29th January 2024

Positive symptoms

Positive symptoms are those that distort the perception of reality. These include:

• Hallucinations: These can affect any of the five senses (auditory, visual, olfactory, gustatory or tactile). Auditory hallucinations are the most common form in schizophrenia and seem to respond the most to antipsychotics. Often, they present as voices, but they can also be sounds. Olfactory, tactile and visual hallucinations are less common and are more likely to be associated with organic pathology, which requires further investigations.
• Delusions: This is defined as a fixed, false belief that is unexplained by cultural norms and that which is unshakeable in the face of strong contradiction. Delusions can be bizarre or non-bizarre. A bizarre delusion could be that an individual believes that they are a shaman that transports spirits across different realms, whereas a non-bizarre delusion may be that an individual believes that HMRC is spying on them for not paying their taxes. Delusions can be further categorised as:
  • Ideas of reference: Individual believes that there is a personal significance behind coincidental or innocuous events, e.g. certain words or songs on TV are relaying a message to the individual
  • Grandiose: Individual believes that they have some sort of special significance, skill or power; e.g. they believe that they are related to the Queen of England
  • Paranoid: Individual believes that they are vulnerable and being targeted. This often leads to forensic issues such as carrying weapons and unpredictable, violent behaviour. Alternatively, it may lead to self-isolation or ‘going off the grid.’ Paranoia can lead to significant issues with treatment compliance and poor contact with services due to fear of being manipulated or poisoned.
  • Nihilistic: Individual believes that they are dead, rotting or have lost their internal organs
  • Delusion of thought interference: Thought insertion, withdrawal, and broadcast
  • Delusions of passivity: Belief that an external source is controlling their body and mind
• Thought disorder: Individuals demonstrate disorganised thinking, which can be observed through abnormal behaviour, speech, and written language.
  • Thought blocking: disruption in the train of thought such that the individual suddenly stops midway through talking
  • Flight of ideas: rapid speech that digresses from one topic to another before completion
  • Tangential speech: digressing off-topic and never returning to the initial conversation
  • Circumstantial speech: Individual offers a lot of irrelevant details and wanders off topic, but eventually, they are able to answer the question in a ’roundabout’ way
  • Neologisms: Creation of new words
  • Word salad: a jumble of random, incoherent words