Schizophrenia

Though not an official diagnostic term, what are often called the positive symptoms of schizophrenia refer to abnormal features that are present (as opposed to absent).

Common positive symptoms of schizophrenia include:

• Hallucinations: These include sensory illusions, in any sensory modality, that can take the form of seeing, hearing, or tasting things that aren’t really there. Auditory hallucinations are more common than visual hallucinations.
• Delusions: Delusions are distorted beliefs that, despite possibly having a kernel of truth, are not supported by the overwhelming evidence accessible to most other objective, non-psychotic observers.
• Thought disorder symptoms: Thought disorders are a general category of dysfunctional features that highlight a person’s break from reality, or indicate their illogical thinking patterns, including loose associations (i.e., bizarre links between two events that are related in a person’s mind).
• Disorganized speech: Speech that does not make logical sense or is incoherent is often referred to as disorganized speech. This can possibly include nonsense syllables or the repetition of the same word or phrase over and over.
• Disorganized behavior: Disorganized behaviors do not fit a given situation, like undressing on a busy street corner.
• Movement symptoms: Disturbances in typical movement may either take the form of simple repetitive movements—like tics—or the lack of movement altogether (also called catatonia).

Negative Symptoms

In contrast to the positive symptoms above, the negative symptoms of schizophrenia refer to the absence of typical, common, or normal features that most individuals regularly exhibit.

Negative symptoms of schizophrenia include the following:

• Flat Affect: A person experiencing flat or blunted affect will show a minimal emotional response to positive or negative events.
• Anhedonia: Anhedonia is the inability to experience pleasure (i.e., hedonism) when engaging in activities that usually bring joy, like sex or playing video games.
• Alogia: Alogia is the lack of making logical sense in one’s arguments.
• Avolition: Someone experiencing avolition will have a lack of motivation to voluntarily complete their regular tasks.
• Diminished Activities of Daily Living (ADLs): These behaviors include avoidance of daily activities such as bathing, oral hygiene, changing clothes, shaving, doing laundry, paying bills, food shopping, taking out garbage, collecting the mail, and cleaning the house.

Though not yet an official diagnostic criterion for a DSM V diagnosis of schizophrenia, the onset of schizophrenia is often preceded by or accompanied by a marked reduction in cognitive functioning. According to research, neurocognitive functioning for those with schizophrenia can be significantly below neurotypical individuals in certain aspects of mental functioning.^3,4

Cognitive symptoms of schizophrenia include impairment of the following:

• Executive functioning: The ability to plan, organize, make decisions, adapt to changing conditions, see things from alternate perspectives, and engage in abstract reasoning.
• Inattention.
• Verbal fluency: The ability to generate words and expand vocabulary.
• Verbal encoding: The ability to commit things to memory that were presented in verbal communication.
• Verbal memory: The ability to recall things that were presented in verbal communication.

The prodromal phase of schizophrenia is a period that can last up to 24 months before an individual meets full criteria for the illness. During this phase, some early warning signs may include isolated symptoms of the illness, along with a significant decline in IQ, general cognitive functioning, academic achievement, communication skills, or verbal memory. In contrast to schizophrenia, other disorders that may also have psychotic symptoms, like depression with psychotic features, don’t typically include such a drastic reduction in cognitive (and especially verbal) functioning.

The onset of schizophrenia in children and adolescents is often insidious—rather than acute—with the illness typically developing for many months before the first psychotic symptoms manifest, usually in the form of auditory hallucinations and delusions. Further complicating the diagnosis of schizophrenia in children and adolescents is that other childhood disorders— such as autism spectrum disorder (ASD), pervasive developmental disorder, depression, conduct disorder can resemble the early signs of schizophrenia. Furthermore, treatment of attention deficit hyperactivity disorder (ADHD) with high doses of psychostimulants (like Vyvanse), as well as heavy cannabis use, can trigger psychotic symptoms that mimic schizophrenia.⁵

Some warning signs of schizophrenia may include the following:

• Increased solitude
• Diminished desire to socialize
• Significant decline in motivation
• Bizarre speech, logic, or behavior
• Hallucinations
• Delusions
• Significant drop in cognitive abilities
• Marked reduction in school/work performance