Schizophrenia causes distorted and bizarre thoughts,
perceptions, emotions, movements, and behavior. It
cannot be defined as a single illness; rather, schizo-
phrenia is thought of as a syndrome or disease process
with many different varieties and symptoms, much
like the varieties of cancer. For decades, the public
vastly misunderstood schizophrenia, fearing it as
dangerous and uncontrollable and causing wild dis-
turbances and violent outbursts. Many people be-
lieved that those with schizophrenia needed to be
locked away from society and institutionalized. Only
recently has the mental health industry come to
learn and educate the community at large that schiz-
ophrenia has many different symptoms and presen-
tations and is an illness that medication can control.
Thanks to the increased effectiveness of newer atyp-
ical antipsychotic drugs and advances in community-
based treatment, many clients with schizophrenia
live successfully in the community. Clients whose ill-
ness is medically supervised and whose treatment is
maintained often continue to live and sometimes work
in the community with family and outside support.
Schizophrenia usually is diagnosed in late ado-
lescence or early adulthood. Rarely does it manifest
in childhood. The peak incidence of onset is 15 to
25 years of age for men and 25 to 35 years of age for
women (APA, 2000). The prevalence of schizophrenia
is estimated at about 1% of the total population. In
the United States, that translates to nearly 3 million
people who are, have been, or will be affected by the
disease. The incidence and the lifetime prevalence are
roughly the same throughout the world (Buchanan &
Carpenter, 2000).
The symptoms of schizophrenia are divided into
two major categories: positiveor hard symptoms/
signs,which include delusions, hallucinations, and
grossly disorganized thinking, speech, and behavior,
and negative or soft symptoms/signssuch as flat af-
fect, lack of volition, and social withdrawal or dis-
comfort. Medication can control the positive symp-
toms, but frequently the negative symptoms persist
after positive symptoms have abated. The persis-
tence of these negative symptoms over time presents
a major barrier to recovery and improved functioning
in the client’s daily life.
The following are the types of schizophrenia ac-
cording to the DSM-IV-TR (APA, 2000). The diag-
nosis is made according to the client’s predominant
symptoms:- Schizophrenia, paranoid type:characterized
by persecutory (feeling victimized or spied
on) or grandiose delusions, hallucinations,
and, occasionally, excessive religiosity (delu-
sional religious focus) or hostile and aggres-
sive behavior - Schizophrenia, disorganized type:character-
ized by grossly inappropriate or flat affect,
incoherence, loose associations, and ex-
tremely disorganized behavior - Schizophrenia, catatonic type:characterized
by marked psychomotor disturbance, either
motionless or excessive motor activity. Motor
14 SCHIZOPHRENIA 297
◗ POSITIVE ANDNEGATIVESYMPTOMS OFSCHIZOPHRENIA
POSITIVE OR HARD SYMPTOMS
Ambivalence:Holding seemingly contradictory beliefs or feelings about the same person, event, or situation
Associative looseness:Fragmented or poorly related thoughts and ideas
Delusions:Fixed false beliefs that have no basis in reality
Echopraxia:Imitation of the movements and gestures of another person whom the client is observing
Flight of ideas:Continuous flow of verbalization in which the person jumps rapidly from one topic to another
Hallucinations:False sensory perceptions or perceptual experiences that do not exist in reality
Ideas of reference:False impressions that external events have special meaning for the person
Perseveration:Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase;
resisting attempts to change the topicNEGATIVE OR SOFT SYMPTOMS
Alogia:Tendency to speak very little or to convey little substance of meaning (poverty of content)
Anhedonia:Feeling no joy or pleasure from life or any activities or relationships
Apathy:Feelings of indifference toward people, activities, and events
Blunted affect:Restricted range of emotional feeling, tone, or mood
Catatonia:Psychologically induced immobility occasionally marked by periods of agitation or excitement;
the client seems motionless, as if in a trance
Flat affect:Absence of any facial expression that would indicate emotions or mood
Lack of volition:Absence of will, ambition, or drive to take action or accomplish tasks