Positive Symptoms of Schizophrenia

As previously described, the positive symptoms of Schizophrenia are described as such because they are a surplus or excess to what is normally experienced by a person. The positive symptoms of schizophrenia consist of hallucinations, delusions and various disturbances of thought process.

Hallucinations are perceptual disturbances which occur in the 5 senses. So the patient will experience something there which in reality is not really there. Hallucinations must be distinguised from the other perceptual disturbance of an illusion which is the misinterpretation of a visual perception which is real, eg seeing a shadow and thinking its a ghost.

1 - Auditory hallucinations: These are the voices which patients experience. The voices can be of varying nature, gender and single or multiple in number. Further characterisation includes comments, insults, instructions, commands and threats. Sometimes multiple voices are talking about the patient and sometimes patients experience their thoughts being repeated back to them as a voice. (thought echo)

2 - Visual hallucinations are images which patients see. These can be partially or fully formed and can include seeing shadows, blurs, ghosts, 'monsters', and fully formed figures, human, animate or inanimate.

3 - Gustatory hallucinations. These are experienced as tastes

4 - Tactile hallucinations. These are experienced as something physically touching the skin

5 - Olfactory hallucinations. These are smells. Often this experience leads clinicians to suspect that something else might be causing the psychotic symptoms. Olfactory hallucinations, usually unpleasant, also occurs in certain forms of epilepsy. In this case, patients should at least undergo an EEG (electro-encephalographic) test to scan for epilepsy. Sometimes they would have to have a series of such tests to exclude epilepsy.

Delusions are defined as fixed (unshifting) ideas which are clearly untrue, and which is out of context to the patient's educational, cultural, and religious background. There are various types of delusions as well. This list is not exhausitive, but it includes persecutory (paranoid), grandiose, religiose. Other types can include erotomanic (belief that someone else is in love with you) and delusions of jealousy (infidelity) and delusions of reference.

Delusions of reference occur when the patient assigns importance to insignificant events or occurences. For example they might think that a group of people innocently involved in a conversation is gossiping or spreading rumours about them; they might also assign importance to inanimate things such as the wind blowing or trees moving and see this as a message from their God. One of the more common themes is the belief that the TV is making reference to them.

Delusions of thought interference. This can present in a number of ways.
Thought insertion is the belief that thoughts are being inserted into your mind.
Thought withdrawal is the belief that thoughts are being withdrawn or removed from your mind.
Thought broadcast is the belief that your thoughts are being read or monitored or literally broadcast over some media (radio, TV, internet).

Capgrass Syndrome is another interesting syndrome. The person having this believes that someone that is usually close to them, such as a family member, is an imposter, who has taken on the form of the person which they know. These can sometimes have very serious consequences such as serious attacks on these individuals. This, in the schizophrenia mind, is the proof that this person is dangerous and needs to be stopped.

Disturbances of thought order

These can be termed and categorised in a number of ways for the clinical. But the lay person will just describe someone who is thougth ordered as 'he talks nonsense', 'he doesn't make any sense', 'he never gets to the point', 'he talks in circles' or 'he starts talking about the topic but jumps to something completely different'.

Some of the terms which are used in the psychiatric profession are 'thought disordered', 'loose association', 'loosening of association', 'tangential thinking', 'circumstantial' or 'over-inclusive'.

Disorganised thoughts usually result in disorganised behaviour which is the another positive symptom of schizophrenia. Patients usually present with bizarre or repetitive behaviour or behaviour which seemingly does not serve any useful purpose. eg they may turn the lights on and off repeatedly through the night, start collecting refuse, start unpacking their cupboards. But bizarre does not always mean disorganised. They may strip all the light and electrical fittings from the home looking for the "listening bug which the aliens planted" - in their mind they have avery rational reason for stripping the whole house.

This list of positive symptoms of schizophrenia is not exhaustive. These are the common ones.