Positive Symptoms in Schizophrenia

Hallucinations, Delusions, Disorganized Thinking, Movement Disorders

Positive symptoms of schizophrenia

Verywell / Cindy Chung

In This Article

The typical positive symptoms of schizophrenia, such as hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive—not a positive experience at all for you or someone you care about who is experiencing them. From the outside, a person with positive symptoms might seem distracted, as if they are listening to something (psychiatrists call this “responding to internal stimuli”).

So why are these types of symptoms called "positive"? Schizophrenia causes a surplus of mental experiences (thoughts, feelings, behaviors). For example, hallucinations, which are not part of the normal, day-to-day experience for most people, are classified as a positive symptom for people with schizophrenia.

The phrase "positive symptoms" refers to symptoms that are in ​excess or added to normal mental functioning.

While these symptoms can be scary and extremely debilitating, taking the time to understand them (and the available treatments) can help you better cope or help a loved one do so.

Hallucinations

In short, to hallucinate means to perceive things that others do not.

People with schizophrenia can experience a variety of hallucinations, but the most common are auditory hallucinations (or hearing noises and voices). This can include clicks and knocks, full conversations between people, or voices that talk to them directly. The voices can be good, but more often they are bad, dismissive, and mean. At times, the voices can be in the form of commands.

In fact, a common reason for people with schizophrenia to come to the hospital is that the voices are telling them to harm or even kill themselves or others. If you feel like you are losing control and/or might act on the voice's orders, call your mental health provider or 911 immediately.

5 Types of Hallucinations

  1. Auditory: hearing voices or sounds that are not there
  2. Visual: seeing people, colors, shapes, or items that aren't real
  3. Tactile: feeling sensations (bugs crawling on or under your skin) or as if you're being touched when you're not
  4. Olfactory: Smelling something that has no physical source
  5. Taste: Experiencing taste in your mouth when you have not eaten anything

Delusions

Delusions are ideas that are not true. For example, people with schizophrenia might believe that the secret service is out to get them, or that TV anchors are transmitting coded messages, or their food is poisoned—and without any evidence.

A fairly common type of delusion in schizophrenia is paranoia, which can cause a person with schizophrenia to feel followed, under close monitoring and surveillance, or afraid of ongoing plots or threats.

Understandably, this can cause the person to become guarded, suspicious of anyone’s intention, and reluctant to answer questions or even associate with other people.

There are several types of delusions and, most often, they involve a specific theme.

Erotomanic

The person believes that a famous or important person (like an actor or politician) is in love with him or her, often resulting in stalking behavior.

Grandiose

Rooted in the French term "grande," grandiosity refers to an exaggerated sense of one's power, talent, knowledge, identity, or importance—and without any evidence. This may cause a person to treat others who are "inferior" with disdain or contempt.

Persecutory

A person with persecutory delusions believes others are out to harm him or her, despite evidence to the contrary. This may include a belief that he or she is being followed or spied on, drugged, slandered, or somehow mistreated.

Somatic

A person with somatic delusions has central themes involving bodily functions or sensations.

Referential

A belief that gestures, comments, or other cues have special meaning directed at oneself. Delusions can be bizarre, such as the belief that one's organs have been removed by aliens, or non-bizarre, such as believing one is under surveillance by the police.

Disorganized Thinking

Disorganized thinking can be extremely frustrating, making it nearly impossible for people with schizophrenia to keep their thoughts straight or express what's on their minds. This positive symptom causes a series of disjointed thoughts, making it hard to follow or make sense of what a loved one with schizophrenia is trying to say.

At times, the language structure is completely lost and the process of thinking may come to a complete, sudden stop (known as thought blocking).

Types of Disorganized Thinking

  • Derailment: shifting topics mid-sentence, before completing original thought
  • Circumstantial thinking: talking in circles, adding unnecessary details and never getting to the point
  • Tangential thinking: answers are unrelated to the questions
  • Loose associations: illogical thinking, or disconnected thoughts
  • Clang associations: choosing words for sound (rhyming or pun associations) rather than meaning
  • Incoherence ("word salad"): no discernible connection between words

Abnormal Motor Behavior

Another positive symptom of schizophrenia is disorganized or abnormal movements or motor behaviors. An example of this is catatonic behavior, which involves a decreased reactivity to the environment.

Treatment

Treating the positive symptoms of schizophrenia ideally involves a multidisciplinary approach that includes psychiatric medication, psychological treatment, and social support.

Psychiatric Medication

Antipsychotic medications are the mainstay of treatment for positive symptoms. These include first generation or "typical" antipsychotics, including Haldol (haloperidol) and Thorazine (chlorpromazine) and second generation or "atypical" antipsychotics such as Ability (aripiprazole), Clozaril (clozapine), or INVEGA (paliperidone)

Psychological Treatment

When combined with the proper medication, therapy is a crucial part of treatment for people with schizophrenia as well as their family members. There are various types of therapies that can help you or someone you love better understand and cope with positive symptoms, including:

  • Cognitive behavioral therapy (CBT): provides a sense of empowerment and strategies to help regulate your thoughts, emotions, and behaviors
  • Family therapy: helps navigate challenges together and communicate each other's needs
  • Group therapy: prevents isolation and provides a safe space to share challenges and fears
  • Social skills training: helps navigate interpersonal dynamics in your family, social, and work lives

Social Support

With schizophrenia, you will need a good support system in place to be on the lookout for behavioral changes or signs of relapse; it's tough to notice these symptoms in yourself. This can include trusted friends and family members, peers, doctors or social workers, or coworkers or schoolmates who want to help you feel good and function at your best.

In addition to joining a local or online support group, people with schizophrenia may want to consider community housing and/or group homes, which can provide high-quality care in a safe environment. Of course, this is an individual decision best made with guidance from your family, mental health professional.

A Word From Verywell

Schizophrenia can be extremely isolating, especially when positive symptoms prevent you from organizing and communicating your thoughts or cause you to see, hear, and believe things no else does. Remember, you are not alone. Taking the time to find the right medication, therapy, and support can help you cope with your symptoms and gain better control of your life.

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