Cognitive Symptoms Of Schizophrenia
Cognitive symptoms of schizophrenia have to do with the way a person thinks. Although cognitive symptoms are not used to diagnose schizophrenia, some are fairly common with the condition, such as:
- Difficulty maintaining attention – The inability to maintain focused attention makes people with schizophrenia seem spacey or out of it.
- Memory problems – Schizophrenia often affects working memory, which is the kind of memory you use to keep things in your head for active processing, like the digits of a phone number youre about to dial.
- Difficulty planning and structuring activities – Caused by reduced executive function. Executive function is a set of mental processes that allows us to identify the steps needed to complete a task and then execute them in a proper order. Executive function also allows us to suppress our response to distractions in order to get something done.
- Lack of insight – People with schizophrenia have a specific cognitive blind spot that prevents them from understanding that they are ill. This means that loved ones and caregivers should remain as vigilant as possible to help the patient maintain the routines of treatment in order to control symptoms.
What Kind Of Symptoms Might People With Schizophrenia Have
People with schizophrenia may have a number of psychotic symptoms. These symptoms can come and go in phases, or they can happen only once or twice in a lifetime. When the illness begins, psychotic symptoms are usually sudden and severe.
During psychotic phases, the person may still understand parts of reality. He or she may lead a somewhat normal life, doing basic activities such as eating, working and getting around. In other cases, the person may be unable to function. Symptoms during psychotic phases include:
- Seeing, hearing, feeling or smelling things that are not real .
- Having strange beliefs that are not based on facts . For example, the person may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head.
- Thinking in a confused way, being unable to make order out of the world, shifting quickly from one thought to the next.
- Having emotions, thoughts and moods that do not fit with events.
People with schizophrenia also may:
- Have a lot of energy or be overly active, or become “catatonic,” a state in which the body becomes rigid and cannot be moved.
- Talk in sentences that do not make sense.
- Not wash or groom.
- Cut themselves off from family, friends and the outside world.
- Be unable to function in school, work, or other activities.
- Lose interest in life.
- Be very sad or have mood swings.
- Have dulled emotions.
Challenging Longstanding Assumptions And Moving Forward
Clozapine, discovered in the 1960s, remains the most effective antipsychotic medication, although its use is restricted due to its side effect profile111. This stagnation in drug development for schizophrenia highlights a key weakness in schizophrenia research a lack of effective bi-directional translation between basic and clinical research. The fact that the current methods of testing for psychotic symptoms in rodents are now misaligned with recent clinical evidence indicates a need to advance how positive symptoms are examined in animal models. We have proposed a combination of behavioural tests in rodents that are sensitive to dysfunction at the primary site of dopaminergic neurobiology observed in schizophrenia. There will never be a perfect model for psychosis in rodents, but it is critical that we acknowledge the limitations of current methods so that an active dialogue is established.
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How Common Is Schizophrenia
Schizophrenia is more common than most people think. About 1 in 200 of the people in the United States will develop schizophrenia over the course of their lives. It’s also important to know that schizophrenia has many different symptoms and can show up in many different ways.
Schizophrenia is not the same as a “split personality.” A split personality is another type of mental illness. Split personality is much less common than schizophrenia.
How Is Schizophrenia Treated
Schizophrenia is a chronic condition for which theres no cure. As such, treatment focuses on managing symptoms and building coping skills for daily life and functioning. It can include a combination of the following treatments:
- Medications. Antipsychotic medications can help with the psychotic symptoms of schizophrenia. These include medications to treat acute psychosis, followed by maintenance medications to help prevent symptoms from returning.
- Therapy. Therapy, which can include CBT, is an important part of treatment. A mental health professional can also help a person with schizophrenia develop coping strategies and teach them how how to recognize signs of a recurrence.
- Family support. Its important that family members learn about schizophrenia and how to support their loved one. Making sure the loved one is taking medication and noting signs of recurrence are also vital.
- Social support. Similar to psychosis, people with schizophrenia can benefit from social support services. These services can help with returning to school or work, improving social skills, and coping with stress and everyday challenges.
Schizophrenia is also associated with several comorbid conditions. These are conditions that can occur along with schizophrenia and can include:
What Are Positive And Negative Symptoms
Positive and negative symptoms are medical terms for two groups of symptoms in schizophrenia.
Positive symptoms add. Positive symptoms include hallucinations , delusions , and repetitive movements that are hard to control.
Negative symptoms take away. Negative symptoms include the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships.
There is also a third group of symptoms, usually called cognitive symptoms. This includes anything related to thinking, such as disorganized thoughts, memory problems, and difficulties with focus and attention.
Where can I learn more?
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.
Q& A is for readers who want to take charge of their well-being, support a friend or loved one, find good help, or just learn more about mental health and substance use. Here, the information and resource experts at HeretoHelp will answer the questions that were asked most often. We’ll offer tips and information, and we’ll connect you with help in BC, Canada. If you have a question youd like to ask, email us at , tweet , or log in to HeretoHelp and post a comment on this page.
Length Of Medication Treatment
- Pierre, J. M. et al. . Antipsychotic discontinuation and recovery: chicken or egg?. Psychological Medicine, 1-2.
- How long should patients remain on antipsychotics for schizophrenia? The general consensus is that patients with chronic schizophrenia should remain on therapy long-term. However, there is some new evidence for first-episode psychosis patients that âless is more.â
- A recent study observed that compared with a standard maintenance treatment regimen, dose reduction or supervised discontinuation of antipsychotic medication during the early phases of FEP led to a higher relapse rate initially, but improved long-term outcomes. This study has been criticized for its unequal distribution across diagnostic groups, high attrition rate, failure to separate the dose reduction and discontinuation groups, and the fact that most patients in each arm of the study still did receive medication.
- Other studies have suggested that up to 40% of first episode psychosis patients are able to achieve good outcomes with either low or no doses of antipsychotics.
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Positive Symptoms: The Psychotic Dimension
Hallucinations are sensations that only the person having them experiences. Whatever causes them happens within the person’s brain, and not outside in the world. Hallucinations may involve sight, sound, taste, smell and touch. The most commonly reported form of hallucination involves hearing people’s voices when those people are not there. These hallucinations happen when the person is fully awake. They appear to come from one or more third parties. They are not like the common odd sensations that many people experience during transitions from waking to sleep or when falling asleep. People with schizophrenia describe the voices as providing a running description of their behaviors and intentions in their heads. The voices might also be forceful and tell them to do or not do certain things. Frequently, the voices are very negative and critical in tone and attempt to humiliate the person.
Delusions are fixed, mistaken ideas that the person holds. These are often odd or incorrect ideas about themselves and the world around them. They may be based on hallucinations, or from faulty thinking about events that either happened or were believed to have happened but which are not real. Delusions vary widely in their themes. they may be persecutory , referential .
Delusions can be:
Psychotic Symptoms And Ptsd
Researchers at the University of Manitoba, Columbia University and the University of Regina examined the data on 5,877 people from across the United States to determine the rates with which people with posttraumatic stress disorder experience different psychotic symptoms.
They found that, among people with PTSD, the experience of positive psychotic symptoms was most common.
Approximately 52% of people who reported having PTSD at some point in their lifetime also reported experiencing a positive psychotic symptom.
The most common positive symptoms were:
- Believing that other people were spying on or following them
- Seeing something that others could not see
- Having unusual feelings inside or outside of their bodies, such as feeling as though they were being touched when no one was really there
- Believing that they could hear what someone else was thinking
- Being bothered by strange smells that no one else could smell
- Believing that their behaviors and thoughts were being controlled by some power or force
The researchers also found evidence that the more PTSD symptoms a person was experiencing, the greater the likelihood that they would also experience positive psychotic symptoms.
To take their study a step further, the researchers also looked at what traumatic events were most commonly related to the experience of psychotic symptoms. They found the following to be most strongly connected:
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Schizophrenia Not A Psychotic Disorder: Bleuler Revisited
Frontiers in psychiatry
Very interesting! Thanks for adding this to the discussion!
, the people with BD didnt have blunted affect or alogia but they did have withdrawal and anhedonia which are more signs of depression which people with BD are more likely to have, which would account for their so called negative symptoms.
I think we need to be very careful in teasing out negative symptoms from depressive symptoms . Anhedonia is seen as a negative symptom of schizophrenia so why can it not be seen as a negative symptom of bipolar?
What If I Am A Carer Friend Or Relative
It can be distressing if you are a carer, friend or relative of someone who has schizophrenia. You can get support.
How can I get support for myself?
You can do the following.
- Speak to your GP about medication and talking therapies for yourself.
- Speak to your relatives care team about family intervention. For more information about family intervention see the further up this page.
- Speak to your relatives care team about a carers assessment.
- Ask for a carers assessment.
- Join a carers service. They are free and available in most areas.
- Join a carers support group for emotional and practical support. Or set up your own.
What is a carers assessment?NICE guidelines state that you should be given your own assessment through the community mental health team to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support.
The CMHT should tell you about your right to have a carers assessment through your local authority. To get a carers assessment you need to contact your local authority.
How do I get support from my peers?You can get peer support through carer support services or carers groups. You can search for local groups in your area by using a search engine such as Google. Or you can call our advice service on 0808 801 0525. They will search for you.
How can I support the person I care for?
You can do the following.
There is no definition for what high risk means. It could include:
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Challenges In Reaching Out
It can be challenging for people with schizophrenia to reach out to a doctor or other health professional about their concerns. This can be particularly tough for people who may be experiencing symptoms that leave them feeling suspicious of others.
Reassurance from people they trust can be helpful in encouraging and prompting someone to speak with a doctor or other mental health professional.
Dopamine Systems: Anatomy And Function
An appreciation for the neuroanatomical differences in subcortical dopaminergic projections/circuitry between rodents and primates is essential for effective communication between clinical and basic researchers. For example, primates feature a more prominent substantia nigra and less distinctive ventral tegmental area than rodents. However, more pertinent to the current review are homologous functional subdivisions of the striatum observed in both rodents and primates2124. These include the limbic, associative and sensorimotor areas .1). The associative striatum, defined by its dense connectivity from the frontal and parietal associative cortices, is key for goal-directed action and behavioural flexibility. The limbic striatum, defined by connectivity to the hippocampus, amygdala and medial orbitofrontal cortex, is involved in reward and motivation. The sensorimotor striatum, defined by connectivity to sensory and motor cortices, is critical for habit formation. These functional subdivisions are also interconnected by feedforward striato-nigro-striatal projections25. The heavy basis on behavioural outcomes in neuropsychiatry has made functional subdivisions such as these more relevant than ever.
Functional subdivisions of the dopamine system across species.
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Challenges In Diagnosing Schizophrenia
Psychiatric symptoms exist on continua from normal to pathological, meaning the threshold for diagnosis of schizophrenia in clinical practice can be challenging. The clinical diagnosis of schizophrenia relies heavily on the positive symptoms associated with a prolonged psychotic episode. However, a relatively high percentage of the general population report delusional experiences or hallucinations in their lifetime1214, but for most people these are transient15. Psychotic symptoms are also not specific to a particular mental disorder16. The clinical efficacy of antipsychotic drugs is heavily correlated with their ability to block subcortical dopamine D2 receptors17, 18, suggesting dopamine signalling is important. In spite of this, no consistent relationship between D2 receptors and the pathophysiology of schizophrenia has emerged19, 20. In contrast, the clinical evidence points towards presynaptic dopamine dysfunction as a mediator of psychosis in schizophrenia19.
What Are Schizophrenia Negative And Positive Symptoms
Schizophrenia symptoms are often classified as negative or positive symptoms. These symptoms are grouped based on whether they reflect diminished or excess function. Positive and negative schizophrenia symptoms have been seen ever since schizophrenia was first noted in medical literature over 100 years ago.
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Changes In Behaviour And Thoughts
A person’s behaviour may become more disorganised and unpredictable.
Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else.
Another feeling is that thoughts are disappearing, as though someone is removing them from their mind.
Some people feel their body is being taken over and someone else is directing their movements and actions.
Why Are They Called Positive
They are called positive symptoms because they refer to changes in behaviors or thoughts that came about after the individual developed schizophrenia, rather than before.
Negative symptoms are named as such because they refer to thoughts and behaviors that the individual had before developing schizophrenia but has since lost. In other words, negative symptoms are key aspects or characteristics of the person that have disappeared.
Although the symptoms of schizophrenia vary in terms of severity, people with this condition have an increased risk of negative outcomes. For instance:
- Schizophrenia is linked with a
- inattentiveness or lack of concentration
Despite receiving less media attention, these negative symptoms also greatly affect the individuals quality of life and their ability to live normally. Without treatment, many people have difficulty coping with these symptoms.
Most people with schizophrenia receive a diagnosis between their teenage years and early 30s. It can sometimes be difficult to diagnose the condition early on because some of the early symptoms such as lethargy, apathy, and lack of motivation can also be common features of adolescence.
Once a person starts experiencing delusions, fully realized hallucinations, thought disorder, and hyperactive behavior, the condition becomes easier to diagnose.
Diagnosis usually includes some or all the following:
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United States And International Statistics
The lifetime prevalence of schizophrenia has generally been estimated to be approximately 1% worldwide. However, a systematic review by Saha et al of 188 studies drawn from 46 countries found a lifetime risk of 4.0 per 1000 population prevalence estimates from countries considered least developed were significantly lower than those from countries classed as emerging or developed. Immigrants to developed countries show increased rates of schizophrenia, with the risk extending to the second generation.
List Of Negative Symptoms Of Schizophrenia
There are two types of negative symptoms. Differentiating between the two can be a challenge.
Primary negative symptoms refer to those that are part of the disorder itself. These can occur during or between exacerbations.
Secondary negative symptoms refer to those due to other things, such as:
- inappropriate emotions for the situation
Positive symptoms are more apparent, so theyre likely to prompt diagnosis and treatment.
On the other end of the spectrum, negative symptoms mean something is missing. That makes them easier to overlook as being linked to schizophrenia.
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