Symptoms

• Positive Symptoms

  Symptoms experienced in addition to normal experiences (An excess or distortion of normal functioning) - eg hallucinations

  More dramatic and responsive to drug treatment
• Negative Symptoms

  The loss of a usual experiences (A diminution or loss of normal functioning)

  Impacts quality of life and usually reported by family/friends

  Less dramatic and less responsive to drug treatment
• Hallucination (Positive)


  Disturbances of perception in any of the senses

  False perceptions that have no basis in reality or warped perceptions of reality

  Most common are auditory hallucinations

  Can be auditory (hearing voices), Olfactory (smelling things), tactile (feeling things), or visual (seeing people)
• Delusions (Negative)


  Firmly held irrational beliefs without reality basis - can be paranoid/persecutory (hearing voices)

  • Delusions of persecution
  • Delusions of grandeur
  • Delusions of control
  • Delusions of reference
• Delusions of persecution

  Belief that others want to harm, threaten or manipulate them (eg government or aliens)
• Delusions of grandeur

  Belief of being an important, god-like individual having extraordinary powers
• Delusions of control

  Belief that their body is under external control (eg government or aliens)
• Delusions of reference

  Belief that events in the environment appear to be directly related to them (eg messages through the tv)
• Disorganise Speech (Positive)


  The result of abnormal thought processes, where the individual has problems organising their thoughts and this shows up in their speech

  They may slip from one topic to another (derailment)

  In extreme cases their speech may be so incoherent it sounds like gibberish (‘Word salad’)
• Grossly disorganised or catatonic behaviour (Positive)


  This individual may dress or act in ways that appear bizarre to other people, such as wearing heavy clothes on a hot day

  Catatonic behaviours are characterised by reduced reaction to the immediate environment, rigid postures or aimless motor activity
• Speech Poverty (Negative)


  Limited speech output with limited, often repetitive content

  Involves reduced frequency and quality of speech

  Sometimes accompanied by a delay in verbal responses during conversation

  Difficulty spontaneously producing words
• Avolition (Negative)


  Lack of purposeful, willed behaviour

  the reduction, difficulty or inability to start and continue with goal-directed behaviour (ie actions performed to achieve a result)

  Results in lowered activity levels (eg no longer going out and meeting friends, poor hygiene, lack of persistence, laziness)
• Affective flattening (Positive)


  A reduction in the range and intensity of emotional expression, including facial expressions, voice tone, eye contact and body language
• Anhedonia (Negative)


  Loss of interest or pleasure in all or almost all activities, or a lack of reactivity to normal pleasurable stimuli

  Can be physical or social
• Physical Anhedonia

  Lack of pleasure from food and bodily contact

  More reliable than social
• Social anhedonia

  Lack of pleasure from interpersonal situations such as interacting with other people

  Less reliable as can overlap with depression
• Classification of schizophrenia - DSM-5

  Two or more of the following symptoms must be present:

  • Delusions
  • Hallucinations
  • Disorganised speech
  • Catatonic behaviour
  • Negative symptoms

  Only one symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the persons behaviour or thoughts
• Classification of schizophrenia - DSM-5

  There must be continuous signs of disturbance for at least 6 months - must include at least one month of symptoms outlined

  For a significant portion of the time, one or more major areas of functioning (eg work, interpersonal relations, or self-care) must be markedly below the level achieved prior to onset
• Classification of schizophrenia - ICD-10

  Two or more negative symptoms or one positive symptom are sufficient for diagnosis

  Recognises a range of subtypes of schizophrenia

  • eg paranoid schizophrenia which is characterised by powerful hallucinations and delusions
  • Hebephrenic schizophrenia which involves primarily negative symptoms

  Previous editions of the DSM recognise subtypes but has been dropped in the DSM-5