Symptom Categories
Schizophrenia is a disease that does not discriminate based on race, culture, social status, or gender. Anywhere in the world, in every culture, one person out of every hundred suffers from schizophrenia. Signs of schizophrenia may emerge in people as young as 15 or as late as one’s forties, but it is most common for true psychotic symptoms to reveal themselves in the late teens and early twenties. Indeed, Emilio appears to follow this pattern.
His bizarre behaviors began in high school, with his first psychiatric hospitalization soon following. Interestingly, men seem to develop schizophrenia at an earlier age than women. The average age of onset of schizophrenia in men is 25 years, whereas 29 is the average age for women. Certain traits, such as having a relative with schizophrenia, increase a person’s risk of developing the disease. We will discuss risk factors for schizophrenia in another section.
There are three categories of schizophrenic symptoms: positive, negative, and disorganized. Dr. E. Fuller Torrey, in his book Surviving Schizophrenia, explained that the adjective positive “... denotes those symptoms which are present and should be absent.”
In simple terms, a positive symptom signals a behavior that shouldn’t be there. Remember that positive as used here does not mean “good.” An example of a positive symptom is hallucination. Hallucinations occur when someone hears, sees, smells, or feels things that are not really there. Emilio is hearing voices and although we do not know what they are saying, they seem to be contributing to his erratic behavior.
Another positive symptom is delusion. Delusions cause the patient to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people’s minds.
Figure 2.1 Colored Positron Emission Tomography (PET) brain scan of a schizophrenic male patient during hallucination. Highlighted in orange are the active visual (at right) and auditory (upper center) areas of the brain, confirming that the patient has “seen and heard” a hallucination.
In simple terms, a positive symptom signals a behavior that shouldn’t be there. Remember that positive as used here does not mean “good.” An example of a positive symptom is hallucination. Hallucinations occur when someone hears, sees, smells, or feels things that are not really there. Emilio is hearing voices and although we do not know what they are saying, they seem to be contributing to his erratic behavior.
Another positive symptom is delusion. Delusions cause the patient to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people’s minds.
Emilio believes that his mother is poisoning him, even though this is not true. This is an example of a paranoid delusion.
Negative symptoms reflect the absence of certain normal characteristics and behaviors. An example of this is blunted affect, which means that someone does not show an appropriate range of emotions. For example, someone with blunted affect might not laugh at a joke that most people would find funny.
Other examples of negative symptoms include an inability to start and follow through with activities, speech that is brief and lacks content, and a lack of pleasure or interest in life. Someone with schizophrenia may have such little energy that he or she can do nothing other than sleep or eat. Blunted affect means that many individuals with schizophrenia may seem like they don’t have feelings. Remember that just because a patient doesn’t show emotion does not mean that he or she doesn’t feel it.
People working with schizophrenia patients must continue to be sensitive to their feelings and treat them with kindness and consideration. Social withdrawal may also be a symptom of schizophrenia. Many patients fear being with other people or believe that they simply cannot keep up with other people so they prefer to be alone. This isolation may contribute to depression in schizophrenia and prevent patients from seeking treatment.
Some patients with negative symptoms also exhibit certain physical behaviors. They might move extremely slowly, make repetitive gestures or walk in circles or pace. Emilio demonstrates some disorganized movements when he walks with exaggerated hip movements and a swing in his step.
Disorganized symptoms include odd and confused thinking, speech, and behavior. Emilio exhibits several disorganized symptoms. To begin, he is dressed in a dirty coat, baseball cap, and bedroom slippers. His speech is slurred and he talks like a child and often uses rhyme, as exhibited by his description of his recent activities as “eating wires and lighting fires.” Rhymes that don’t make sense are called clang associations.
Schizophrenia is also associated with changes in cognition.
Cognition is the way we perceive and think about things. People with schizophrenia may have problems remembering things and find it difficult to plan for the future. Many patients with schizophrenia have problems focusing their attention on a task for more than a brief period of time. Motivation is absent in many of these patients and they often feel that many goals are simply out of their reach. Research has indicated that the cognitive problems of schizophrenia may be important factors in determining treatment outcome. Outcome is a general measure of how well a patient is functioning over the long-term.
Many individuals affected with schizophrenia become depressed or have clinically significant mood swings. People with schizophrenia may experience symptoms of depression such as feeling hopeless or believing that life has no meaning.
Some patients have feelings of guilt for the trouble they have caused for their family members and friends and they may feel unworthy and unlovable. In extreme cases, a person with schizophrenia may become so depressed that they wish to end their life.
They may talk of suicide or even attempt to harm themselves.
When mood instability is a major feature of schizophrenia, it is called schizoaffective disorder. In schizoaffective disorder, elements of schizophrenia and mood disorders are observed in the same individual. It is not clear whether schizoaffective disorder is a distinct condition or simply a subtype of schizophrenia. A mental health professional who is formulating a treatment plan for a patient with schizophrenia must consider mood as well as psychotic symptoms. In the next section, you will learn about specific symptoms within these symptom categories.
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What Is It Like to Have Schizophrenia?
One negative symptom of schizophrenia is flat or blunted affect. Individuals with this symptom rarely show their emotions, even in the presence of apparently disturbing stimuli.
Ann Kring and John Neale, professors at the State University of New York at Stony Brook, wanted to know if patients who didn’t show their emotions also didn’t feel emotions to the same extent as people without schizophrenia. These researchers took a group of schizophrenia patients and a group of healthy adults and showed each group three types of film clips.
The film clips were intended to elicit very positive, very negative, or neutral emotions. While the participants were watching the film clips, the researchers videotaped them.
Additionally, researchers measured the participants’ autonomic arousal, or physical indicators of emotion (heartbeat is an example of a way in which we can measure autonomic arousal). Next, the participants were asked about what emotions they experienced during the film. After the film clips were over and the participants went home, experienced raters watched the videotapes and noted the facial expressiveness of all the participants.
Not surprisingly, the schizophrenia patients showed less facial expressiveness than the controls. That is, relative to the non-schizophrenic participants, they appeared to be indifferent to the film clips. The schizophrenia patients did indicate, however, that they were experiencing emotion on the other measures. When asked how they felt watching the film clips, participants with schizophrenia reported just as much if not more intense emotion than did the healthy participants.
The physiological indicators were consistent with patients’ self-report as their physiological reactivity exceeded that of the normal participants. This study provides promising evidence that, although schizophrenia patients may appear to be cold and indifferent, in fact they appear to have emotional experience quite similar to people without schizophrenia.
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Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles,
and received her Ph.D. in psychology from Harvard University in 2004. She
is the author of several journal articles investigating information processing
and the self in borderline personality disorder. Currently, she is the Director
of Clinical Research for the Laboratory of Adolescent Sciences at Vassar
College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband
and children.
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