Schizophrenia: Classification of Symptoms & Treatment

‍Positive Symptoms of Schizophrenia

Schizophrenia causes a surplus of mental experiences and positive symptoms refers to those which are in excess or added to normal mental functioning. Positive symptoms in schizophrenia can be further classified based on:

• Hallucinations: Hallucinations are false perceptions. It means that the individual senses things that do not exist in reality. Hallucinations play an important part in creating a different reality that is not real or true, making them dysfunctional in the actual reality that we share. Hallucinations in schizophrenia can be experienced through all the senses:

• Auditory hallucinations: Auditory hallucinations are the most common in schizophrenia. They are unreal voices the individual hears. They can also be particular sounds like music, footsteps, animal sounds, etc. There can be one or more voices the individual hears. These voices may talk to the individual or talk among themselves.

They could be commenting on the individual’s activities or instructing them. Auditory hallucinations can be life-threatening if the voices command the individual to stop taking medications or harm themselves. These kinds of voices make the individual vulnerable to suicidal and violent behaviour.

• Visual hallucinations: Here, the individual sees people, animals, or objects that are not in reality. Visual hallucinations are the second common hallucinations in schizophrenia. The unreal image the individual sees can be clear or distorted. These hallucinations can be very frightening depending on what the individual sees.

• Olfactory hallucinations: Here, the individual can smell unreal odors that no one else can smell. These may involve particular stinks that may be associated with a particular place. In many cases, it is seen that individuals get these unpleasant smells from themselves, where they feel their body is decaying. This may cause embarrassment to the individual when in public.
• Tactile hallucinations: This involves the sense of touch. The individual might feel someone is touching them, a finger running over their body, or someone holding them. They may also feel that someone is hurting them or slapping them. These can be disturbing as they could feel the pain to be real.
• Gustatory hallucinations: These involve the sense of taste. Here, the individual feels a bad taste in their mouth as if they had eaten something.
• Delusions: Delusions are strong false beliefs that the individuals may have. The person may believe that their thoughts or actions are being controlled by some external forces. The person may also believe that they have supernatural powers and they may feel that they are a famous personality or historical figure.

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There are several types of delusions associated with schizophrenia, most of which involve a particular theme:

• Grandiose: The individual may feel a sense of exaggerated power, identity, and importance, and consider others around them as inferior.

• Referential: The individual may make bizarre claims that their organs and other motor functions are under control by aliens or every movement of theirs is under constant surveillance.

• Persecutory: The individual may claim that someone or something is out to harm them, despite no evidence of such instances.
• Erotomania: The individual may falsely believe that a famous personality or high-ranking official is in love with them.
• Disorganized thoughts and speech: Individuals with schizophrenia can experience difficulty in organizing thoughts. They are easily distracted or unable to follow the given instructions. When they talk, their words do not make sense, and they answer questions in an irrelevant way. Speech is also affected: they may speak in a disorganized manner, and their statements may consist of meaningful but jumbled words, creating a word salad.

Schizophrenia may be diagnosed in such cases if the individual showcases:  

• Derailment: Shifting words in a sentence or cutting off a flow of words to start another sentence

• Incoherence: Jumbling and connecting words that don’t make sense together

• Tangential thinking: Giving irrelevant answers to questions
• Circumstantial thinking: Beating around the bush and never landing to the point of a conversation
• Loose associations: An illogical and disconnected thought process
• Disorganized behaviour: The individual may face issues with goal-directed self-care behaviour like poor personal hygiene. Sudden impulsive and socially inappropriate behaviour may also be seen. For example, the individuals may wear a cotton shirt in winter, and they may wear odd or improper makeup, or they may shout at others without reason, etc.
• Disorganized movements: The individual may perform the same movements again and again like agitated body movement, constant twitching, etc. Sometimes they may  be rigid in a particular posture and  cannot move for hours or days.

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Negative Symptoms of Schizophrenia

Negative symptoms may surface in individuals as lack of facial expression, monotonous and monosyllabic speech. They may seem to be less interested in other people. They find it difficult to experience pleasure or act spontaneously. A person with schizophrenia tends to lack interest in activities. These symptoms are hard to recognize in teenagers because healthy adolescents also may have frequent mood swings.

• Apathy: The individual may have an absence of enthusiasm for activities that were interesting to them, for example, their work or studies or entertaining activities such as sports. Likewise, they may quit caring for themselves properly and decreased cleanliness and appearance are noticeable. They may feel hesitant to go out or even their room.
• Blunt feelings: The individual may not react appropriately when they hear good news or bad news. For example, laughing at sad news or feeling unhappy when hearing good news.
• Disorganized speech: The individual may have a low interest in talking with others and may be unable to respond properly to a particular question. Lack of communication skills can affect the individual ability to take part in activities or find employment. They are disconnected sentences and they often speak gibberish.
• Social withdrawal: The individual may keep away from social contact. They will find it difficult to mingle with the people around them.
• Impaired attention: The individual may have trouble concentrating on discussion and lack of concentration on even simple tasks.
• Anhedonia: Anhedonia means unable to experience  pleasure. The individual may often feel empty or hollow.
• Laziness: The person may have difficulty in doing day-to-day activities and also feeling tired frequently. They may not be able to keep up with plans.  

Negative symptoms affect an individual’s quality of life greatly and influence their ability to experience many facets of life such as long term relationships, financial stability, and work.

Cognitive Symptoms of Schizophrenia

Among the most widely known schizophrenia facts, there has been evidence that the disorder affects thinking and cognitive abilities. These symptoms are often very hard to detect:

• Memory deficits: Individuals with schizophrenia may showcase instances of poor long and short-term memory. Their IQ levels also tend to be lower than normal.

• Poor thought processing: The working memory of a person with schizophrenia can show signs of dysfunction, leading to an inability to arrange and encode information.

• Low attention spans: Individuals are less likely to stick to any given task for a prolonged and consistent amount of time.
• Verbal deficits: The speech patterns and fluency of the language is also affected, rendering a person with schizophrenia unable to structure a coherent sentence.

Can Schizophrenia Be Diagnosed?

Signs of schizophrenia are quite difficult to detect and may be easily missed which leads to late diagnosis and possible complications later in life. However, early diagnosis and appropriate treatment can prevent complications. Family and friends play a major role in encouraging and supporting the individual to seek treatment and follow it.

There is no single health test or a brain scan that can suffice for the diagnosis of schizophrenia. Since the doctors are still unaware of the exact cause of schizophrenia, to determine how to treat schizophrenia, multiple psychometric tests and exams need to be done before confirming the diagnosis. These health exams comprise of the following:

• During the initial appointment, the doctor needs to know the entire medical history of the patient and their family, followed by their normal mental health, mood patterns, and substance abuse problems. They may also ask for school or work performance reports to get insights into the cognitive abilities of the patient.
• For the next step, the doctor may prescribe several blood tests, physical examinations, and imaging tests like Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI).
• Even psychometric assessments are essential to establish the diagnosis.
• For the final step and confirmed diagnosis, the patient should have experienced symptoms of ‘positive’ schizophrenia in a one-month period. These symptoms are hallucinations, delusions, and disorganized speech.

People with schizophrenia lose interest in things. One of the common examples is a lack of self-interest in hygiene and grooming. These signs can be hard to find, especially in cases of teenagers as they suffer from mood swings frequently during this period.

Also, depression can have the same symptoms like schizophrenia. One-fourth of people diagnosed with schizophrenia meet the criteria for depression. It’s very easy to misjudge a person’s disorder as the following symptoms are common in depression and schizophrenia –

• Depressed mood nearly every day
• Diminished interest in all activities
• Significant weight loss or gain
• Sleep disturbance (insomnia or hypersomnia)
• Psychomotor agitation (restlessness)
• Retardation (slowing down)
• Fatigue or loss of energy
• Feelings of guilt or worthlessness
• Decreased ability to think or concentrate or poor decision making
• Recurrent suicidal ideation

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Treatments for Schizophrenia

Schizophrenia treatment includes a combination of medications, therapies, social support, and lifestyle changes to help reduce schizophrenia symptoms. Long term treatment for schizophrenia and schizophrenia care is very crucial to avoid new episodes and to effectively manage symptoms of schizophrenia.

Here are some methods that are commonly practiced to treat person with schizophrenia:

• Psychotherapy: This method involves engaging in a conversation with the patient to help them understand and manage their symptoms. Psychotherapy is practiced in 3 ways:
• Individual psychotherapy: A psychiatrist will request a one-to-one sit down with the patient to assess the problems and advice on how best to tackle such instances.
• Cognitive Behavioural Therapy (CBT): This method is used to help patients change their thought process and behaviour to more positive thinking. The psychiatrist may prescribe some medications to help reduce the chance of a psychotic episode.
• Cognitive Enhancement Therapy (CET): This method helps patients regain basic cognitive skills that they may have lost due to schizophrenic incidents. It usually involves brain-training exercises.
• Psychosocial Therapy: If psychotherapy is showing signs of improvement in the patient, psychosocial therapy is given to help them slowly readjust to societal norms. Methods include:
• Social skills training: Helping patients regain communication skills
• Family education: Support from loved ones is a crucial healing process for patients with schizophrenia.
• Rehabilitation: For those patients whose psychotic episodes triggered during a time they were pursuing a career, rehabilitation in money management and job-based soft skills should be taken up.
• Self-help groups: Community care and outreach programs can help those recovering from psychic episodes get back into a social atmosphere and do something productive.
• Electroconvulsive Therapy (ECT): This method is only advised if psychotic episodes become chronic and result in severe mental issues. The process involves placing the patient under general anesthesia and attaching electrodes to their temple.

The treatment is done on multiple occasions if needed and is said to result in controlled seizures. These seizures can help release neurotransmitters in the brain, which in turn helps in the recovery process.

• Antipsychotic drugs: There are many drugs a psychiatrist may prescribe to complement the treatment procedures. These have to be taken under the careful supervision of a caregiver, as patients may tend to develop a dependency.  

Schizophrenia cannot be cured but with effective treatment and care, can be managed efficiently. A holistic treatment approach is necessary to ensure the well-being of the individual suffering from schizophrenia and their families and caregivers. If you or someone you know is suffering from schizophrenia, reach out to Cadabam’s hospital. Our multispecialty team of experts work round the clock to ensure you get the care you deserve.  Reach out to us on our 24/7 helpline at +91 96111 94949

Disclaimer – We strive to treat our patients with dignity and the utmost sensitivity. We understand that schizophrenia is a disease and that it is not a sign of weakness. The term schizophrenic is used not in a derogatory fashion but to remain relevant to user search trends and common usage. It is important to note that patients should be referred to as ‘people/individual suffering from schizophrenia’.

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