Schizophrenia always involves deterioration and changes from a previous level of functioning. Family members and friends often notice that the person is “not the same.” Men, women and adolescents with schizophrenia have difficulty in separating what is real from that which is unreal. With the stress and demands of day to day living, the person may withdraw and the symptoms become more pronounced. Deterioration is noticeable in areas such as:

  • Work or academic achievement.
  • How one relates to others.
  • Personal care and hygiene.

Components of schizophrenia are:

  • Positive Symptoms
  • Negative Symptoms
  • Cognitive Symptoms
  • Mood Symptoms

“Positive” means something added to the personality that should not be there.
“Negative” means something taken away from the personality that should be there.
Positive Symptoms:
The most common ones, which are also symptoms of the acute or (psychotic) phase, are:

  • Hallucinations – can affect all five senses. People may see, hear, smell, taste and feel things that are not really there. Most often the hallucination involves hearing voices.
  • Delusions – These are fixed beliefs that have no bases in reality. There may be the false belief of being persecuted or having supernatural powers or being a famous film star. Often there is a connection to religious or technological imagery.

Negative Symptoms:
Negative symptoms usually appear before the positive symptoms. They are often not recognized as early signs of schizophrenia and may be confused with behaviours of adolescence. They include:

  • Social withdrawal and isolation.
  • Lack of motivation and concentration.
  • Difficulties with expressing emotions.
  • Inability to enjoy pleasure.
  • Extreme tiredness.
  • Difficulty with abstract thinking.
  • Poverty of speech (conversation).

Cognitive Symptoms:
Disturbed thought process with cognitive deficits is a part of schizophrenia. The person’s “executive skills” are affected in terms of memory, concentration, decision making and new learning. This may be accompanied by incoherent and illogical reasoning shown by fragmented speech and jumbled talk. 
Mood Symptoms:

The person experiences depression, lack of insight, demoralization and may struggle with suicidal ideation.
Characteristic signs of schizophrenia may be noticed by family members in several of the following areas (This is known as the prodromal stage of schizophrenia.):

  • Personality changes are keys to recognizing schizophrenia. They may be subtle at
    first and difficult to notice. A normally outgoing person may become withdrawn, quiet, moody, inappropriate or aggressive. Emotions (affect) may be altered
    e.g.: when told a sad story, the person may laugh, or there may be no reaction at all.
  • Thought changes. One of the most profound changes is the barrier to clear thinking. Thoughts may be slow in forming (poverty of thought), come extra fast, or not at all. Conversations may jump from topic to topic in an incoherent way, with difficulty reaching easy conclusions.
  • Perceptual changes turn the world of the ill person topsy-turvy. The brain’s ability to decode sensory messages from the eyes, ears, nose, skin and taste buds become confused and jumbled, and the person experiences sensations which are not real (hallucinations).
  • Frequently, people with schizophrenia hear voices in their heads condemning them, making them laugh or giving orders such as “hang yourself”. There may be hyper-sensitivity to sounds, which appear to be at the very loudest pitch all at the same time. Touch, taste and smell may all be distorted, e.g. feeling there are insects crawling over the skin. Sometimes there is no sensation to touch so the person may not even feel pain and could injure him/herself.
  • Loss of sense of self. When one or all five senses are affected, the person may feel out of time, space, disembodied and non-existent as a person. The person will struggle with identity issues of worth, significance and security.

It’s not difficult to understand why the individual who experiences these profound and frightening changes will seek to keep them secret, deny that anything is happening or avoid people and situations where they may be discovered. Never underestimate the impact of stigma around mental illness. The pain of schizophrenia is further accentuated by the person’s awareness of the worry and suffering they may be causing their family and friends.