10.03.

2016

Schizophrenia:Symptoms,Types,Causes,andEarlyWarningSigns

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Schizophrenia
Symptoms,Types,Causes,andEarlyWarningSigns
Schizophreniaisachallengingdisorderthat
makesitdifficulttodistinguishbetweenwhat
isrealandunreal,thinkclearly,manage
emotions,relatetoothers,andfunction
normally.Butthatdoesn'tmeanthereisn't
hope.Schizophreniacanbesuccessfully
managed.Thefirststepistoidentifythe
signsandsymptoms.Thesecondstepisto
seekhelpwithoutdelay.Withtheright
treatmentandsupport,apersonwith
schizophreniacanleadahappy,fulfillinglife.

Whatisschizophrenia?
Schizophreniaisabraindisorderthataffectsthewayapersonbehaves,thinks,andseestheworld.
Peoplewithschizophreniaoftenhaveanalteredperceptionofreality.Theymayseeorhearthingsthat
dontexist,speakinstrangeorconfusingways,believethatothersaretryingtoharmthem,orfeellike
theyrebeingconstantlywatched.Thiscanmakeitdifficulttonegotiatetheactivitiesofdailylife,and
peoplewithschizophreniamaywithdrawfromtheoutsideworldoractoutinconfusionandfear.
Althoughschizophreniaisachronicdisorder,thereishelpavailable.Withsupport,medication,and
therapy,manypeoplewithschizophreniaareabletofunctionindependentlyandlivefulfillinglives.

Commonmisconceptionsaboutschizophrenia
MYTH:Schizophreniareferstoa"splitpersonality"ormultiplepersonalities.
FACT:Multiplepersonalitydisorderisadifferentandmuchlesscommondisorderthan
schizophrenia.Peoplewithschizophreniadonothavesplitpersonalities.Rather,theyaresplitoff
fromreality.
MYTH:Schizophreniaisararecondition.
FACT:Schizophreniaisnotrarethelifetimeriskofdevelopingschizophreniaiswidelyacceptedto
bearound1in100.
MYTH:Peoplewithschizophreniaaredangerous.
FACT:Althoughthedelusionalthoughtsandhallucinationsofschizophreniasometimesleadto
violentbehavior,mostpeoplewithschizophreniaareneitherviolentnoradangertoothers.
MYTH:Peoplewithschizophreniacantbehelped.
FACT:Whilelongtermtreatmentmayberequired,theoutlookforschizophreniaisnothopeless.
Whentreatedproperly,manypeoplewithschizophreniaareabletoenjoylifeandfunctionwithin
theirfamiliesandcommunities.

Earlywarningsignsofschizophrenia
Insomepeople,schizophreniaappearssuddenlyandwithoutwarning.Butformost,itcomesonslowly,
withsubtlewarningsignsandagradualdeclineinfunctioninglongbeforethefirstsevereepisode.Many
friendsandfamilymembersofpeoplewithschizophreniareportknowingearlyonthatsomethingwas
wrongwiththeirlovedone,theyjustdidntknowwhat.
Inthisearlyphase,peoplewithschizophreniaoftenseemeccentric,unmotivated,emotionless,and
reclusive.Theyisolatethemselves,startneglectingtheirappearance,saypeculiarthings,andshowa
generalindifferencetolife.Theymayabandonhobbiesandactivities,andtheirperformanceatworkor
schooldeteriorates.

Themostcommonearlywarningsignsofschizophreniainclude:
Socialwithdrawal
Hostilityorsuspiciousness
Deteriorationofpersonalhygiene
Flat,expressionlessgaze
Inabilitytocryorexpressjoy
Inappropriatelaughterorcrying

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Depression
Oversleepingorinsomnia
Oddorirrationalstatements
Forgetfulunabletoconcentrate
Extremereactiontocriticism
Strangeuseofwordsorwayofspeaking
Whilethesewarningsignscanresultfromanumberofproblemsnotjustschizophreniatheyarecause
forconcern.Whenoutoftheordinarybehavioriscausingproblemsinyourlifeorthelifeofalovedone,
seekmedicaladvice.Ifschizophreniaoranothermentalproblemisthecause,treatmentwillhelp.

Signsandsymptomsofschizophrenia
Therearefivetypesofsymptomscharacteristicofschizophrenia:delusions,hallucinations,disorganized
speech,disorganizedbehavior,andthesocallednegativesymptoms.However,thesignsandsymptoms
ofschizophreniavarydramaticallyfrompersontoperson,bothinpatternandseverity.Noteveryperson
withschizophreniawillhaveallsymptoms,andthesymptomsofschizophreniamayalsochangeover
time.

Delusions
Adelusionisafirmlyheldideathatapersonhasdespiteclearandobviousevidencethatitisnttrue.
Delusionsareextremelycommoninschizophrenia,occurringinmorethan90%ofthosewhohavethe
disorder.Often,thesedelusionsinvolveillogicalorbizarreideasorfantasies.Commonschizophrenic
delusionsinclude:
DelusionsofpersecutionBeliefthatothers,oftenavaguethey,areouttogethimorher.
Thesepersecutorydelusionsofteninvolvebizarreideasandplots(e.g.Martiansaretryingtopoison
mewithradioactiveparticlesdeliveredthroughmytapwater).
DelusionsofreferenceAneutralenvironmentaleventisbelievedtohaveaspecialandpersonal
meaning.Forexample,apersonwithschizophreniamightbelieveabillboardorapersononTVis
sendingamessagemeantspecificallyforthem.
DelusionsofgrandeurBeliefthatoneisafamousorimportantfigure,suchasJesusChristor
Napolean.Alternately,delusionsofgrandeurmayinvolvethebeliefthatonehasunusualpowersthat
nooneelsehas(e.g.theabilitytofly).
DelusionsofcontrolBeliefthatonesthoughtsoractionsarebeingcontrolledbyoutside,alien
forces.Commondelusionsofcontrolincludethoughtbroadcasting(Myprivatethoughtsarebeing
transmittedtoothers),thoughtinsertion(Someoneisplantingthoughtsinmyhead),andthought
withdrawal(TheCIAisrobbingmeofmythoughts).

Danielsstory
Danielis21yearsold.Sixmonthsago,hewasdoingwellincollegeandholdingdownaparttimejob
inthestockroomofalocalelectronicsstore.Butthenhebegantochange,becomingincreasingly
paranoidandactingoutinbizarreways.First,hebecameconvincedthathisprofessorswereoutto
gethimsincetheydidntappreciatehisconfusing,offtopicclassroomrants.Thenhetoldhis
roommatethattheotherstudentswereinontheconspiracy.Soonafter,hedroppedoutofschool.
Fromthere,thingsjustgotworse.Danielstoppedbathing,shaving,andwashinghisclothes.Atwork,
hebecameconvincedthathisbosswaswatchinghimthroughsurveillancebugsplantedinthestores
televisionsets.Thenhestartedhearingvoicestellinghimtofindthebugsanddeactivatethem.
Thingscametoaheadwhenheactedonthevoices,smashingseveralTVsandscreamingthathe
wasntgoingtoputupwiththeillegalspyinganymore.Hisfrightenedbosscalledthepolice,and
Danielwashospitalized.

Hallucinations
Hallucinationsaresoundsorothersensationsexperiencedasrealwhentheyexistonlyintheperson's
mind.Whilehallucinationscaninvolveanyofthefivesenses,auditoryhallucinations(e.g.hearingvoices
orsomeothersound)aremostcommoninschizophrenia.Visualhallucinationsarealsorelatively
common.Researchsuggeststhatauditoryhallucinationsoccurwhenpeoplemisinterprettheirowninner
selftalkascomingfromanoutsidesource.
Schizophrenichallucinationsareusuallymeaningfultothepersonexperiencingthem.Manytimes,the
voicesarethoseofsomeonetheyknow.Mostcommonly,thevoicesarecritical,vulgar,orabusive.
Hallucinationsalsotendtobeworsewhenthepersonisalone.

Disorganizedspeech
Fragmentedthinkingischaracteristicofschizophrenia.Externally,itcanbeobservedinthewayaperson
speaks.Peoplewithschizophreniatendtohavetroubleconcentratingandmaintainingatrainofthought.
Theymayrespondtoquerieswithanunrelatedanswer,startsentenceswithonetopicandend
somewherecompletelydifferent,speakincoherently,orsayillogicalthings.
Commonsignsofdisorganizedspeechinschizophreniainclude:
LooseassociationsRapidlyshiftingfromtopictotopic,withnoconnectionbetweenonethought
andthenext.
NeologismsMadeupwordsorphrasesthatonlyhavemeaningtothepatient.

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PerseverationRepetitionofwordsandstatementssayingthesamethingoverandover.
ClangMeaninglessuseofrhymingwords(IsaidthebreadandreadtheshedandfedNedatthe
head").

Disorganizedbehavior
Schizophreniadisruptsgoaldirectedactivity,causingimpairmentsinapersonsabilitytotakecareofhim
orherself,work,andinteractwithothers.Disorganizedbehaviorappearsas:
Adeclineinoveralldailyfunctioning
Unpredictableorinappropriateemotionalresponses
Behaviorsthatappearbizarreandhavenopurpose
Lackofinhibitionandimpulsecontrol

Negativesymptoms(absenceofnormalbehaviors)
Thesocallednegativesymptomsofschizophreniarefertotheabsenceofnormalbehaviorsfoundin
healthyindividuals.Commonnegativesymptomsofschizophreniainclude:
LackofemotionalexpressionInexpressiveface,includingaflatvoice,lackofeyecontact,and
blankorrestrictedfacialexpressions.
LackofinterestorenthusiasmProblemswithmotivationlackofselfcare.
SeeminglackofinterestintheworldApparentunawarenessoftheenvironmentsocial
withdrawal.
SpeechdifficultiesandabnormalitiesInabilitytocarryaconversationshortandsometimes
disconnectedrepliestoquestionsspeakinginmonotone.

Causesofschizophrenia
Thecausesofschizophreniaarenotfullyknown.However,itappearsthatschizophreniausuallyresults
fromacomplexinteractionbetweengeneticandenvironmentalfactors.

Geneticcausesofschizophrenia
Schizophreniahasastronghereditarycomponent.Individualswithafirstdegreerelative(parentor
sibling)whohasschizophreniahavea10percentchanceofdevelopingthedisorder,asopposedtothe
onepercentchanceofthegeneralpopulation.
Butschizophreniaisonlyinfluencedbygenetics,notdeterminedbyit.Whileschizophreniarunsin
families,about60%ofschizophrenicshavenofamilymemberswiththedisorder.Furthermore,
individualswhoaregeneticallypredisposedtoschizophreniadontalwaysdevelopthedisease,which
showsthatbiologyisnotdestiny.

Environmentalcausesofschizophrenia
Twinandadoptionstudiessuggestthatinheritedgenesmakeapersonvulnerabletoschizophreniaand
thenenvironmentalfactorsactonthisvulnerabilitytotriggerthedisorder.
Asfortheenvironmentalfactorsinvolved,moreandmoreresearchispointingtostress,eitherduring
pregnancyoratalaterstageofdevelopment.Highlevelsofstressarebelievedtotriggerschizophreniaby
increasingthebodysproductionofthehormonecortisol.
Researchpointstoseveralstressinducingenvironmentalfactorsthatmaybeinvolvedinschizophrenia,
including:
Prenatalexposuretoaviralinfection
Lowoxygenlevelsduringbirth(fromprolongedlabororprematurebirth)
Exposuretoavirusduringinfancy
Earlyparentallossorseparation
Physicalorsexualabuseinchildhood

Abnormalbrainstructure
Inadditiontoabnormalbrainchemistry,abnormalitiesinbrainstructuremayalsoplayarolein
schizophrenia.Enlargedbrainventriclesareseeninsomeschizophrenics,indicatingadeficitinthevolume
ofbraintissue.Thereisalsoevidenceofabnormallylowactivityinthefrontallobe,theareaofthebrain
responsibleforplanning,reasoning,anddecisionmaking.
Somestudiesalsosuggestthatabnormalitiesinthetemporallobes,hippocampus,andamygdalaare
connectedtoschizophreniaspositivesymptoms.Butdespitetheevidenceofbrainabnormalities,itis
highlyunlikelythatschizophreniaistheresultofanyoneprobleminanyoneregionofthebrain.

Effectsofschizophrenia
Whenthesignsandsymptomsofschizophreniaareignoredorimproperlytreated,theeffectscanbe
devastating,bothtotheindividualwiththedisorderandthosearoundhimorher.Someofthepossible
effectsofschizophreniaare:
Relationshipproblems.Relationshipssufferbecausepeoplewithschizophreniaoftenwithdrawand
isolatethemselves.Paranoiacanalsocauseapersonwithschizophreniatobesuspiciousoffriendsand
family.
Disruptiontonormaldailyactivities.Schizophreniacausessignificantdisruptionstodaily

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functioning,bothbecauseofsocialdifficultiesandbecauseeverydaytasksbecomehard,ifnot
impossibletodo.Aschizophrenicpersonsdelusions,hallucinations,anddisorganizedthoughtstypically
preventhimorherfromdoingnormalthingslikebathing,eating,orrunningerrands.
Alcoholanddrugabuse.Peoplewithschizophreniafrequentlydevelopproblemswithalcoholor
drugs,whichareoftenusedinanattempttoselfmedicate,orrelievesymptoms.Inaddition,they
mayalsobeheavysmokers,acomplicatingsituationascigarettesmokecaninterferewiththe
effectivenessofmedicationsprescribedforthedisorder.
Increasedsuiciderisk.Peoplewithschizophreniahaveahighriskofattemptingsuicide.Any
suicidaltalk,threats,orgesturesshouldbetakenveryseriously.Peoplewithschizophreniaare
especiallylikelytocommitsuicideduringpsychoticepisodes,duringperiodsofdepression,andinthe
firstsixmonthsaftertheyvestartedtreatment.

Diagnosingschizophrenia
Adiagnosisofschizophreniaismadebasedonafullpsychiatricevaluation,medicalhistory,physicalexam,
andlabtests.
PsychiatricevaluationThedoctororpsychiatristwillaskaseriesofquestionsaboutyouoryour
lovedone'ssymptoms,psychiatrichistory,andfamilyhistoryofmentalhealthproblems.
MedicalhistoryandexamYourdoctorwillaskaboutyourpersonalandfamilyhealthhistory.He
orshewillalsoperformacompletephysicalexaminationtocheckformedicalissuesthatcouldbe
causingorcontributingtotheproblem.
LaboratorytestsWhiletherearenolaboratoryteststhatcandiagnoseschizophrenia,simpleblood
andurinetestscanruleoutothermedicalcausesofsymptoms.Thedoctormayalsoorderbrain
imagingstudies,suchasanMRIoraCTscan,inordertolookforbrainabnormalitiesassociatedwith
schizophrenia.

Criteriatodiagnoseschizophrenia
Thepresenceoftwoormoreofthefollowingsymptomsforatleast30days:
1.Hallucinations
2.Delusions
3.Disorganizedspeech
4.Disorganizedorcatatonicbehavior
5.Negativesymptoms(emotionalflatness,apathy,lackofspeech)
Significantproblemsfunctioningatworkorschool,relatingtootherpeople,andtakingcareof
oneself.
Continuoussignsofschizophreniaforatleastsixmonths,withactivesymptoms(hallucinations,
delusions,etc.)foratleastonemonth.
Noothermentalhealthdisorder,medicalissue,orsubstanceabuseproblemiscausingthe
symptoms.

Conditionsthatcanlooklikeschizophrenia
Themedicalandpsychologicalconditionsthedoctormustruleoutbeforediagnosingschizophrenia
include:
OtherpsychoticdisordersSchizophreniaisatypeofpsychoticdisorder,meaningitinvolvesa
significantlossofcontactwithreality.Butthereareotherpsychoticdisordersthatcausesimilar
symptomsofpsychosis,includingschizoaffectivedisorder,schizophreniformdisorder,andbrief
psychoticdisorder.Becauseofthedifficultyindifferentiatingbetweenthepsychoticdisorders,itmay
takesixmonthsorlongertoarriveatacorrectdiagnosis.
SubstanceabusePsychoticsymptomscanbetriggeredbymanydrugs,includingalcohol,PCP,
heroin,amphetamines,andcocaine.Someoverthecounterandprescriptiondrugscanalsotrigger
psychoticreactions.Atoxicologyscreencanruleoutdruginducedpsychosis.Ifsubstanceabuseis
involved,thephysicianwilldeterminewhetherthedrugisthesourceofthesymptomsormerelyan
aggravatingfactor.
MedicalconditionsSchizophrenialikesymptomscanalsoresultfromcertainneurologicaldisorders
(suchasepilepsy,braintumors,andencephalitis),endocrineandmetabolicdisturbances,and
autoimmuneconditionsinvolvingthecentralnervoussystem.
MooddisordersSchizophreniaofteninvolveschangesinmood,includingmaniaanddepression.
Whilethesemoodchangesaretypicallylessseverethanthoseseeninbipolardisorderandmajor
depressivedisorder,theycanmakediagnosistricky.Schizophreniaisparticularlydifficulttodistinguish
frombipolardisorder.Thepositivesymptomsofschizophrenia(delusions,hallucinations,and
disorganizedspeech)canlooklikeamanicepisodeofbipolardisorder,whilethenegativesymptomsof
schizophrenia(apathy,socialwithdrawal,andlowenergy)canlooklikeadepressiveepisode.
Posttraumaticstressdisorder(PTSD)PTSDisananxietydisorderthatcandevelopafter
exposuretoatraumaticevent,suchasmilitarycombat,anaccident,oraviolentassault.Peoplewith
PTSDexperiencesymptomsthataresimilartoschizophrenia.Theimages,sounds,andsmellsofPTSD
flashbackscanlooklikepsychotichallucinations.ThePTSDsymptomsofemotionalnumbnessand
avoidancecanlooklikethenegativesymptomsofschizophrenia.

Hopeforschizophrenia
Treatmentoptionsforschizophreniaaregood,andtheoutlookforthedisordercontinuestoimprove.
Withmedication,therapy,andastrongsupportnetwork,manypeoplewithschizophreniaareableto
controltheirsymptoms,gaingreaterindependence,andleadfulfillinglives.
Ifyouthinkthatsomeoneclosetoyouhasschizophrenia,youcanmakeadifferencebyshowingyour

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loveandsupportandhelpingthatpersongetproperlyevaluatedandtreated.Tolearnmore,seethe
relatedarticlesbelow.

Morehelpforschizophrenia
Wouldimprovedstressmanagementandcommunicationbeofvalue?FEELINGLOVED
canhelp. LEARNMORE

HelpingaPersonwithSchizophrenia:OvercomingChallengesWhileTakingCareofYourself
SchizophreniaTreatmentandRecovery:GettingtheHelpandSupportYouNeed
SubstanceAbuseandMentalHealth:SubstanceAbuseandCoOccurringDisorders
SuicideHelp:DealingwithSuicidalThoughtsandFeelings
SuicidePrevention:HowtoHelpSomeonewhoisSuicidal
CaregiverStressandBurnout:TipsforRechargingandFindingBalance

Youhavethepowertomakeadifferenceinthelivesofmanypeople.LEARNMORE

Resourcesandreferences
Schizophrenia
SchizophreniaProvidesacomprehensiveoverviewdiscussingcauses,symptoms,diagnosis,treatment
andcurrentresearchonschizophrenia.(NationalInstituteofMentalHealth)
LearnMoreAboutSchizophreniaAguidetothesymptoms,causes,diagnosis,andtreatmentof
schizophrenia.(SchizophreniaSocietyofCanada)
BasicFactsAboutSchizophrenia(PDF)This40pagebookletcoversthemostfrequentlyasked
questionsaboutschizophrenia,includingwhatitslikeandhowfamiliescanhelp.(BritishColumbia
SchizophreniaSociety)
UnderstandingSchizophreniaandRecovery(PDF)Coverswhatpeoplewithschizophreniaand
theirfamiliesneedtoknowaboutschizophreniaanditstreatment.(NationalAllianceonMentalIllness)

Symptomsandearlywarningsignsofschizophrenia
SchizophreniainChildrenDescribessymptomsinchildren,whichmaybedifferentfromthosein
adults.(AmericanAcademyofChildandAdolescentPsychiatry)
TheFirstSignsofSchizophreniaReadthroughpersonalstories,offeredbybothpeoplewith
schizophreniaandtheirlovedones,describingtheearlysignsandsymptomstheyobserved.
(Schizophrenia.com)

Typesofschizophrenia
ParanoidSchizophreniaLearnaboutthemostcommonsubtypeofschizophrenia,includingtypical
signsandsymptomssuchasparanoiddelusions.(PsychCentral)
CatatonicSchizophreniaOverviewofthesignsandsymptomsofcatatonicschizophrenia,aswellas
itscausesandeffects.(PsychCentral)
DisorganizedSchizophreniaGuidetodisorganizedschizophreniassignsandsymptoms,suchas
disorganizedthinking,disorganizedbehavior,andflataffect.(MedlinePlus)

Causesofschizophrenia
PossibleCausesofSchizophreniaReviewsthepossiblecausesofschizophrenia,includingbiological,
psychological,andsocialfactors.(SchizophreniaFellowshipofNSW)
WhatCausesSchizophrenia?Coversthecombinationofcausesinvolvedinschizophrenia,including
genes,brainchemistry,andbrainstructure.(NationalInstituteofMentalHealth)

Authors:MelindaSmith,M.A.,andJeanneSegal,Ph.D.Lastupdated:February
2016.
Helpguide.org.Allrightsreserved.ThisreprintisforinformationonlyandNOTasubstituteforprofessionaldiagnosisandtreatment.
Helpguide.orgisanadfreenonprofitresourceforsupportingbettermentalhealthandlifestylechoicesforadultsandchildren.

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