Positive Symptoms in Schizophrenia

...voices, delusions, and disorganized thinking


I have been asked quite a few times – by patients with schizophrenia and family members – what is positive about the “positive symptoms”?

The typical positive symptoms, including hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive – so it is hard to think of instances when patients would actually feel that these are positive experiences.

So, one thing is clear: the “positive” in positive symptoms does not refer to the patient’s experience and does not mean that these are “good” symptoms to have.

Why are they called positive symptoms?

Compared to a normal mental state some people might have more mental experiences (thoughts, feelings, behaviors) than most people. For example, hallucinations are not part of the normal, day to day experience for most people. Then, by convention they are classified as a surplus or positive symptom.

As a rule, positive symptoms refer to symptoms that are in excess or added to normal mental functioning.

What are the positive symptoms?

Hallucinations. To hallucinate means that you might hear voices or sounds or noises that are not real, see visions, smell or taste things that others don’t smell. In short, perceive things that others don’t.

People with schizophrenia can experience a variety of hallucinations but by far, most commonly they experience hearing noises and voices (auditory hallucinations). The voices can be good but most times they are bad, dismissing and mean.

From the outside, a patient who hears voices appears distracted, as if they are listening to something (psychiatrists call this “responding to internal stimuli”). From the inside, you might hear clicks and knocks or even full conversations between multiple people or voices that talk to you directly.

At times the voices might tell you to do things. One of the common reasons for patients with schizophrenia to come to the hospital is that the voices are telling you to harm or even kill themselves or others Please ask for help and talk to a doctor as soon as possible if you feel that you are losing control and might act on the voices orders.

Delusions. Delusions are ideas that are not true. People with schizophrenia might feel that the secret service is out to get them when there is no evidence for that, that TV anchors transmit them coded messages by the way they move, talk or dress, or that their food is poisoned. A fairly common type of delusion in schizophrenia is paranoia. A patient with paranoia feels threatened by others. From the outside, a patient with paranoia will be guarded, suspicious of anyone’s intention and closed up, not happy to answer questions or even associate with other people. From the inside, you might see evidence for plots and threats all around or you might feel followed or under close monitoring and surveillance everywhere they go.

Disorganized thinking. From the outside, disorganized thinking looks like a series of disjointed thoughts. It is hard to follow and make sense of what a patient with disorganized thinking is trying to say. At times the language structure is completely los; the words are no longer connected in sentences or the patient uses words that do not exist and have no clear meaning (neologisms). At times it seems like to process of thinking collapses or comes to a complete, sudden stop (thought blocking). From the inside, you might feel that is hard to keep your thoughts straight or say what you have in mind.

Movement disorders. Patients with schizophrenia at times present with excessive and agitated body movements. How does that feel? It’s hard to say as most times patients are either unaware of the movements  or have a difficult time saying what’s wrong.

Further reading:

National Institute of Health: What is schizophrenia?

WebMD: Schizophrenia symptoms

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