Symptoms

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The first signs of schizophrenia develop during adolescence or young adulthood, but they can also occur in people over the age of 40.10

Both women and men are at risk of developing schizophrenia. In men, the symptoms usually occur at an earlier age than in women. 11

The symptoms of schizophrenia vary individually, but they are usually classified as follows: 5

Positive symptoms

Symptoms that are not present in healthy people, developed as something “more” as a result of the disease.

  • Hallucination: Sensing things that are not there in reality. Hallucinations can affect any of all five senses: visual, auditory, olfactory, gustatory and tactile.  However, the most common are auditory hallucinations.
  • Delusions: Ingrained irrational and inaccurate beliefs which arise from the fact that the patient is unable to distinguish between what is real and what is not.
  • Unfocused thinking: Loose associations, drawing conclusions not based on reality, inability to apply logical reasoning.
  • Agitation: Discomfort associated with increased tension and irritability.

Negative symptoms

These symptoms can be observed as “missing” behaviors. Abilities that  most people have, but schizophrenia patients “lost” to a certain extent. 5

  • Lack of initiative: Lying in bed for prolonged periods, not feeling like doing anything.
  • Withdrawal from social interactions/depression: The patient gives the impression that s/he wants to be alone and not meeting anyone.
  • Apathy: Feeling empty. Inability to carry out plans.
  • Lack of emotional reactions: Lack of normal emotional responses, happiness or sadness, for example, reduced facial expressions.

Affective symptoms

that can affect mood such as depression, anxiety, loneliness or suicidal thoughts.

Cognitive symptoms

including concentration and memory disorders; for example, lack of attention, slow thinking, lack of disease awareness (understanding and accepting the disease).

Schizophrenia patients can experience dysfunctions in one or more major life activities such as mutual relationships with others, work or study, family life, communication and self-sufficiency. 5
Most schizophrenia patients experience several psychotic episodes (periods when the positive symptoms have been much more pronounced) during their lifetime. 6-8 
The positive symptoms usually change over time: they can deteriorate during relapses and improve during recovery periods. 1 During the periods between psychotic episodes, schizophrenia patients have a relatively normal life, they are apparently emotionally more healthy and stable, though negative symptoms often occur after the first episode which persist for a long time and can progress afterwards. 1, 9 
One of the forms of this disease that shows a continuous or recurring pattern is called chronic schizophrenia.
Most schizophrenia patients need long-term treatment that usually includes medication. 1, 9

  • References

    1. APA Clinical Guidelines. American Psychiatric Association. Practice guidelines for the treatment of patients with schizophrenia. 2004
    2. Falkai P et al. World J Biol Psychiatry 2005; 6: 132-191.
    3. Kendler KS et al. Arch Gen Psychiatry 1996; 53: 1022-1031.
    4. World Health Organization. The World Health Report: 2001: Mental health: new understanding, new hope.
    5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition Text Revision (DSM-IV-TR). Arlington: American Psychiatric Publishing Inc. 2000.
    6. Lieberman JA et al. J Clin Psychiatry 1996; 57(suppl 9): 5-9.
    7. Breier A et al. Am J Psychiatry 1994; 151: 20-26.
    8. Robinson DG et al. Am J Psychiatry 1999; 156: 544-549.
    9. National Institute for Clinical Excellence. National Clinical Practice Guidelines Number 82.
    10. Howard R et al. Am J Psychiatry 2000; 157: 172-178.
    11. Angermeyer MC et al. Schizophr Bull 1990; 16: 293-307.
    12. Murray RM and Fearon P. J Psychiatr Res 1999; 33: 497-499.
    13. Lang UE et al. Cell Physiol Biochem 2007; 20: 687-702.
    14. Harrigan SM et al. Psychol Med 2003; 33: 97-110.
    15. Bottlender R et al. Schizophr Res 2003; 62: 37-44.
    16. Lynn Starr h. et al: Comparison of long-acting and oral antipsychotic treatment effects in patients with schizophrenia, comorbid substance abuse, and a history of recent incarceration: An exploratory analysis of the PRIDE study; Schizophr Res. 2018 Apr;194:39-46. doi: 10.1016/j.schres.2017.05.005. Epub 2017 Jun 7
    17. Awad AG et al. Pharmacoeconomics 2008; 26: 149-162.
    18. Keith SJ et al. Psychiatr Serv 2004; 55: 997-1005.
    19. Lieberman JA et al. Pharmacol Rev 2008; 60: 358-403.
    20. Tandon R et al. Psychoneuroendocrinology 2003; 28(suppl 1): 9-26.
    21. Wyatt RJ. Schizophr Bull 1991; 17: 325–351
    22. Robinson DG et al. Arch Gen Psychiatry 1999; 56: 241-247.
    23. Weiden PJ et al. Psychiatr Serv 2004; 55: 886-891.
    24. Koen L et al. Psychosomatics 2007; 48: 128-134.
    25. Novick D et al. Psychiatry Res 2010; 176: 109-113.
    26. Kozma CM et al. Changes in schizophrenia-related hospitalization and ER use among patients receiving paliperidone palmitate. Current Medical Research and Opinion. 2011.27;1603-1611

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