Schizophrenia

Symptoms

Schizophrenia may have a variety of symptoms. Usually the illness develops slowly over months or even years.

At first, the symptoms may not be noticeable. For example, you may feel tense, or have trouble sleeping or concentrating. You can become isolated and withdrawn, and have trouble making or keeping friends.

As the illness continues, psychotic symptoms develop:

• An appearance or mood that shows no emotion (flat affect)
• Bizarre motor behavior in which there is less reaction to the environment (catatonic behavior)
• False beliefs or thoughts that have nothing to do with reality (delusions)
• Hearing, seeing, or feeling things that are not there (hallucinations)
• Thoughts "jump" between unrelated topics (disordered thinking)

Symptoms can be different depending on the type of schizophrenia.

Catatonic type:

• Agitation
• Decreased sensitivity to pain
• Inability to take care of personal needs
• Negative feelings
• Motor disturbances
• Rigid muscles
• Stupor

Paranoid type:

• Anger
• Anxiety
• Argumentativeness
• Delusions of persecution or grandeur
• Violence

Disorganized type:

• Child-like (regressive) behavior
• Delusions
• Flat affect
• Hallucinations
• Inappropriate laughter
• Not understandable (incoherence)
• Repetitive behaviors
• Social withdrawal

Undifferentiated type may include symptoms of more than one type of schizophrenia.

Residual type -- symptoms of the illness have gone away, but some features, such as hallucinations and flat affect, may remain.

Exams and Tests

Because other diseases can cause symptoms of psychosis, psychiatrists should make the final diagnosis. The diagnosis is made based on a thorough interview of the person and family members.

No medical tests for schizophrenia exist. The following factors may suggest a schizophrenia diagnosis, but do not confirm it:

• Course of illness and how long symptoms have lasted
• Changes from level of function before illness
• Developmental background
• Genetic and family history
• Response to medication

CT scans of the head and other imaging techniques may find some changes that occur with schizophrenia and may rule out other disorders.

References

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:115-124.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1541-1548.

Schultz SH, North SW, Shields CG. Schizophrenia: a review. Am Fam Physician, 2007;75:1821-1829.

Lieberman JA. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia: efficacy, safety and cost outcomes of CATIE and other trials. J Clin Psychiatry, 2007;68:e04.

Addington D, Bouchard RH, Goldberg J, Honer B, Malla A, Norman R, Tempier R. Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry, 2005;50:7s-57s.