The symptoms of schizophrenia known as “positive symptoms” are some of the most recognizable ones. They are often features of psychosis. Psychosis is a loss of connection with reality.1
There are 3 main phases of schizophrenia. These phases are called the prodromal, active, and residual phases. Positive symptoms can happen at any time. However, they are most severe during the active phase. This period is when episodes of psychosis occur.1,2
What are positive symptoms?
Positive symptoms are additions to the experienced behaviors or thought patterns. For example, having a belief (delusion) that someone is following you is an atypical experience. It is a new thought pattern.1-4
These symptoms are called positive because something is added. It is not because they are “good” or “better” than negative symptoms. Negative symptoms are losses of behaviors typical for the person. Speaking less or losing the desire to socialize are negative symptoms.1-4
The most common positive symptoms of schizophrenia include:1-6
- Hallucinations
- Delusions
- Disorganized thinking and speech
- Disorganized or unpredictable behavior
Hallucinations
Hallucinations involve sensing things that are not present in reality. All senses can be impacted. This includes sight, sound, taste, touch, and smell. Hearing voices or seeing things that are not there are examples of hallucinations. Touch, taste, and smell are less common symptoms of schizophrenia and should be assessed separately if they develop during treatment.1-6
Delusions
Delusions are firmly held beliefs in things that are not true. Delusions can be bizarre, like thinking dogs are planning to take over the world. They can also be more realistic, like thinking a spouse is cheating.1-6
Erotomanic delusions center around believing others, even people you have never met, are in love with you. Grandiose delusions are beliefs that you have a special ability or power that does not exist or that you are a person of great importance. Paranoid delusions involve feeling followed or in danger. Delusions of persecution are beliefs that a specific group or unknown entity are plotting against them.1-6
Showing a person with schizophrenia that their delusions or hallucinations are not real may not make a difference. They may still believe in whatever they are experiencing. This lack of insight (personal awareness) is called anosognosia. Continuing to follow hallucinations or delusions can lead to problems functioning in daily life.7
Disorganized thinking and speech
People with schizophrenia often have disorganized or hard-to-follow thoughts. One way to tell this is happening is by their speech.1-6
A person with schizophrenia may not speak in complete, understandable sentences. They can have many ideas at once or not answer questions directly. They may also talk in a way that is difficult, if not impossible, to follow. Some people will not make any sense at all.1-6
Disorganized or unpredictable behavior
People with schizophrenia may have inappropriate emotions or childlike silliness. They may be unable to follow instructions. People may also have excessive or hard-to-control movements. These are called motor symptoms. Agitation and impulsiveness are common, too.1-6
Why do positive symptoms happen in schizophrenia?
The exact cause of schizophrenia and its symptoms is not known. It is thought to be a combination of genetics and factors in the environment. Many of these factors affect the balance of neurotransmitters in the brain. Neurotransmitters are chemicals that send messages that tell your body what to do and how to feel.1,8,9
Dopamine, serotonin, and glutamate are all examples of neurotransmitters. Many experts believe that an imbalance of these, especially dopamine, may lead to positive symptoms of schizophrenia. Dopamine may be overactive in a part of the brain called the mesolimbic pathway. Another pathway, called the nigrostriatal pathway, may be responsible for some of the motor symptoms of schizophrenia.8,9
How are positive symptoms treated?
The positive symptoms of schizophrenia are treated with antipsychotic drugs. Antipsychotics are considered either typical or atypical antipsychotics. But they all impact dopamine and other neurotransmitters.1,8,10
Typical antipsychotics mostly target positive symptoms. These drugs are used less often because they have many side effects. Atypical antipsychotics help treat positive and negative symptoms. They are used more often and have fewer side effects.1,8,10
Several forms of therapy can be helpful, too. They include cognitive behavioral therapy (CBT) and family therapy. These options can help people learn coping skills. They can also help people think differently about their symptoms to help with their overall functioning.1,5,8
If psychosis symptoms do not respond to drugs and therapy, electroconvulsive therapy (ECT) may be used. This treatment involves sending electric currents into the brain under sedation in the care of medical professionals. ECT has risks but your doctor will review them and potential benefits to help decide if it is right for your treatment. It must be done in a closely controlled, monitored setting.1,5,8
Regular treatment is needed to keep positive symptoms under control. Stopping treatment or missing doses can make symptoms worse or lead to them returning. Talk with your doctor about the best treatment plan for you.1