Schizophrenia Early Warning Signs
May is Mental Health Awareness Month.
In the coming series I will talk in detail about schizophrenia: starting from the onset of symptoms, how a diagnosis is made, the differences between types of symptoms, and treatments available through the recovery and hopefully remission stages.
To start: I will offer a list of schizophrenia early warning signs that I cribbed from the now-defunct schiophrenia.com. On that site a disclaimer was made: these behaviors can exist in everyday people; it’s the severity of the behaviors and whether someone goes over the edge with them that warrants a consultation with a professional.
Only a qualified psychiatrist, psychologist or in some areas a social worker can diagnose schizophrenia. In the coming SharePosts I hope to list the DSM-IV criteria for making diagnoses of the various related illnesses: schizophrenia, schizoaffective, schizophreniform, and others, and give information about how each differs.
As of today, the only way a professional has of diagnosing schizophrenia or any other mental health condition is to observe a person’s behavior and take a history leading up to the breakdown or symptom manifestation. Research is being conducted about a possible blood test to use to diagnose schizophrenia.
The list is subdivided into Physical Symptoms, Feelings and Mood, Behavior, Cognitive Problems, Delusions, and Hallucinations.
Examples of Physical Symptoms----
–A blank, vacant facial expression. An inability to smile or express emotion through the face is so characteristic of the disease that it was given the name of affective flattening or a blunt affect.
–Overly acute senses- lights are too bright, sounds are too loud.
–Staring, while in deep thought, with infrequent blinking.
–Clumsy, inexact motor skills
–Sleep disturbances- insomnia or excessive sleeping
–Involuntary movements of the tongue or mouth (facial dyskinesias). Grimacing at the corners of the mouth with the facial muscles, or odd movements with the tongue.
–Parkinsonian type symptoms- rigidity, tremor, jerking arm movements, or involuntary movements of the limbs
–An awkward gait (how you walk)
–Eye movements- difficulty focusing on slow moving objects
–Unusual gestures or postures
–Movement is speeded up- i.e. constant pacing
–Movement is slowed down- staying in bed (in extreme cases, catatonia)
Examples of Feelings/Emotions----
–The inability to experience joy or pleasure from activities (called anhedonia)
–Sometimes feeling nothing at all
–Appearing desireless-seeking nothing, wanting nothing
–Feeling indifferent to important events
–Feeling detached from your own body (depersonalization)
–Hypersensitivity to criticism, insults, or hurt feelings
Examples of Mood----
–Sudden irritability, anger, hostility, suspiciousness, resentment
–Depression- feeling discouraged and hopeless about the future
–Low motivation, energy, and little or no enthusiasm
–Suicidal thoughts or suicidal ideation
–Rapidly changing mood-from happy to sad to angry for no apparent reason (called labile mood)
Changes in Behavior associated with schizophrenia ----
–Dropping out of activities and life in general
–Inability to form or keep relationships
–Social isolation- few close friends if any. Little interaction outside of immediate family.
–Increased withdrawal, spending most of the days alone.
–Becoming lost in thoughts and not wanting to be disturbed with human contact
–Neglect in self-care-i.e. hygiene, clothing, or appearance
–Replaying or rehearsing conversations out loud- i.e. talking to yourself (very common sign)
–Finding it difficult to deal with stressful situations
–Inability to cope with minor problems
–Lack of goal-directed behavior. Not being able to engage in purposeful activity
–Functional impairment in interpersonal relationships, work, education, or self-care
–Deterioration of academic or job-related performance
–Inappropriate responses- laughing or smiling when talking of a sad event, making irrational statements.
–Catatonia- staying in the same rigid position for hours, as if in a daze.
–Intense and excessive preoccupation with religion or spirituality
–Drug or alcohol abuse
–Smoke or have the desire to want to smoke (70-90% do smoke) - note: this is a very normal behavior for people who do not have schizophrenia also
–Frequent moves, trips, or walks that lead nowhere
Examples of Cognitive Problems Associated with Schizophrenia ----
–Ruminating thoughts- these are the same thoughts that go around and round your head but get you nowhere. Often about past disappointments, missed opportunities, failed relationships.
–Making up new words (neologisms)
–Becoming incoherent or stringing unrelated words together (word salad)
–Frequent loose association of thoughts or speech- when one thought does not logically relate to the next. For example, “I need to go to the store to buy some band-aids. I read an article about how expensive AIDS drugs are. People take too many street drugs. The streets should be clean from the rain today, etc” The need to go to the store to buy band-aids is forgotten.
–Directionless-lack goals, or the ability to set and achieve goals
–Lack of insight (called anosognosia). Those who are developing schizophrenia are unaware that they are becoming sick.
The part of their brain that should recognize that something is wrong is damaged by the disease.
–In conversation you tend to say very little (called poverty of speech or alogia)
–Suddenly halting speech in the middle of a sentence (thought blocking)
–Trouble with social cues- i.e. not being able to interpret body language, eye contact, voice tone, and gestures appropriately. --Often not responding appropriately and thus coming off as cold, distant, or detached.
–Difficulty expressing thoughts verbally. Or not having much to say about anything.
–Speaking in an abstract or tangential way. Odd use of words or language structure
–Difficulty focusing attention and engaging in goal directed behavior
–Poor concentration/ memory. Forgetfulness
–Difficulty understanding simple things
–Thoughts, behavior, and actions are not integrated
–Obsessive compulsive tendencies- with thoughts or actions
–Thought insertion/ withdrawal- thoughts are put it or taken away without a conscious effort
–Conversations that seem deep, but are not logical or coherent
Examples of Delusions----
The most common type of delusion or false beliefs are paranoid delusions. These are persecutory in nature and take many forms:
–Overpowering, intense feeling that people are talking about you, looking at you
–Overpowering, intense feeling you are being watched, followed, and spied on (tracking devices, implants, hidden cameras)
–Thinking that someone is trying to poison your food
–Thinking people are working together to harass you
–Thinking that something is controlling you- i.e. an electronic implant
–Thinking that people can read your mind/ or control your thoughts
–Thinking that your thoughts are being broadcast over the radio or tv
–Delusions of reference- thinking that random events convey a special meaning to you. An example is that a newspaper headline or a license plate has a hidden meaning for you to figure out. That they are signs trying to tell you something.
–Religious delusions- that you are Jesus, God, a prophet, or the antichrist.
–Delusions of grandeur- the belief that you have an important mission, special purpose, or are an unrecognized genius, or famous person.
–Delusions that someone, often a famous person, is in love with you when in reality they aren’t. Also called erotomania or de Clerembault syndrome.
Examples of Hallucinations----
–Hallucinations are as real as any other experience to the person with schizophrenia. As many as 70 percent hear voices, while a lesser number have visual hallucinations.
–Auditory hallucinations can be either inside the person’s head or externally. When external, they sound as real as an actual voice. Sometimes they come from no apparent source, other times they come from real people who don’t actually say anything, other times a person will hallucinate sounds.
–When people hear voices inside their heads, it is as if their inner thoughts are no longer alone. The new voices can talk to each other, talk to themselves, or comment on the person’s actions. The majority of the time the voices are negative.
–Visual hallucinations operate on a spectrum. They start with the overacuteness of the senses, then in the middle are illusions, and on the far end are actual hallucinations.
Disclaimer: Illnesses like bipolar can also present with these symptoms. A diagnosis of schizophrenia requires that symptoms are present for at least six months, including one month of certain key symptoms like delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, and negative symptoms like severe emotional flatness or apathy.
Consult a professional if you suspect you or a loved one is experiencing symptoms beyond the normal range of these behaviors.
The earlier someone exhibiting symptoms of schizophrenia gets treated with medication and therapy: the better the outcome.
Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.