Positive, Negative & Cognitive Symptoms of Schizophrenia

What is Schizophrenia?

Schizophrenia is a very chronic and serious mental health condition that severely affects how a person behaves, thinks and feels. Schizophrenia is a serious mental disorder that substantially affects a person’s capability to differentiate between reality, imagination and fantasy. Schizophrenic patients are unresponsive and withdrawn and they find it challenging to express normal emotions in social situations.

What is Schizophrenia?

What are the Symptoms of Schizophrenia?

Research shows that this serious and complex mental disorder known as schizophrenia can impact both men and women almost equally; however, it has an earlier onset in men. Schizophrenia symptoms start appearing in the late adolescence around the age of 16 or early adulthood around the age of 30. In some of the cases, schizophrenia develops at a very slow pace and for years, the person affected by schizophrenia is actually not aware of its existence and in some cases, schizophrenia can develop quickly and strike suddenly. It is also common in children, these days.

Schizophrenia symptoms can be broadly classified into three categories, namely positive symptoms, negative symptoms, and cognitive symptoms.

Positive Symptoms of Schizophrenia

Symptoms that are psychotic in nature are termed as positive schizophrenia symptoms. Some of the positive symptoms of schizophrenia include:

Delusions: Delusions are falsely held ideas, beliefs or impressions that schizophrenia patients maintain even if there is a real evidence that contradicts or argues the rationality of the same. Some schizophrenic patients think that someone is spying on them; some schizophrenic patients think that they are famous celebrities; some think that their entire family is plotting to kill them. These are just a few examples of common delusions.

Hallucinations: Hallucinations in simple terms means hearing, feeling, seeing, tasting or smelling something that does not exist. It is a real perception of something that is not real. Different schizophrenic patients exhibit different types of hallucinations. Some common kinds of hallucinations seen in patients include auditory hallucinations, visual hallucinations, olfactory hallucinations, tactile hallucinations and proprioceptive hallucinations. One of the typical examples would be a patient hearing multiple voices that command him to act in a particular way or execute an order.

Disordered Thinking and Speech: Schizophrenic patients exhibit incoherence and derailment. Behaviors like losing thought while making a conversation, giving unrelated answers to asked questions, switching topics without a potent and logical reason depict disordered thinking in schizophrenia impacted patients. Disordered speech includes behaviors such as a patient constantly speaking without getting to a point and giving out unnecessary and irrelevant details, the constant repetition of ideas and words without a reason and making up words and sounds that don’t make sense and do not exist.

Disordered Behavior: This is one of the most common positive schizophrenia symptoms. Behaviors like unprovoked, bizarre and unpredictable socially inappropriate outbursts, problems with hygiene, inappropriate selection of clothes as per weather, the feeling of being agitated, anxious or tensed without any logical reason are some of the examples of disordered behavior exhibited by patients.

Negative Symptoms of Schizophrenia

Negative schizophrenia symptoms are more troublesome for an individual with the disease because it alters their capability to function normally. Negative schizophrenia symptoms relate to disturbances to otherwise normal emotions, thoughts and behaviors. So basically these symptoms relate to characteristics of an individual’s behavior that have become distorted in nature. Some of the most common negative schizophrenic symptoms exhibited by patients include:

Alogia: Alogia refers to trouble with speech as a result of mental defect. Schizophrenic patients exhibit a substantial decrease in total speech output and verbal fluency. Giving brief answers to simple questions also becomes difficult sometimes for affected patients.

Affective Flattening: This is one of the most common negative schizophrenia symptoms seen in patients. Relatively immobile and unresponsive facial expressions, poor eye contact, reduced body language and body movement are some of the common examples of negative symptoms of schizophrenia.

Avolition: The lack of will or desire and lack of motivation to participate in any activity is termed as avolition. Schizophrenic patients showcase avolition in different ways.

Some sit still for a long time period demonstrating absolute indifference towards their environment or surroundings and some show absolutely no interest in any work or social activity. Social withdrawal and apathy are very common negative symptoms of schizophrenia.

Anhedonia: This refers to as the incapability of an individual to experience any kind of pleasure. People who experience this often describe their life as empty or grey, a life without normal ups and downs. Some schizophrenia patients experiencing this have also conveyed feeling hollow or empty.

Cognitive Symptoms of Schizophrenia

Cognitive schizophrenia symptoms are severe for some schizophrenic patients and subtle for the others. Some of the commonly known cognitive symptoms of schizophrenia include:

Attention Deficit: Patients impacted by schizophrenia struggle in paying attention and focusing on even simplest of the things in their daily lives.

Dementia: Dementia is one of the most common cognitive schizophrenia symptoms found in patients. Dementia affects that area of the brain which is responsible for language, learning, memory, decision making, reasoning, and thinking. Hence patients exhibit impaired reasoning, memory loss and major personality changes.

Altered Executive Functioning: Schizophrenic patients experience altered executive functioning. This means that they struggle to manage time, organize and plan, pay adequate attention, remember details and switch focus. Schizophrenic patients also have trouble doing things independently and maintaining relationships. Even day to day functioning becomes challenging and complex for schizophrenic patients.

What are the Causes of Schizophrenia?

What exactly causes schizophrenia is not known. Just like the disease, the causes of schizophrenia are also complex. However, researchers believe that a combination of brain chemistry, environment and genetics contributes to the development of schizophrenia. Some of the common probable risk factors sighted by researchers as causes of schizophrenia include genetic inheritance, family relationships, a chemical imbalance in the brain, drug abuse during the teenage years or young adulthood, father’s older age, and pregnancy and birth-related complications like exposure to toxins and viruses.

Misconception Regarding Schizophrenia

A lot of people confuse schizophrenia to be multiple personality disorder and split personality disorder. Contrary to this common public perception, schizophrenia is nothing like the two. Most of the people diagnosed with schizophrenia are not violent and do not pose any danger to people around them. Some of the common perceptions around schizophrenia are that it is caused as a result of childhood experiences, lack of self-esteem and bad parenting. However, this is not true. Schizophrenia symptoms vary considerably from one schizophrenic patient to another.

Can You Prevent Schizophrenia?

There is no guaranteed way to prevent schizophrenia, as this is a very complex and serious mental disease. However, consistently following the treatment plan, as prescribed by the physician, can prevent worsening of schizophrenia symptoms. Researchers are currently researching about the other risk factors associated with the disease and are trying out various ways to diagnose schizophrenia at an early stage.

How Can You Treat Schizophrenia?

Schizophrenia treatment, as of now, usually continues for lifelong, right from the time of diagnosis. Treatment for schizophrenia needs to be continued even when the schizophrenia symptoms seem to have subsided or faded. Schizophrenia treatment is generally a combination of medication, coordinated specialty care services and psychotherapy. A team that comprises of a psychiatrist, psychiatric nurse, social worker and psychologist should guide the schizophrenia treatment.

Medications acts as a foundation in schizophrenia treatment. Antipsychotic medication and anti-tremor medications are commonly prescribed to schizophrenic patients. The combinations of various neuro-psychotic medications as well as doses are decided based on the severity of the schizophrenia symptoms.

Along with medications, schizophrenic patients also need strong social support. This is also referred to as psychological intervention and following are some of these therapies:

Family Therapy in Schizophrenia: This therapy educates the family on how to support and deal with the family member suffering from schizophrenia.

Individual Therapy for Treating Schizophrenia: Regular psychotherapy can normalize thought patterns in a schizophrenic patient to a great extent. Individual therapy also includes teaching the patients on how to identify warning signs of a schizophrenia relapse, cope up with stress. It also helps the individuals to be able to manage their illness overall.

Social Skill Training for Schizophrenic Patients: This concentrates on improving the schizophrenic patient’s communication, social interactions, and their overall capability to participate in the daily activities.

Vocational Rehabilitation to help Schizophrenic Patients: This focuses on helping schizophrenic patients to prepare for a job, searching it and most important, maintaining it.

Electroconvulsive Therapy for Unresponsive Schizophrenia: Some schizophrenic patients do not respond to medications or therapy. In such cases Electroconvulsive therapy (ECT) is considered. This may also be helpful for a schizophrenic patient if he or she is depressed.


This challenging disease, schizophrenia, is not only difficult and complex to treat; but is also difficult to cope up with. Various therapies, self-help groups, social support systems and medications can help a schizophrenic patient lead a normal life. Hospitalization may be required in the times of crisis or periods with extreme symptoms, in order to maintain basic hygiene, proper nutrition, and adequate sleep and to ensure safety of the patient and family members. With disciplined treatment, the schizophrenic patients can relatively have a good quality of life and for sure, can live longer.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:January 19, 2019

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