IT'S NOT JUST HEARING VOICES! THE SYMPTOMS THAT MAKE UP SCHIZOPHRENIA

The term "schizophrenic" is thrown around a lot, but it minimizes the scope of the illness. I have worked with patients with all sorts of combinations of the below symptoms, which are measured by a research scale called the Positive and Negative Symptom Scale (PANSS). P=positive N=negative G=general.
  1. P1. Delusions
    The key here is conviction: the patient not only believes s/he created the world, or controls people from afar, but knows for a fact that it is the truth. It is pretty powerful how much people can make their reality, however far fetched, seem valid.
  2. P2. Conceptual Disorganization
    Speaks A LOT and/or FAST (pressured speech) with irrelevancies and disconnected thoughts.
  3. P3. Hallucinatory Behavior
    auditory (hearing noises/voices), visual (distorted vision, seeing things that seem life-like that others don't see), olfactory (smelling unusual things that others cannot smell), tactile (such as feeling of bugs crawling on your skin, or someone consistently tapping you)
  4. P4. Excitement
    hyper-awareness, and over-arousal, such as affective discharges, inappropriate laughing outbursts, or inability to sit down for an extended period of time.
  5. P5. Grandiosity
    Unrealistic feelings of superiority, like having a superpower, receiving personal communication from the radio, or being recognizeable from the TV or newspaper
  6. P6. Suspiciousness/Persecution
    Does the person's distrust of people impair his or her interpersonal reactions, sleep, appetite, and daily functioning?
  7. P7. Hostility
    Is the patient easily irritable and frustrated? Does s/he get into fights often?
  8. N1. Blunted affect
    Does the patient show emotion or expression, in eyes/face, tone of voice, body language, etc.?
  9. N2. Emotional Withdrawal
    Does the patient go about everything in a mechanical and uninterested way? This was taught to me as the opposite of "zest for life"
  10. N3. Poor rapport
    Is the patient engaging or does s/he act mechanically, uninterested or sarcastic in his or her responses?
  11. N4. Passive/apathetic social withdrawal
    What is a typical week like for them socially? Are they spending most of their spare time alone? Is anyone else involved in their life?
  12. N5. Difficulty in Abstract Thinking
    The patient is asked to make a connection between 4 pairs of items, and interpret 4 phrases (eg: "how are a table and chair alike?" and "what does it mean when I say: it's as plain as the nose on your face")
  13. N6. Lack of Spontaneity and Flow of Conversation
    Markedly lacking productivity and fluidity in conversation, associated with avolition or apathy, or cognitive deficit
  14. N7. Stereotyped Thinking
    This has to do with being perseverative - do they keep coming back to a specific theme, issue or delusion?
  15. G1. Somatic concern
    How concerned is s/he about his or her bodily functions and to what degree is that concern valid from a health perspective? Is s/he seeking help to address these concerns, or is the patient spiraling in anxiety?
  16. G2. Anxiety
    How much does their feeling of worry and panic interfere with their daily functioning?
  17. G3. Guilt Feelings
    The patient exhibits concern over a past incident - real OR delusional - that s/he feels s/he deserves punishment for (sometimes self-inflicted, sometimes says the schizophrenia is his/her punishment). To assess severity, we ask how hard it is for the patient to get his/her attention off of the incident when it comes to mind.
  18. G4. Tension
    This relates to the specific physical manifestations of anxiety that you observe while interviewing the patient, such as tensing up, shaking, etc. If the patient denies anxiety, they cannot be rated on tension.
  19. G5. Mannerisms and Posturing
    Some patients have a tendency to sit in an usual position, or rock back and forth as they talk.
  20. G6. Depression
    Feelings of helplessness, pessimism and discouragement. Does it prevent the patient from social interaction, or have an impact on sleep and appetite? Self-neglect is an important aspect as well: how often does s/he change clothes, brush teeth, shower and do laundry?
  21. G7. Motor Retardation
    Some patients have markedly slow speech, and pause for many seconds before responding, while others exhibit slowness in movement.
  22. G8. Uncooperativeness
    Is the patient defensive and guarded during the interview or does s/he cooperate with the questions being asked? Keep in mind that this is used primarily in research, so the patient has made an informed decision to participate in the interview.
  23. G9. Unusual Thought Content
    Is the patient's thinking characterized by bizarre or fantastic ideas, that are distorted and illogical? For example, the patient may say s/he has hundreds of children, receives messages through a tooth filling,or has recently escaped from death row.
  24. G10. Disorientation
    Can the patient identify the time, date, location, his/her address and phone number, and name the president, governor and mayor?
  25. G11. Poor Attention
    To what extent is the patient distracted throughout the interview? Remember that this may relate to internal stimuli. Patients often have thought blocking, or ask you to repeat the question after many seconds of silence.
  26. G12. Lack of Judgment and Insight
    This is measured by asking the patient to name: his/her current location, doctors, the names and roles of some staff at his/her clinic or hospital, the president, governor and mayor, and his or her address and phone number.
  27. G13. Disturbance of volition
    This describes a patient who is highly indecisive in speech and/or movement. This includes Catatonia.
  28. G14. Poor Impulse Control
    Does the patient lose control? This is exhibited by sudden discharge of emotion without concern for consequences, such as responding to internal stimuli, or sexually offensive behavior.
  29. G15. Preoccupation
    Is the patient daydreaming or absorbed in autistic experiences that interfere with communication and functioning? This can also present as bringing a conversation back to egocentric themes, with little concern for other things/people.
  30. G16. Active Social Avoidance
    Does the patient avoid social involvements SPECIFICALLY due to unwarranted fear and hostility? Does s/he leave events early due to social anxiety or suspiciousness?