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Psychiatry & Psychotherapy Podcast

May 27, 2019

Clinical manifestations

Many people worry that they have schizophrenia. I receive messages or inquires often of people asking about symptoms and manifestations. If you have those types of questions, or if you’re a mental health professional who needs to brush up on symptoms and medications, this article should help you.

There are many clinical observations of how schizophrenia presents itself. Cognitive impairments usually precede the onset of the main symptoms[1], while social and occupational impairments follow those main symptoms.


Here are the main symptoms of schizophrenia:

Hallucinations: a perception of a sensory process in the absence of an external source. They can be auditory, visual, somatic, olfactory, or gustatory reactions.

Most common for men “you are gay”

Most common for women “you are a slut or whore”

Delusions: having a fixed, false belief. They can be bizarre or non-bizarre and their content can often be categorized as grandiose, paranoid, nihilistic, or erotomanic

Erotomania = an uncommon paranoid delusion that is typified by someone having the delusion that another person is infatuated with them.

This is a common symptom, approximately 80% of people with schizophrenia experience delusions.

Often we only see this from their changed behavior, they don’t tell us this directly.

Disorganization: present in both behavior and speech.

Speech disorganization can be described in the following ways:

Tangential speech – The person gets increasingly further off the topic without appropriately answering a question.

Circumstantial speech – The person will eventually answer a question, but in a markedly roundabout manner.

Derailment – The person suddenly switches topic without any logic or segue.

Neologisms – The creation of new, idiosyncratic words.

Word salad – Words are thrown together without any sensible meaning.

Verbigeration – Seemingly meaningless repetition of words, sentences, or associations

To note, the most commonly observed forms of abnormal speech are tangentiality and circumstantiality, while derailment, neologisms, and word salad are considered more severe.

Cognitive impairment:

Different processing speeds

Verbal learning and memory issues

Visual learning and memory issues

Reasoning/executive functioning (including attention and working memory) issues

Verbal comprehension problems

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