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Symptoms and features of Schizophrenia

Sz is a mental illness that can affect the way someone thinks, speals or feels to such a degree that they lose focus on reality. There are a number of ways of characterising Sz, including giving first and second rank symptoms or positive and negative symptoms. First rank symptoms include hearing voices and ideas about being guided by others. Second rank symptoms include flattened emotions.

A yet there is no pysical way of diagnosing Sz, although research looking at the possibility of using a blood test or eye tracking is currently underway. Only a psychiatrist can make a diagnosis of Sz using symptoms and features.

Positive and negative symptoms of Sz

Positive symptoms are additions to behaviour and actual symptoms that can be noted. They include first rank symptoms. Negative symptoms are where normal functioning is not present. Diagnosis of Sz according to the DSM requires one month of two or more positive symptoms.

  • Positive symptoms
  • These are about changes in thinking in the person:
    • Hallucinations, such as seeing or hearing things that are not there. Hearing voices in some cultures is not seen as a sign of mental disorder, but of a personal spiritual capability. In these cases the voices are often kind and positive, whereas with Sz the voices are often harsh and critical. Critical voices provide a running commentary on what the person is doing. Controlling voices tell the person what to do - usually uncharacteristic acts.
    • Delusions, such as someone thinking their movements are being controlled by someone else. A common form of delusion is the paranoid delusion; the sufferer believes that someone is trying to mislead, manipulate or even kill them. Someone suffers from delusions of grandeur when they think ther are in a prominent position of power, such as king, or that the posses special power, such as a cure to cancer. Delusions can also take the form of the person thinking that unrelated things are in fact intended to relate to them; they may feel that a newspaper headline carries a secret message for them. Delusions can lead to strange behaviour, such as covering windows to shut out the sound of the voice of god.
    • Thought disorders, which make someone's speech hard to follow. They might also lose concentration at work or complain of having muddled thinking. The person may become disorganised. Further developments of thought disorders are 'thought insertion' (a person thinks their own thoughts are put there by someone else) or 'thought broadcasting' (thinking other can hear their thoughts).
  • Evaluation:
    • Positive symptoms tend to have greater weight when diagnosing Sz but they can be affected by cultural differences so perhaps should be weighted as strongly as negative symptoms, which might be more objectively measured.
  • Negative symptoms
  • These often start before positive ones, sometimes years before Sz patients are diagnosed. This is known as the prodromal period. They include:
    • Lack of energy and apathy E.g. no motivation to do faily chores.
    • Social withdrawel E.g. avoiding family and friends…


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