Symptoms of Schizophrenia: The 4 Classifications

Despite around 24 million people worldwide dealing with schizophrenia, more than two out of three people experiencing psychosis don’t receive the specialized care they need.

However, while those statistics are concerning, the good news is that symptoms for at least one-third of people with schizophrenia subside.

Here, we take a closer look at the symptoms accompanying this mental health condition and share expert tips on living with them.

What Is Schizophrenia?

Schizophrenia is a brain disorder that causes people to interpret reality abnormally; they don’t know what sights, sounds, and experiences are real or what they are imagining.

The manifestation of schizophrenia usually presents delusions (false beliefs), hallucinations (seeing or hearing things that don’t exist), unusual physical behavior, and disorganized thinking and speech. Hearing voices and having paranoid thoughts are also common for people with schizophrenia.

Causes of Schizophrenia

Rarely diagnosed in childhood, schizophrenia tends to start in early adulthood. The causes of schizophrenia consist of changes in neurochemistry — notably altered activity in dopamine markers and glutamate (a neurotransmitter) transmission — and changes in the brain structure, such as enlarged cerebral ventricles, thinning of the cortex, decreased size of the anterior hippocampus and other brain regions.

A family history of schizophrenia has been linked to the condition’s onset. However, environmental factors can also play a role. While it affects men and women similarly, symptoms start earlier in men than in women. Other risk factors include urban living, poverty, childhood trauma, neglect, and prenatal infections.

There are many myths surrounding schizophrenia, one being that people with the condition have a “split personality.” This confusion may come from the name: “Schizein” means “splitting” in Greek and “phren” means “mind.” With that said, it’s not intended to imply that someone’s personality splits in two but that there’s a split between their rationality and emotions.

It’s also untrue that people with schizophrenia are more aggressive or violent than the general population.

Types of Schizophrenia

There are several types of schizophrenia. Melissa Galica, a licensed professional counselor (LPC) at Grow Therapy, summarizes each:

Paranoid Schizophrenia: Characterized by delusions and hallucinations, often with themes of persecution. Patients display paranoia and agitation.

Hebephrenic Schizophrenia: Marked by severe disorganization of thought and behavior. Patients display inappropriate affect, unpredictable laughter, no emotions in their facial expressions, and regressive behaviors.

Catatonic Schizophrenia: The main features are disturbances of movement, like stupor, rigidity, motionless staring, and purposeless excitation. There are extremes of activity and inactivity.

Undifferentiated Schizophrenia: Psychotic symptoms are present, but the clinical picture doesn’t conform to the other subtypes, and symptoms are variable.

Residual Schizophrenia: The residual phase is where positive symptoms (delusions and hallucinations) have diminished, but the negative symptoms of schizophrenia, like apathy, anhedonia, and social withdrawal, persist.

Simple Schizophrenia: Slow and gradual development over years of negative symptoms like avolition (a severe lack of motivation), flattened affect, and social withdrawal without progression.

Unspecified Schizophrenia: Psychotic symptoms characteristic of schizophrenia are present, but criteria for a specific subtype aren’t met.

Symptoms of Schizophrenia

The symptoms of schizophrenia can generally be split into four categories: positive, negative, disorganized, and cognitive deficits. Here are some specific symptoms in each category according to MSD Manuals:

Negative Symptoms:

• Blunted affect: the decreased ability to show any emotional expression on the face, in the tone of voice, and physical movements

• Lack of conversation

• Anhedonia: A reduced level of interest in activities previously enjoyed

• Asociality: A lack of motivation to take part in social interaction

Disorganized Symptoms:

• Thought disorders: Thinking tends to be disorganized, with rambling, aimless speech that shifts from one topic to another.

• Bizarre behaviors: Includes childlike silliness and unrest, unsuitable appearance, personal hygiene, or conduct.

Cognitive Symptoms (difficulty with the following):

• Attention

• Processing speed

• Short- and long-term memory

• Abstract thinking

• Problem-solving

• Understanding of social interactions

Positive Symptoms:

• Hallucinations: Auditory hallucinations tend to be the most common, but they can also be visual, olfactory (of smell), gustatory (of taste), or tactile (of touch).

• Delusions: A delusion is something a person is convinced is real or true despite clear evidence that it’s not.

There are persecutory delusions, where people with schizophrenia believe they’re being tormented, followed, tricked, or spied on. Then there are delusions of reference, where patients believe that excerpts from books, newspapers, song lyrics, or other external cues are directed at them.

Finally, patients who experience delusions of thought withdrawal or thought insertion believe that people can read their minds, that their thoughts are being broadcast to others, or that outside influences are making them have certain thoughts and impulses.

The symptoms of schizophrenia commonly reduce a person’s ability to perform complex and difficult cognitive and motor functions. Therefore, symptoms can significantly interfere with work, social relationships, and self-care.

What Are Some Schizophrenia-Related Conditions?

Several conditions appear similar to schizophrenia but have slight variations in symptoms.

It’s worth noting that obsessive-compulsive disorder (OCD) can exist alongside schizophrenia, as can substance use disorders, which means that when it comes to treatment, these conditions must be managed along with schizophrenia.

Delusional disorder: Someone with delusional disorder will experience false beliefs (delusions) that continue for at least one month. The delusions can be bizarre (regarding things that can’t possibly occur) or non-bizarre (about things that are possible but not likely).

Brief psychotic disorder: If someone has a brief psychotic disorder, they’ll experience a sudden short period of psychotic behavior. This episode usually lasts between one day and one month, and after that, the symptoms disappear, and the person returns to their normal state.

Schizophreniform disorder: Schizophrenia and schizophreniform disorder are both on the schizophrenia spectrum and share similar symptoms. However, schizophreniform disorder symptoms only last for a minimum of one month and less than six months. If the symptoms persist for over six months, the diagnosis changes to schizophrenia.

Schizoaffective disorder: People with schizoaffective disorder experience symptoms of a major mood episode of depression or bipolar disorder (major depression or mania) simultaneously with symptoms of schizophrenia.

Schizotypal personality disorder: A person with schizotypal personality disorder will encounter a pervasive pattern of intense discomfort with and reduced capacity for close relationships, distorted cognition and perceptions, and eccentric behavior.

Treatment Options for Schizophrenia

Galica states that many aspects of someone’s life are affected when they have schizophrenia, such as work or school, relationships, independent living, health, finances, legal issues, and the discrimination and stigma that surround this condition.

Homelessness is also a big problem among those with schizophrenia. As published by the National Alliance to End Homelessness, around one percent of Americans have schizophrenia, but among the homeless population, that number is closer to 20 percent. This might be because the symptoms can make it difficult for people to access treatment and maintain employment and housing; therefore, they end up losing their homes.

Not only does this highlight the importance of diagnosing schizophrenia as early as possible, but also the necessity for life-long treatment. Treatment can take the following forms:

Medication

There are two kinds of antipsychotic medications: first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs).

SGAs may offer some advantages, such as greater efficacy and decreased probability of an involuntary movement disorder and other related adverse effects. However, SGAs present a greater risk of metabolic syndrome — excess abdominal fat, insulin resistance, dyslipidemia, and hypertension — compared to conventional antipsychotics.

Several antipsychotics in both groups can cause long QT syndrome, a problem with the electrical system that controls your heartbeat, and also increase the risk of fatal arrhythmias.

Therapy

“There are several therapeutic modalities to choose from when treating schizophrenia; cognitive behavioral therapy (CBT) is usually the most recommended. Others that have proven useful can include cognitive remediation, social skills training, family therapy, psychological rehabilitation, and art/music/pet therapy,” advises Galica.

Cognitive remediation therapy may improve neurocognitive functions, such as attention, working memory, and executive functioning, and help patients learn or relearn how to do tasks. Ultimately, this type of therapy can enable patients to function better.

Research from the National Institutes of Health (NIH) has shown that CBT is an effective therapy in treating schizophrenia, especially positive symptoms, alongside antipsychotic medication.

Rehabilitation and Community Support Services

For severe lapses, or if a patient has suicidal thoughts and poses a threat to themselves or others, hospitalization is required.

However, if symptoms are under control, psychosocial skill training and vocational rehabilitation programs can help patients work, shop, look after themselves, manage a household, get along with others, and work with mental health care practitioners.

Other valuable services include supported employment, whereby patients are put in a work setting with an on-site job coach to help with adjustments, and community support, which can include periodic home visits or round-the-clock assistance if needed.

Programs such as these can reduce the chances of a person’s relapse and the need for hospitalization.

How to Live With Schizophrenia

Alongside therapy and medication, these tips from Galica can help you take an active role in managing your symptoms:

Identify Triggers

Determine situations, people, or stressors that exacerbate your symptoms and try to avoid them.

Get Adequate Sleep

Lack of sleep can worsen symptoms, so try to maintain a regular sleep routine.

Avoid Drugs and Alcohol

Both drugs and alcohol can interfere with medication effectiveness and worsen your symptoms.

Use Calendars and Reminders

These will help you stay organized and remember appointments, medication times, etc.

Learn Relaxation Techniques

Develop stress-management skills like deep breathing, meditation, or yoga.

Find an Activity or Hobby

Engaging in your interests can help reduce feelings of isolation and boost self-esteem.

Develop a Support System

Maintaining close relationships with family, friends, or a support group provides someone with essential social connections.

Educate Family Members and Friends

Help loved ones better understand schizophrenia and how to support you.

Create a Crisis Plan

Devise an action plan for what to do if your symptoms severely worsen and include emergency contacts.

Join Support Groups

Connecting with others facing similar challenges can give you a feeling of community.

And, of course, find a therapist. “Psychotherapy provides coping skills, symptom management, and emotional support,” adds Galica.

How to Support a Loved One With Schizophrenia

If you think a family member, friend, or loved one may be experiencing signs of schizophrenia, getting help immediately from a healthcare provider and mental health professional is essential.

While it’s worrying to have a loved one dealing with intense mental health problems, you can help them and yourself in many ways. Galicia lends her advice:

Educate Yourself About the Illness

Learn about symptoms, treatments, and how you can best provide support. Understanding schizophrenia helps reduce stigma.

Participate in Their Treatment Plan

If they consent, collaborate with their mental health team. Help with monitoring medication side effects, providing feedback, and being part of crisis planning.

Help Minimize Stress

Schizophrenia is exacerbated by stress, so create a low-stress home environment and help limit overstimulation.

Encourage Treatment Adherence

Gently remind them about appointments and medication schedules and express why staying on track is important.

Develop a Daily Routine

Structure and regular habits can be stabilizing. Help your loved one create and implement schedules for meals, sleep, and activities.

Foster Independence

Support goals for school, work, and independent living. You can help, but make sure to let them take the lead to build self-confidence.

Watch for Warning Signs

Know the signs that a psychotic episode may be developing, like social withdrawal, thought disorders, or agitation, and have a plan ready to get help.

Be Patient and Understanding

Schizophrenia symptoms can be difficult to understand, so try to keep communication lines open, be patient, and focus on emotional support.

Don’t Neglect Your Own Self-Care

Being a caregiver is difficult. It’s essential to make time for your needs, maintain social connections, and seek counseling if needed.

The Grow Therapy marketplace is great for finding a therapist who can help support you or your loved one.

Live A Happy Life With Schizophrenia

While there is no known cure for schizophrenia, those dealing with the condition can lead happy, meaningful lives while managing their symptoms.

With support from the right therapist, medication if necessary, social skills and vocational training, along with a strong foundation of family and friends to help with the journey, symptoms of schizophrenia can improve, and the chances of them recurring can decrease.