, speak in confusing ways, believe that others are trying to harm them, or feel like they're being constantly watched. This can cause relationship problems, disrupt normal daily activities like bathing, eating, or running errands, and lead to alcohol and drug abuse in an attempt to self-medicate.
Many people with schizophrenia withdraw from the outside world, act out in confusion and fear, and are at an increased risk of attempting suicide, especially during psychotic episodes, periods of depression, and in the first six months after starting treatment.
There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all the symptoms, and the symptoms of schizophrenia may also change over time.
A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn't true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies, such as:
Delusions of persecution – Belief that others, often a vague “they,” are out to get you. These harassing delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).
Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, you might believe a billboard or a person on TV is sending a message meant specifically for you.
Delusions of grandeur – Belief that you are a famous or important figure, such as Jesus Christ or Napoleon. Alternately, delusions of grandeur may involve the belief that you have unusual powers, such as the ability to fly.
Delusions of control – Belief that your thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
Hallucinations are sounds or other sensations experienced as real when they exist only in your mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. These often occur when you misinterpret your own inner self-talk as coming from an outside source.
Schizophrenic hallucinations are usually meaningful to you as the person experiencing them. Many times, the voices are those of someone you know, and usually they're critical, vulgar, or abusive. Visual hallucinations are also relatively common, while all hallucinations tend to be worse when you're alone.
Schizophrenia can cause you to have trouble concentrating and maintaining your train of thought, which may manifest itself in the way that you speak. You may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech include:
Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next.
Neologisms – Made-up words or phrases that only have meaning to you.
Perseveration – Repetition of words and statements; saying the same thing over and over.
Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head”).
Schizophrenia disrupts goal-directed activity, impairing your ability to take care of yourself, your work, and interact with others. Disorganized behavior appears as:
· A decline in overall daily functioning
· Unpredictable or inappropriate emotional responses
· Behaviors that appear bizarre and have no purpose
· Lack of inhibition and impulse control
The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals, such as:
Lack of emotional expression – Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
Lack of interest or enthusiasm – Problems with motivation; lack of self-care.
Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.
Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in a monotone.
Types of schizophrenia:
There are several types of schizophrenia.
This is the most common type of schizophrenia. It may develop later in life than other forms. Symptoms include hallucinations and/or delusions, but your speech and emotions may not be affected.
Also known as ‘disorganised schizophrenia’, this type of schizophrenia typically develops when you’re 15-25 years old. Symptoms include disorganised behaviours and thoughts, alongside short-lasting delusions and hallucinations. You may have disorganised speech patterns and others may find it difficult to understand you.
People living with disorganised schizophrenia often show little or no emotions in their facial expressions, voice tone, or mannerisms.
This is the rarest schizophrenia diagnosis, characterised by unusual, limited and sudden movements. You may often switch between being very active or very still. You may not talk much, and you may mimic other’s speech and movement.
Your diagnosis may have some signs of paranoid, hebephrenic or catatonic schizophrenia, but it doesn’t obviously fit into one of these types alone.
You may be diagnosed with residual schizophrenia if you have a history of psychosis, but only experience the negative symptoms (such as slow movement, poor memory, lack of concentration and poor hygiene).
Simple schizophrenia is rarely diagnosed in the UK. Negative symptoms (such as slow movement, poor memory, lack of concentration and poor hygiene) are most prominent early and worsen, while positive symptoms (such as hallucinations, delusions, disorganised thinking) are rarely experienced.
People with cenesthopathic schizophrenia experience unusual bodily sensations.
Symptoms meet the general conditions for a diagnosis but do not fit into any of the above categories.
Causes of schizophrenia:
The cause of schizophrenia is unknown, but it is usually a combination of the following factors:
Some people develop schizophrenia following a stressful event, such as the death of a loved one or the loss of a job.
Experiences like growing up in a town or city, stressful life events and moving to new a new town or country can also trigger symptoms of psychosis and schizophrenia.
There’s also a strong link between the use of strong cannabis and the development of schizophrenia.