Schizophrenia

Hallucinations. A hallucination is something a person sees,
hears, smells, or feels that no one else can see, hear, smell, or feel.
“Voices” are the most common type of hallucination in schizophrenia.
Many people with the disorder hear voices that may comment on their
behavior, order them to do things, warn them of impending danger, or
talk to each other (usually about the patient). They may hear these
voices for a long time before family and friends notice that something
is wrong.¹
Other types of hallucinations include seeing people or objects that are
not there, smelling odors that no one else detects (although this can
also be a symptom of certain brain tumors), or feeling things like
invisible fingers touching their bodies when no one is close by.

Delusions. Delusions are false personal beliefs that are not
part of the person’s culture and do not change, even when other people
present proof that the beliefs are not true or logical. People with
schizophrenia can have delusions that are quite bizarre, such as
believing that neighbors can control their behavior with magnetic waves,
people on television are directing special messages to them, or radio
stations are broadcasting their thoughts aloud to others. They may also
have delusions of grandeur and think they are a famous historical
figure. People with paranoid schizophrenia can believe that others are
deliberately cheating, harassing, poisoning, spying upon, or plotting
against them or the people they care about. These beliefs are called
delusions of persecution.

Thought Disorder. People with schizophrenia often have
unusual thought processes. One dramatic form is disorganized thinking
where the person may have difficulty organizing his thoughts or
connecting them logically. Speech may be garbled or hard to understand.
Another form is “thought blocking” where the person stops abruptly in
the middle of a thought. When asked sometimes the person says it felt as
if the thought had been taken out of his head. Finally, the individual
might make up unintelligible words, so-called “neologisms.”

Disorders of Movement. People with schizophrenia can be
clumsy and uncoordinated. They may also show involuntary movements and
may show grimacing or unusual mannerisms. They may repeat certain
motions over and over or, in extreme cases, may become catatonic.
Catatonia is a state of immobility and unresponsiveness that was more
common when treatment for schizophrenia was not available; fortunately,
it is now rare.^{2, 3}

Negative symptoms

The term “negative symptoms” refers to reductions in normal emotional and behavioral states. These include:

• flat affect (immobile facial expression, monotonous voice),
• lack of pleasure in everyday life,
• diminished ability to initiate and sustain planned activity, and
• speaking infrequently, even when forced to interact.

People with schizophrenia often neglect basic hygiene and need help
with everyday living activities. Because it is not as obvious that
negative symptoms are part of a psychiatric illness, people with
schizophrenia are often perceived by others as lazy and not willing to
better their lives.

Cognitive symptoms

Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include:

• poor executive functioning (the ability to absorb and interpret information and make decisions based on that information),
• inability to sustain attention, and
• problems with working memory (the ability to keep recently learned information in mind and