Symptoms of Schizophrenia

Flip It Video: Positive and Negative Symptoms of Schizophrenia

• 68-1 What patterns of perceiving, thinking, and feeling characterize schizophrenia?

Schizophrenia comes in varied forms. People with schizophrenia display symptoms that are positive (inappropriate behaviors are present) or negative (appropriate behaviors are absent). Those with positive symptoms may experience hallucinations, talk in disorganized and deluded ways, and exhibit inappropriate laughter, tears, or rage. Those with negative symptoms may exhibit an absence of emotion in their voices, expressionless faces, or unmoving—mute and rigid—bodies.

DISTURBED PERCEPTIONS AND BELIEFS

People with schizophrenia sometimes have hallucinations—they see, feel, taste, or smell things that exist only in their minds. Most often, the hallucinations are voices, which sometimes make insulting remarks or give orders. The voices may tell the person that she is bad or that she must burn herself with a cigarette lighter. Imagine your own reaction if a dream broke into your waking consciousness, making it hard to separate your experience from your imagination. When the unreal seems real, the resulting perceptions are at best bizarre, at worst terrifying.

hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus.

Hallucinations are false perceptions. People with schizophrenia also have disorganized, fragmented thinking, often distorted by false beliefs called delusions. If they have paranoid tendencies, they may believe they are being threatened or pursued.

delusion

a false belief, often of persecution or grandeur, that may accompany psychotic disorders.

One cause of disorganized thinking may be a breakdown in selective attention. Recall from Module 16 that we normally we have a remarkable capacity to give our undivided attention to one set of sensory stimuli while filtering out others. People with schizophrenia are easily distracted by tiny unrelated stimuli, such as the grooves on a brick or tones in a voice. This selective attention difficulty is but one of dozens of cognitive differences associated with schizophrenia (Reichenberg & Harvey, 2007).

DISORGANIZED SPEECH

Maxine, a young woman with schizophrenia, believed she was Mary Poppins. Communicating with Maxine was difficult because her thoughts spilled out in no logical order. Her biographer, Susan Sheehan (1982, p. 25), observed her saying aloud to no one in particular, “This morning, when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars. . . . Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday.”

Jumbled ideas may make no sense even within sentences, forming what is known as word salad. One young man begged for “a little more allegro in the treatment,” and suggested that “liberationary movement with a view to the widening of the horizon” will “ergo extort some wit in lectures.”

AP^® EXAM TIP

When psychologists refer to “positive” and “negative” schizophrenia symptoms (as with positive and negative reinforcement in Unit VI), the terms positive and negative don’t mean “good” and “bad.” Symptoms are positive and negative in a mathematical sense (adding or subtracting behaviors).

DIMINISHED AND INAPPROPRIATE EMOTIONS

The expressed emotions of schizophrenia are often utterly inappropriate, split off from reality (Kring & Caponigro, 2010). Maxine laughed after recalling her grandmother’s death. On other occasions, she cried when others laughed, or became angry for no apparent reason. Others with schizophrenia lapse into an emotionless flat affect state of no apparent feeling. For example, monetary perks fail to provide the normal brain reward center activation (Radua et al., 2015). Most also have an impaired theory of mind—they have difficulty perceiving facial expressions and reading others’ states of mind (Bora & Pantelis, 2016). Unable to understand others’ mental states, those with schizophrenia struggle to feel sympathy and compassion (Bonfils et al., 2016). These emotional deficiencies occur early in the illness and have a genetic basis (Bora & Pantelis, 2013). Motor behavior may also be inappropriate and disruptive. Those with schizophrenia may experience catatonia, characterized by motor behaviors ranging from a physical stupor—remaining motionless for hours—to senseless, compulsive actions, such as continually rocking or rubbing an arm, to severe and dangerous agitation.

Art by someone diagnosed with schizophrenia Commenting on the kind of artwork shown here (from Craig Geiser’s 2010 art exhibit in Michigan), poet and art critic John Ashbery wrote: “The lure of the work is strong, but so is the terror of the unanswerable riddles it proposes.”

AP^® EXAM TIP

Be sure you can differentiate between hallucinations (false sensory experiences) and delusions (false beliefs).

As you can imagine, such disturbed perceptions and beliefs, disorganized speech, and out of place emotions profoundly disrupt social and work relationships. As with other disorders, many have sleep problems, which can increase night eating and obesity (Baglioni et al., 2016; Palmese et al., 2011). Given a supportive environment and medication, over 40 percent of people with schizophrenia will have periods of a year or more of normal life experience (Jobe & Harrow, 2010). But only 1 in 7 will have a full and enduring recovery (Jääskeläinen et al., 2013).

“ Now consider this: The regulator that funnels certain information to you and filters out other information suddenly shuts off. Immediately, every sight, every sound, every smell coming at you carries equal weight; every thought, feeling, memory, and idea presents itself to you with an equally strong and demanding intensity.”

Elyn R. Saks, The Center Cannot Hold, 2007