Mental health articles

OF mental health care and mentally ill

Schizophrenia symptoms and signs

Positive symptoms and signs

These are essentially disordered versions of the normal brain functions of thinking, perceiving, formation of ideas and sense of self. Patients with thought disorder may present with complaints of poor concentration or of their mind being blocked or emptied (thought block): a patient stopping in a perplexed fashion while in mid-speech and the interviewer having difficulty in following the speech are typical signs.

Hallucinations

These are false perceptions in any of the senses in the absence of real external stimuli: a patient experiences a seemingly real voice or smell, for example, although nothing actually occurred. The hallmark of schizophrenia is that patients experience voices talking about them as ‘he’ or ‘she’ (third person auditory hallucinations), but second person ‘command’ voices also occur, as do olfactory, tactile (both somatic and visceral) and visual hallucinations. Functional MRI research indicates that misattribution of self-generated ‘inner’ perceptions may account for such experiences.

Delusions

These are abnormal beliefs held with absolute certainty, dominating the patient’s mind, and untenable in terms of the sociocultural background.

Delusions often derive from attempts to make sense of other symptoms such as the experience of passivity (sensing that someone or something is controlling one’s body, emotions or thoughts). Typical experiences are of thoughts being taken or sucked out of the head (a patient insisted that her mother was ‘stealing her brain’) or inserted into the mind, or of one’s thoughts being known to others (respectively termed thought withdrawal, thought insertion and thought broadcast). Cult beliefs in telepathy and mind control may relate to partial forms of these experiences.

Negative symptoms

A negative symptom is the absence of some ability or attribute a normal person would possess. These include loss of personal abilities such as initiative, interest in others and the sense of enjoyment (anhedonia). Blunted or fatuous emotions (flat affect), limited speech and much time spent doing nothing are typical behaviours. Subtle cognitive deficits often persist (or even worsen) despite continuing treatment.

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