Medically reviewed by Kathleen Daly, MD
Schizophrenia is a mental illness that impacts how someone thinks, feels, and behaves. A person may seem like they’ve had a break from reality and are experiencing delusions, hallucinations, and disordered thinking and behavior.
While schizophrenia can cause significant disruptions in everyday functioning, treatments are available that can help people manage their symptoms.
The symptoms of schizophrenia can vary widely among individuals, but they are largely grouped into standard categories that include positive and negative symptoms. Regarding schizophrenia, "positive" refers to symptoms that are heightened or in excess of typical behavior or cognition, and "negative" refers to the absence of typical features of cognition or emotion.
This article will discuss the positive and negative symptoms of schizophrenia, the factors that can impact symptoms, and how symptoms are managed.
General Schizophrenia Symptoms
Recognizing symptoms of schizophrenia is important in order to get appropriate treatment as soon as possible. Typically, a person is diagnosed after the first episode of psychosis (a break with reality), which often occurs between the ages of 16 and 30.
While this is usually the first significantly noticeable symptom, it’s been found that small and gradual changes in cognition and functioning are usually present before that first psychotic episode takes place.
Symptoms can vary among individuals but generally fall into three main categories: positive (also called psychotic), negative, and cognitive.
It’s very difficult to identify early symptoms of schizophrenia because they are so nonspecific, meaning they are so general that they can occur with many different conditions. They can include things like sleep problems, changes in hygiene, irritability, a drop in grades if a student, or reduced motivation.
Because these symptoms can indicate a wide variety of causes, it’s not always clear that schizophrenia is on the horizon.
Positive symptoms, also called psychotic symptoms, are those that change how an individual experiences their world and impact the way they think and act. Symptoms can include:
Delusions: Beliefs that go against reality
Hallucinations: Sensory experiences that don't exist (i.e., hearing, seeing, smelling things that aren't there)
Thought disorder: Disorganized speech and/or thinking
Disorganized or abnormal behavior, such as involuntary movements, problems coordinating movement, inappropriate posture, agitation
Negative symptoms are symptoms that exhibit a reduction or absence of typical behaviors. They are the most common first symptom of schizophrenia, and up to 60% of individuals with schizophrenia exhibit negative symptoms. They are also related to higher morbidity (illness) and poor functional outcomes.
Negative symptoms include:
Absence of motivation
No interest in daily activities
Withdrawing from any social engagement
Trouble displaying emotions
Difficulty with typical functioning
Sometimes, these symptoms can be mistaken for depression, which makes getting an accurate diagnosis especially important.
Cognitive symptoms impact memory, attention, and concentration. Symptoms can include:
Difficulty with information processing, which makes it harder to make decisions
Trouble with paying attention or concentrating
Difficulty using information after hearing it
Schizophrenia Symptoms on a Spectrum
Schizophrenia is a spectrum disorder, meaning people with schizophrenia may be affected by it to a higher or lower degree. Some may be able to function relatively independently, maintain relationships, and have a job. Others may have symptoms that moderately or severely affect their ability to function independently.
Comorbid Schizophrenia Symptoms
For a long time, symptoms of major depressive disorder, anxiety, and obsessive-compulsive disorder were seen as part of schizophrenia. However, these are slowly beginning to be approached, when present, as potential comorbid conditions (those that are present along with schizophrenia). More research is needed on this association.
The prevalence of depression among those with schizophrenia ranges from 25% to 81%, depending on the population being examined and the treatment setting.
Obsessive-compulsive symptoms are also often seen in 23% of people with schizophrenia. Themes of contamination (fear of acquiring germs), somatic symptoms (focusing on body functions), and religion are often present and may or may not be accompanied by compulsions and intrusiveness.
Schizophrenia Symptom Differences
It’s not always clear what impacts the severity of symptoms, but two things that commonly affect severity are age of onset and genetic effects.
An earlier age of symptom onset has been associated with increased symptom severity and poorer outcomes, but it’s not precisely clear why. Age of onset is also often indications a heritable (passed down from parent to offspring) condition, meaning genetics may also play a role in impacting symptom severity.
Men vs. Women
Gender has also been associated with variations in symptom severity, as well as age of onset. The incidence of schizophrenia is higher among men than women, and the age of onset tends to be earlier in males.
Males typically prominently display more negative symptoms, whereas females have more affective symptoms like depression and emotional instability. This might be due to underlying biological factors and sex differences in the brain, but genetic and environmental factors need to be taken into account.
A Note on Gender and Sex Terminology
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” in the way they are used in the sources.
Teens vs. Adults
When the onset of schizophrenia occurs in childhood or adolescence, a poorer course and outcomes are often reported. Delays in diagnosis and treatment are common with this illness, which also contributes to the severity of symptoms and adverse outcomes.
There tends to be a higher prevalence of heritability and genetic factors with earlier onset, which can contribute to symptom severity.
Managing Schizophrenia Symptoms
A large part of treating schizophrenia is symptom management. This can be done with medication, cognitive behavioral therapy (CBT), behavioral skills training, and things like employment that provides supports for the individual.
Treatment plans can change over time, depending on what symptoms are most prevalent, the effectiveness of medications, and any pressing needs that arise.
Medication usually consists of antipsychotic drugs. They are prescribed based on an individual's medical history and symptoms. Medication is paired with psychosocial treatments like therapy, social supports, and cognitive training to help reshape thinking patterns and help with cognitive and behavioral functioning.
Coordinated care programs might be necessary for those with more severe symptoms. A treatment team provides help with employment and/or school, case management, therapy and medications, family support, education about the condition for family and friends, and help with day-to-day functioning.
Schizophrenia symptoms generally fall into categories of positive, negative, or cognitive symptoms. Positive symptoms include delusions and hallucinations. Negative symptoms include reduced motivation, interest in activities, and social interactions. Cognitive symptoms include difficulty processing and using information.
Negative symptoms usually indicate a more serious course of illness and are common in schizophrenia. Prominent symptoms can differ according to genetics, the age of onset, sex, and environmental and social factors.
Despite the seriousness of schizophrenia and its symptoms, treatments are available, and symptom management is possible.
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