Schizophrenia symptoms seem to worsen and improve in cycles known as relapses and remissions. About 1% of Americans have schizophrenia. Signs and symptoms of schizophrenia fall into three main categories:

» Positive Symptoms

People who show signs of positive symptoms often lose touch with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following:

• Hallucinations: This happens when a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. Hearing voices is the most common type of hallucination. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. People with schizophrenia could hear voices for a long time before family and friends notice the problem.
• Delusions: This happens when people demonstrate false beliefs that are not part of the person’s culture and do not change. The person believes delusions even after other people prove that the beliefs are not true or logical. People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. Sometimes they believe they are someone else, such as a famous historical figure.
• Thought disorders: This happens when people demonstrate unusual or dysfunctional ways of thinking. One form of thought disorder is called “disorganized thinking.” This is when a person has trouble organizing his or her thoughts or connecting them logically. They may talk in a garbled way that is hard to understand. Another form is called “thought blocking.” This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or “neologisms.”
• Movement disorders: This may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available.

» Negative Symptoms

Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following:

• “Flat affect” (a person’s face does not move or he or she talks in a dull or monotonous voice)
• Lack of pleasure in everyday life
• Lack of ability to begin and sustain planned activities
• Speaking little, even when forced to interact.

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

» Cognitive Symptoms

Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following:

• Poor “executive functioning” (the ability to understand information and use it to make decisions)
• Trouble focusing or paying attention
• Problems with “working memory” (the ability to use information immediately after learning it).

Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.