The symptoms of schizophrenia
Schizophrenia symptoms can be divided into five groups (dimensions), where a patient may demonstrate only one symptom or two symptoms but also a few, ouf of the symptoms specified below, are possible as well. At the same time, a person diagnosed with schizophrenia may for a long time not experience any symptoms of schizophrenia.
It should be remembered that the ill person usually displays only a small number of the above-mentioned symptoms and the severity of these symptoms depends on the stage of illness. During exacerbation the symptoms accrue, in a period of improvement (remission) they decrease or completely disappear.
The term "positive symptoms" does not indicate their positive impact on a person's functioning. It refers to the fact that there are mental phenomena, absent in mentally healthy people, symptoms as if added to a person's normal way of mental functioning. The cause of positive symptoms is a disturbed biochemical balance - hyperactivity of dopamine (one of the neuromediators) in certain brain areas. The positive symptoms include hallucinations and delusions.
Delusions, abnormal thoughts, suspicion
Some judgements of schizophrenics are strange, erroneous, deviate significantly from reality, from beliefs of their family and friends, as well as from their previous convictions. For instance, they can believe that other people know their thoughts, that they are followed, that others are plotting against them or control their thoughts or behaviours.
Using colloquial language, one may say that they have a feeling of being "transparent" or "cornered". Sometimes their judgements are so close to reality that their families or friends may believe them, thinking that their teacher or colleagues at work are are ill-disposed to them or harassing them.
Especially at the onset of schizophrenia, the schizophrenics themselves, as well as their families, may believe that the cause of such strange judgements is a"poison" or a "drug" added to their food or drink. Schizophrenics may misinterpret real stimuli – this usually arouses their fear – they may, for instance, hear somebody's steps to the rhythm of a really ticking clock.
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Delusions are then false judgements, based on wrong conclusions, concerning the outer reality, maintained despite unequivocal evidence which clearly denies them. The definition of delusions is not satisfied by convictions / beliefs, which are a part of our cultural or religious tradition.
Schizophrenics may sometimes hear voices of people whom they cannot hear at the moment, as these persons are not around. Usually, these unreal voices say something negative about the schizophrenic, order or forbid something.
A patient schizophrenia often surrenders to these voices, fulfilling their commands, or attempting to defend against them, e.g. by turning on loud music in their mp3 player, or plugging their ears. Schizophrenics can rarely see something that at the moment is not within their sight (so their hallucinations are rarely visual).
In the course of schizophrenia - beside the most frequent auditory and rare visual hallucinations, there may also appear other hallucinations, for instance olfactory (smelling strange odours), taste (conviction that the taste of food is different and thus denial to eat) or tactile hallucinations (e.g. feeling that a pressure on the back is exerted by the Angel of Death). The "voices" sometimes urge upon the patient to put medicines aside. The patient follows the heard "orders" and gives up medication without consulting his/her doctor, what may bring about deterioration with the necessity of repeated hospitalisation.
The "voices" sometimes urge upon the patient to put medicines aside. The patient follows the heard "orders" and gives up medication without consulting his/her doctor, what may bring about deterioration with the necessity of repeated hospitalisation.
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Hallucinations are perceptions of objects which do not exist but are only created by the brain as real. Hallucinations may involve any sensory modality (e.g. auditory, visual, olfactory, taste and tactile). but auditory hallucinations are most frequent. Hallucinations are usually accompanied by coherent delusions. Sometimes, voices order the patient to do something what may hurt himself/herself or other persons.
Negative symptoms result from disturbances in the biochemical balance - deficit of dopamine activity in certain brain areas. Negative symptoms include flattening of emotions, decrease of motivations, emotional indifference and laconic character of statements.
The term "negative symptoms" does not indicate their negative impact on a person's functioning. It refers to the fact that they are mental phenomena somehow "taken away" from mental functioning of healthy people, "something that is missing in the mind at the moment".
Flattening of emotions
In the course of schizophrenia people may have difficulties in experiencing and expressing their feelings or with immediate understanding of other people's feelings. Some schizophrenics have problems with telling others about their experiences, especially the real ones, even if they are overtly emotionally involved in experiencing the illness. If such symptoms become intensified, the person may withdraw from life or become isolated from other people.
Decrease of motivation to act or reduced vital energy
People with symptoms of schizophrenia have often difficulty in starting or completing some activities. In extreme, rare cases they may have problems with everyday activities, such as getting dressed, washing or preparing food. Motivation decrease hampers the therapeutic process - the patient does not feel any need of systematic medication and stops the reception of medicines, what may result in the necessity of hospitalisation.
Schizophrenics may lose interest in activities that once gave them pleasure. They may also feel worthless or unnecessary. Such feelings may lead to suicidal thoughts or even suicidal attempts.
In some people schizophrenia causes reluctance to speak – decreases the amount of spontaneous statements, they become short, very specific, lose their descriptive dimension.
Especially at the onset of illness, schizophrenics experience different mood disorders, most often periods of depression. Symptoms of depression do not differ significantly from depression symptoms in other mental disorders, so patients feel down, constantly tired, they have low self-esteem, they consider themselves worse than others, or they even may make suicidal attempts.
Cognitive symptoms (cognitive deficits)
Many schizophrenics experience problems in the cognitive area (cognitive deficits). Cognitive dysfunctions reflect problems with concentration and with memory, i.e. attention disturbance, retardation of thinking processes, memory, disorders in social perception and anosognosia (the lack of disease awareness and denial of being ill).
Their causes are complex. In the initial stage, the symptoms result from disturbed biochemical balance in the brain but in later, more advanced stages - in persons after many psychotic episodes - cognitive deficits may also be a consequence of progressive damage of the nerve cells (neurons).
This does not mean that their intelligence quotient becomes reduced, or that the occurring changes are so advanced that they make it impossible to continue their education. The most frequent cognitive deficits include disorders in concentration, memory and working memory.
Such a person is not able to focus on one subject and, for instance, spends hours over one page of a book (one of methods of diagnosing such dysfunctions is. among others, the Stroop test). Disturbed concentration hampers the acquisition of new knowledge, learning and may become one of the causes of school failures.
A patient with concentration problems at a visit to a doctor will have problems with describing his/her problems, as well as with understanding of what the doctor is saying. Such a patient may not understand and remember how to receive medicines and, when he/she leaves the doctor's office, he/she may not even know what to do with the prescription. Wrongly administered medication or breaking of pharmacotherapy may deteriorate the condition and end up in hospital.
Such people lose things, forget recently booked appointments, they are not able to recall frequently used words (one of the methods of testing this function is, for example, verbal fluency test). A patient who forgets about medication is particularly exposed to the risk of psychosis relapse. Already a 10-day break in medication doubles the risk of hospitalisation.
Working memory disorders
Working memory disorders are especially characteristic for schizophrenia - working memory is necessary for planning and executing even simple daily activities. Such persons have trouble solving tasks requiring planning, prediction, or use of practical knowledge (one of the methods used to test this function is, for example, the Wisconsin Card Sorting Test).
Depending on the intensity of disorders, the patient may have problems with complicated tasks, what may, in turn, impede, achieving the occupational goals. In case of major intensity of working memory disorders, the patient may have troubles with the organisation of daily activities, payment of bills, the organisation of day schedule. In extreme cases, even "everyday routines" may be compromised, what may lead to hygienic negligence and malnutrition.
Deep disturbances of working memory and executive functions make it impossible for the patient to independently control the therapy process. Patients with such problems demonstrate troubles with compliance with doctor's recommendations, are not able to plan medication and quickly stop taking their medicines, especially, when they should be taken a few times daily. In such a situation, support of caregivers and simplification of treatment regimens are necessary, the latter, for example, by replacing daily dosage by long-acting medicines, administered in sustained release injections once-to-twice a month.
The listed tests to evaluate cognitive functions are not used for diagnosis but they are very useful in tracking changes in the patient's cognitive abilities – second-generation antipsychotic drugs usually improve mental functioning of patients and positively influence the cognitive functions.
Symptoms of mental disorganisation
The most frequent symptoms of mental disorganisation include dormal thought disorders and behavioural disorganisation.
Formal thought disorders.
People with symptoms of schizophrenia may have difficulties in clear thinking, understanding what others say to them, or their statements may become difficult to be understood by others. This may periodically hinder learning or problem solving abilities.
In the course of schizophrenia, people may display strange behaviours, such as bizarre gestures, agitation or movement retardation (bradykinesia).