Schizophrenia is a mental disorder interfering with a person’s ability to recognize what is real, manage his or her emotions, think clearly, make judgements and communicate.

People with schizophrenia usually suffer strange symptoms, such as hearing imaginary voices, and believing that these voices are controlling their thoughts and actions. They may believe that people are plotting to harm them. They become frightened and withdrawn. Their speech and behaviour become disorganized.

The onset of schizophrenia is generally gradual, and rarely sudden or dramatic. Certain symptoms can develop slowly, in an almost imperceptible fashion, while other symptoms develop more rapidly and are very easy to recognize.

Scientists have classified the symptoms of schizophrenia as positive and negative. ‘Positive’ does not imply that the symptoms are ‘good’ for the patient, but that they are easily noticeable, more disruptive to the family, more distressing to the patient and make the patient more responsive to medicines. Some of the positive symptoms are hallucinations, delusions and thought disorders.

The negative symptoms are not easily discernible and are not very disruptive socially, but can be more disabling than the positive symptoms. Patients with these symptoms are generally less responsive to medicines. Reduced motivation and drive, difficulty in experiencing pleasure, lack of emotions and lack of energy are some of the common negative symptoms. The patient displaying these symptoms is often taken to be deliberately lazy or not making an effort, and the family may turn hostile towards him/her on account of these symptoms.

Behavioural changes
A common manifestation is behavioural change. Often, this is more easily recognized by the family members, who then take the patient to a doctor. Behavioural change could take different forms, such as social withdrawal, isolation, restlessness, irritability, aggressiveness and antisocial behaviour. These result in an impairment of day-to-day functioning - a drop in school attendance and performance, increasing unproductivity, difficulties in interpersonal relationships, neglect of household activities and preoccupation in a personal world are the common manifestations seen in clinical practice.

Delusions

Delusions are patients’ fixed belief in something that is obviously untrue. They may believe that they are being persecuted, that people are conspiring against them at work or at home; they may suspect their spouse of infidelity and may take to watching them constantly; they may believe that their thoughts are being controlled by some external force, e.g. that a radio receiver is planted in their head. These beliefs will not be shaken by attempts to reason with them.

Hallucinations

Hallucinations are imaginary voices which the patients hear and respond to. They are seen apparently talking to themselves in a disjointed way, often laughing, gesticulating or smiling. These voices can be distressing and can sometimes control the patients. Often, the patients see frightening figures and their fear may make it difficult for others to control them. They could even be driven to suicide.

Thought disturbances

Schizophrenia is often characterized by disturbances in thinking - this may be reflected in incoherent and irrelevant speech. The patients may also report that their thoughts are muddled, are withdrawn by somebody else or that other people get to know what they are thinking. The patients may also believe that thoughts are inserted into their mind.