Table of Contents
People with schizophrenia may have perceptions of reality that are strikingly different
from the reality seen and shared by others around them. Living in a world distorted by
hallucinations and delusions, individuals with schizophrenia may feel frightened, anxious,
In part because of the unusual realities they experience, people with schizophrenia may behave very differently at various times. Sometimes they may seem distant, detached, or preoccupied and may even sit as rigidly as a stone, not moving for hours or uttering a sound. Other times they may move about constantly always occupied, appearing wide-awake, vigilant, and alert.
Hallucinations and illusions are disturbances of perception that are common in people
suffering from schizophrenia. Hallucinations are perceptions that occur without connection
to an appropriate source. Although hallucinations can occur in any sensory form
auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory
(smell) hearing voices that other people do not hear is the most common type of
hallucination in schizophrenia. Voices may describe the patients activities, carry
on a conversation, warn of impending dangers, or even issue orders to the individual.
Illusions, on the other hand, occur when a sensory stimulus is present but is incorrectly
interpreted by the individual.
Delusions are false personal beliefs that are not subject to reason or contradictory
evidence and are not explained by a persons usual cultural concepts. Delusions may
take on different themes. For example, patients suffering from paranoid-type symptoms
roughly one-third of people with schizophrenia often have delusions of
persecution, or false and irrational beliefs that they are being cheated, harassed,
poisoned, or conspired against. These patients may believe that they, or a member of the
family or someone close to them, are the focus of this persecution. In addition, delusions
of grandeur, in which a person may believe he or she is a famous or important figure, may
occur in schizophrenia. Sometimes the delusions experienced by people with schizophrenia
are quite bizarre; for instance, believing that a neighbor is controlling their behavior
with magnetic waves; that people on television are directing special messages to them; or
that their thoughts are being broadcast aloud to others.
Substance abuse is a common concern of the family and friends of people with
schizophrenia. Since some people who abuse drugs may show symptoms similar to those of
schizophrenia, people with schizophrenia may be mistaken for people "high on
drugs. While most researchers do not believe that substance abuse causes
schizophrenia, people who have schizophrenia often abuse alcohol and/or drugs, and may
have particularly bad reactions to certain drugs. Substance abuse can reduce the
effectiveness of treatment for schizophrenia. Stimulants (such as amphetamines or cocaine)
may cause major problems for patients with schizophrenia, as may PCP or marijuana. In
fact, some people experience a worsening of their schizophrenic symptoms when they are
taking such drugs. Substance abuse also reduces the likelihood that patients will follow
the treatment plans recommended by their doctors.
The most common form of substance use disorder in people with schizophrenia is nicotine
dependence due to smoking. While the prevalence of smoking in the U.S. population is about
25 to 30 percent, the prevalence among people with schizophrenia is approximately three
times as high. Research has shown that the relationship between smoking and schizophrenia
is complex. Although people with schizophrenia may smoke to self medicate their symptoms,
smoking has been found to interfere with the response to antipsychotic drugs. Several
studies have found that schizophrenia patients who smoke need higher doses of
antipsychotic medication. Quitting smoking may be especially difficult for people with
schizophrenia, because the symptoms of nicotine withdrawal may cause a temporary worsening
of schizophrenia symptoms. However, smoking cessation strategies that include nicotine
replacement methods may be effective. Doctors should carefully monitor medication dosage
and response when patients with schizophrenia either start or stop smoking.
Schizophrenia often affects a persons ability to think straight.
Thoughts may come and go rapidly; the person may not be able to concentrate on one thought
for very long and may be easily distracted, unable to focus attention.
People with schizophrenia may not be able to sort out what is relevant and what is not relevant to a situation. The person may be unable to connect thoughts into logical sequences, with thoughts becoming disorganized and fragmented. This lack of logical continuity of thought, termed thought disorder, can make conversation very difficult and may contribute to social isolation. If people cannot make sense of what an individual is saying, they are likely to become uncomfortable and tend to leave that person alone.
People with schizophrenia often show blunted or flat affect.
This refers to a severe reduction in emotional expressiveness. A person with schizophrenia
may not show the signs of normal emotion, perhaps may speak in a monotonous voice, have
diminished facial expressions, and appear extremely apathetic. The person may withdraw
socially, avoiding contact with others; and when forced to interact, he or she may have
nothing to say, reflecting impoverished thought. Motivation can be greatly
decreased, as can interest in or enjoyment of life. In some severe cases, a person can
spend entire days doing nothing at all, even neglecting basic hygiene. These problems with
emotional expression and motivation, which may be extremely troubling to family members
and friends, are symptoms of schizophrenia not character flaws or personal
At times, normal individuals may feel, think, or act in ways that resemble
schizophrenia. Normal people may sometimes be unable to think straight. They
may become extremely anxious, for example, when speaking in front of groups and may feel
confused, be unable to pull their thoughts together, and forget what they had intended to
say. This is not schizophrenia. At the same time, people with schizophrenia do not always
act abnormally. Indeed, some people with the illness can appear completely normal and be
perfectly responsible, even while they experience hallucinations or delusions. An
individuals behavior may change over time, becoming bizarre if medication is stopped
and returning closer to normal when receiving appropriate treatment.
Schizophrenia Is Not "Split Personality"|
There is a common notion that schizophrenia is the same as "split personality
a Dr. Jekyll-Mr. Hyde switch in character.
This is not correct.