NIH – NIMH Schizophrenia “What is schizophrenia? Schizophrenia is a chronic, severe, and disabling brain disorder that has been recognized throughout recorded history. It affects about 1 percent of Americans.1 People with schizophrenia may hear voices other people don't hear or they may believe that others are reading their minds, controlling their thoughts, or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation. People with schizophrenia may not make sense when they talk, may sit for hours without moving or talking much, or may seem perfectly fine until they talk about what they are really thinking. Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well. What are the symptoms of schizophrenia? The symptoms of schizophrenia fall into three broad categories: • Positive symptomsare unusual thoughts or perceptions, including hallucinations, delusions, thought disorder, and disorders of movement. • Negative symptomsrepresent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression. • Cognitive symptoms(or cognitive deficits) are problems with attention, certain types of memory, and the executive functions that allow us to plan and organize. Cognitive deficits can also be difficult to recognize as part of the disorder but are the most disabling in terms of leading a normal life. ... Positive symptoms Positive symptoms are easy-to-spot behaviors not seen in healthy people and usually involve a loss of contact with reality. They include hallucinations, delusions, thought disorder, and disorders of movement. Positive symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. ,,, Negative symptoms The term "negative symptoms" refers to reductions in normal emotional and behavioral states. These include the following: • flat affect (immobile facial expression, monotonous voice), • lack of pleasure in everyday life, • diminished ability to initiate and sustain planned activity, and • speaking infrequently, even when forced to interact. People with schizophrenia often neglect basic hygiene and need help with everyday activities. Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived as lazy and unwilling to better their lives. Cognitive symptoms Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include the following: • poor "executive functioning" (the ability to absorb and interpret information and make decisions based on that information), • inability to sustain attention, and • problems with "working memory" (the ability to keep recently learned information in mind and use it right away) Cognitive impairments often interfere with the patient's ability to lead a normal life and earn a living. They can cause great emotional distress.”

NIH – Schizophrenia (Medical Encyclopedia) “There are 5 types of schizophrenia: • Catatonic • Disorganized • Paranoid • Residual • Undifferentiated Schizophrenia usually begins before the age of 45, symptoms last for 6 months or more, and people start to lose their ability to socialize and work. Schizophrenia is thought to affect about 1% of people worldwide. Schizophrenia appears to occur in equal rates among men and women, but in women it begins later. For this reason, males tend to account for more than half of patients in services with high numbers of young adults. Although schizophrenia usually begins in young adulthood, there are cases in which the disorder begins later (over 45 years). Childhood-onset schizophrenia begins after the age of 5 and, in most cases, after normal development. Childhood schizophrenia is rare and can be difficult to tell apart from other developmental disorders of childhood, such as autism.

NIH – Schizophrenia “Schizophrenia is a severe, lifelong brain disorder. People who have it may hear voices, see things that aren't there or believe that others are reading or controlling their minds. In men, symptoms usually start in the late teens and early 20s. They include hallucinations, or seeing things, and delusions such as hearing voices. For women, they start in the mid-20s to early 30s. Other symptoms include • Unusual thoughts or perceptions • Disorders of movement • Difficulty speaking and expressing emotion • Problems with attention, memory and organization “

NHS – Schizophrenia “Symptoms: The symptoms of schizophrenia can be divided into positive and negative symptoms. Positive symptoms are a feature of acute schizophrenia (acute syndromes) and negative ones are a feature of the chronic syndrome. Although the positive symptoms are often the most dramatic and, at least initially, the most distressing, the negative ones can cause the most problems, as they last longer and are more difficult to treat. The main positive symptoms are: • Restless, noisy and irrational behaviour • Sudden mood changes • Inappropriateness of mood • Disordered thinking • Feelings of being controlled by outside forces, having one's thoughts and actions taken over • Delusions • Hallucinations • Lack of insight: no awareness of the abnormality of ones thoughts, experiences and behaviour • Suspiciousness, which in some cases can become paranoia. A delusion is a fixed belief in something manifestly absurd or untrue, and that can't be overcome by reason. Delusions can't always be easily distinguished from rigidly held but generally rejected opinions, especially if a group shares these. But most are so inherently improbable, or so obviously based on defective perceptions or reasoning, as to indicate serious mental disturbance. Psychotic delusions fall into several categories and include: • Delusions of persecution (paranoid delusions) • Delusions of grandeur • Hypochondriacal delusions (unfounded beliefs about having an illness) • Delusions that the sufferer's body shape is abnormal • Delusions of unreality or depersonalisation • Delusions of being influenced by others or by malignant forces • Self-deprecatory (self-belittling) delusions of unworthiness. A hallucination is a sense perception not caused by an external stimulus. It is thus a hallucination to see something that is not present or to hear voices that don't come from any present source of sound. Hallucinations should be distinguished from delusions, which are mistaken ideas. Hallucinations are a common feature of schizophrenia. They may apparently come through the senses of vision (visual hallucinations); hearing, sometimes musical (auditory); touch (tactile); taste (gustatory); or smell (olfactory), or may relate to the size of things (Lilliputian). Hallucinations commonly occur in the general population as they are falling asleep (hypnagogic hallucinations), or while waking from sleep (hypnopompic hallucinations). The negative symptoms include tiredness, loss of concentration and lack of energy and motivation, which may be made worse by the side effects of drugs used to treat the positive symptoms. Because of these symptoms, the individual may be unable to cope with everyday tasks. Other behaviour patterns seen in chronic schizophrenia include: • Social withdrawal • Underactivity • Lack of conversation • Lack or absence of hobbies or leisure activities • Flatness of the expression of emotion (called flat affect) • Physical slowness • Physical overactivity • Self-neglect • Bizarre physical movements or postures (uncommon). ... Diagnosis: A psychiatrist will diagnose schizophrenia when there is evidence of a profound break in reality manifesting itself in one or more of the following symptoms for several months: • Thought insertion: the belief that someone is putting thoughts into the person's head. • Thought broadcasting: the belief that others can hear the person's thoughts as they occur. • Feelings of passivity: the belief that the person's thoughts and actions are being controlled by someone else. • Hearing voices commenting on the person's actions. • Other delusional beliefs out of the blue. • Physical hallucinations: for example, that someone is sitting on the person during the night.

Highlighted Articles

How Frequent is Chronic Multiyear Delusional Activity and Recovery in Schizophrenia: A 20-Year Multi-follow-up. (Schizophr Bull. 2008) “Twenty-six percent of the patients with schizophrenia were delusional at all follow-ups over the 20 years. Overall, 57% had frequently recurring or persistent delusions. A subgroup of over 25% of the schizophrenia patients had no delusional activity at any of the 6 follow-ups over 20 years. Schizophrenia patients with posthospital delusional activity had increased work disability (P < .05). Delusions that persisted after the acute phase in schizophrenia patients predicted a lower likelihood of future global recovery (P < .01). In conclusion, slightly over half of modern-day schizophrenia patients are vulnerable to frequent or "chronic" delusional activity after the acute phase. Schizophreniform patients and other types of psychotic disorders are vulnerable to posthospital delusional activity, but less frequently, less severely, and more episodically. Delusional activity is associated with work disability. Internal factors such as good premorbid developmental achievements and favorable prognostic factors are protective factors that reduce the probability of chronic multiyear, delusional activity in schizophrenia (P < .01).”

Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories. (Psychol Med. 2008) “RESULTS: Of the 27 early signs and symptoms reported by patients, depression and anxiety were the most frequent. Five factors were identified based on these early signs and symptoms: depression, disorganization/mania, positive symptoms, negative symptoms and social withdrawal. Longer duration of untreated illness was associated with higher levels of depression and social withdrawal. Individuals with a history of drug abuse prior to the onset of psychosis scored higher on pre-psychotic depression and negative symptoms. The two mood-related factors, depression and disorganization/mania, distinguished the eventual first-episode diagnosis of affective psychosis from schizophrenia. Individuals with affective psychosis were also more likely to have a 'mood-related' sign and symptom as their first psychiatric change than individuals later diagnosed with schizophrenia. CONCLUSIONS: Factors derived from early signs and symptoms reported by a full diagnostic spectrum sample of psychosis can have implications for future diagnostic trajectories. The findings are a step forward in the process of understanding and characterizing clinically important phenomena to be observed prior to the onset of psychosis.”