Signs of Schizophrenia | Signs and Symptoms of Schizophrenia

Signs and Symptoms of Schizophrenia:

Schneider’s First-Rank Symptoms of Schizophrenia (SFRS)

Kurt Schneider proposed the first rank symptoms of schizophrenia in 1959. The presence of even one of these symptoms is considered to be strongly suggestive of schizophrenia. They include:

  • Hearing one’s thoughts spoken aloud (audible thoughts or thought echo).
  • Hallucinatory voices in the form of statement and reply (the patienth ears voices discussing him in the third person).
  • Hallucinatory voices in the form of a running commentary (voices commenting on one’s action).
  • Thought withdrawal (thoughts cease and subject experiences them as removed by an external force).
  • Thought insertion (subject experiences thoughts imposed by some external force on his passive mind).
  • Thought broadcasting (subject experiences that his thoughts are escaping the confines of his self and are being experienced by others around).
  • Delusional perception (normal perception has a private and illogical meaning).
  • Somatic passivity (bodily sensations especially sensory symptoms are experienced as imposed on body by some external force).
  • Made volition or acts (one’s own acts are experienced as being under the control of some external force, the subject being like a robot).
  • Made impulses (the subject experiences impulses as being imposed by some external force).
  • Made feelings or affect (the subject experiences feelings as being imposed by some external force).

What are the symptoms of Schizophrenia?

Clinical Features

The predominant clinical features in acute schizophrenia are delusions,hallucinations and interference with thinking. Features of this kind are often called positive symptoms or psychotic features while most of the patients recover from the acute illness, some progress to the chronic phase, during which time the main features are affective flattening or blunting, avolitionapathy(lack of initiative),  attentional impairment,  anhedonia (inability to experience pleasure), asociality, alogia (lack of speech output).

These are called as negative symptoms. Once the chronic syndrome is established, few patients recover completely. The signs and symptoms commonly encountered in schizophrenic patients may be grouped as follows:

Thought and Speech Disorders

  • Autistic thinking (preoccupations totally removing a person from reality).
  • Loosening of associations (a pattern of spontaneous speech in which the things said in juxtaposition lack a meaningful relationship with each other).
  • Thought blocking (a sudden interruption in the thought process).
  • Neologism (a word newly coined, or an everyday word used in a  special way, not readily understood by others).
  • Poverty of speech (decreased speech production).
  • Poverty of ideation (speech amount is adequate but content conveys little information).
  • Echolalia (repetition or echo by patient of the words or phrases of examiner).
  • Perseveration (persistent repetition of words or themes beyond the point of relevance).
  • Verbigeration (senseless repetition of some words or phrases over and
  • over again).
  • Delusions of various kinds i.e. delusions of persecution (being persecuted against); delusions of grandeur (belief that one is especially very powerful, rich, born with a special mission in life);
  • delusions of reference (being referred to by others); delusions of control (being controlled by an external force); somatic delusions.
  • Other thought disorders are over inclusion (tending to include irrelevant items in speech), impaired abstraction, concreteness.

Disorders of Perception

  • Auditory hallucinations (described under SFRS).
  • Visual hallucinations may sometimes occur along with auditory hallucinations; tactile, gustatory and olfactory types are far less common

Disorders of Affect

These include apathy, emotional blunting, emotional shallowness, anhedonia and inappropriate emotional responses. The incapacity of the patient to establish emotional contact leads to lack of rapport  with the examiner.

Disorders of Motor Behaviour

There can be either an increase or a decrease in psychomotor activity. Mannerisms, grimacing stereotypes, decreased self-care and po-grooming are common features.

Other Features

Decreased functioning in work, social relations and self-care, as compared to earlier life.

  • Loss of ego boundaries.
  • Loss of insight.
  • Poor judgment.
  • Suicide can occur due to the presence of associated depression, command hallucination, impulsive behaviour, or return of insight that causes the patient to comprehend the devastating nature of the illness and take his life.
  • There is usually no disturbance of consciousness, orientation,attention, memory and intelligence.
  • There is no underlying organic cause.