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Symptoms

Reviewed by: HU Medical Review Board | Last reviewed: July 2023

There are many possible signs of schizophrenia. It is considered a syndrome, which means it can have a wide variety of typical symptoms. Each person’s experience with the condition is different, but there are some common symptoms.1,2

There are 3 phases of schizophrenia:1,2

  • Prodromal – The period between the start of schizophrenia symptoms and the first episode of psychosis
  • Active – The period when a person has psychosis. This is when a person loses touch with reality.
  • Residual – The period after the active phase, when symptoms may lessen

Different symptoms, or symptoms with different severity, can occur in each phase. It is also possible to go through periods of remission where no symptoms are present.1,2

Groups of symptoms of schizophrenia are called:1

  • Positive symptoms
  • Negative symptoms
  • Cognitive symptoms

Positive symptoms

Positive symptoms are things that are added to a person’s behavior or way of thinking. Positive symptoms of schizophrenia include signs of psychosis.1-3

Common positive symptoms include:1-4

  • Hallucinations – Hearing, seeing, touching, smelling, or tasting things that are not really there. Hearing voices is an example of a hallucination.
  • Delusions – Firm beliefs that are not true and hard to reverse. Delusions can be realistic or bizarre (like being abducted by aliens). They often center around love, having superpowers, being followed, and other themes.
  • Disorganized thoughts and speech – Thinking or speaking in ways that are hard to understand. This may be going off on tangents or speaking in vague metaphors. Some people may speak in a jumbled way that cannot be understood at all (word salad).
  • Disorganized behavior – Acting in ways that do not make sense. Loss of impulse control, childlike silliness, awkward movements, and agitation are all possible. Inappropriate emotional responses (like laughing at something sad) may occur, too.

Positive symptoms are most noticeable and severe during the active phase of schizophrenia. However, milder positive symptoms can be present during the prodromal and residual phases as well.1,2

Treating positive symptoms

Positive symptoms are treated with antipsychotic drugs. Second-generation antipsychotics are most commonly prescribed. These drugs are also called atypical antipsychotics. First-generation, or typical, antipsychotics are older and have more side effects. So, they are prescribed less often.2,5,6

Some forms of therapy also can help people recognize and cope with the positive symptoms of schizophrenia. One effective type of therapy is cognitive behavioral therapy (CBT). If a person’s positive symptoms are severe, they may need to be treated in the hospital for a time.2

Negative symptoms

Negative symptoms are the absence or loss of behaviors or feelings that used to be present. Negative symptoms often come on slowly. They are subtle at first and hard to spot. These symptoms first appear during the prodromal phase.1-5,7

Negative symptoms can be similar to signs of depression. This sometimes makes diagnosing schizophrenia hard in its early phases.1-3,7

Examples of negative symptoms include:1-5,7

  • Having no emotions or not expressing emotions
  • Lacking facial expressions (sometimes called flat affect)
  • Speaking less than normal or not at all (alogia)
  • Not being able to enjoy activities, or being unable to experience pleasure (anhedonia)
  • Having lower motivation and lacking the desire to reach goals (avolition)
  • Not wanting to interact and socialize with others (asociality)
  • Ignoring personal hygiene or appearance

Negative symptoms also can occur during the active and residual phases of schizophrenia. Positive symptoms can sometimes drive negative ones, too. For example, if a person has a delusion that they are being followed, they may not want to socialize.1,2

Treating negative symptoms

Typical antipsychotic drugs do not help negative symptoms much. But experts think the atypical ones work better. More research is needed to know exactly which ones are the most effective.2,5,6

CBT, social skills training, and other types of therapy can help people manage negative symptoms as well.2,5,6

In some cases, schizophrenia can overlap with another mood disorder like depression. In this case, taking an antidepressant drug with antipsychotics and therapy might help.1-3,5

Cognitive symptoms

Cognitive symptoms involve trouble thinking and processing information. Like negative symptoms, they can be subtle and slow to appear. They may be related to changes in the brain that happen with schizophrenia. But they also may be related to treatment side effects. More research is needed to better understand these symptoms.1,2

Common cognitive symptoms in people with schizophrenia include:1-3

  • Trouble learning new things or paying attention
  • Trouble remembering things
  • Problems concentrating
  • Trouble processing new information quickly
  • Problems planning and organizing tasks
  • Trouble reading social cues from others

Another cognitive symptom is called anosognosia. This means a lack of insight or personal awareness. It is common in people with schizophrenia and makes treatment challenging. People with anosognosia do not realize they have symptoms of a mental health condition.8

For example, a person may be given clear evidence that a delusion they are having is not true. If they have anosognosia, this will not make a difference. They will carry on with the delusion without realizing it is not based in reality.8

Treating cognitive symptoms

Cognitive symptoms are some of the trickiest to treat. There are no specific drugs that target them. Some experts think that some atypical antipsychotics may help. But research is mixed about their effects on cognitive symptoms.9,10

Therapy may be best for managing these issues. Types of therapy that might help include:2,11

  • CBT
  • Cognitive enhancement therapy (CET)
  • Social skill support
  • Self-management tactics

In some cases, anti-inflammatory or anti-dementia drugs may be useful. But research results are mixed. The use of other drugs must be determined on a case-by-case basis, as all drugs have side effects.10

Other potential symptoms

The symptoms discussed so far are not the only possible symptoms of schizophrenia. There are other potential symptoms as well, including:1-3

  • Signs of depression, anxiety, or other mental health distress
  • Abnormal physical behaviors. These may include holding awkward body postures, mimicking others’ speech, or constantly moving without purpose (psychomotor agitation).
  • Problems sleeping

Talk with your doctor about what other symptoms you or your loved one may be at risk for. They can help you best prepare for and treat whatever might come next. Note that all antipsychotic drugs have significant side effects. Ask your doctor what to expect before starting any treatment.

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