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Schizophrenia means you have problems with the way your brain works. This affects the way you see the world, and the way you think and feel.

There are three main types of symptoms that people get with schizophrenia. How often you get these symptoms varies a lot from person to person. The three types are:

• Losing touch with reality (a psychotic episode)
• Feeling withdrawn, isolated or emotionless (called negative symptoms)
• Having problems with your thinking and memory.

During a psychotic episode, you may have some of these symptoms:¹

• Beliefs that couldn't be true. These are called delusions. Delusions are beliefs that you hold very firmly, even when they don't stand up to reason. For example, you might believe someone is trying to poison you, or control your thoughts. Or you might believe you are very powerful and can control other people.
• Experiences no-one else shares. These are called hallucinations. You might hear voices inside your head, when there's nobody there. But hallucinations aren't just sounds: you might smell, see or feel things that are not really there.

These are the symptoms people are most likely to think of when you mention schizophrenia. They can be very frightening. But taking antipsychotics can usually bring these symptoms under control. When you lose touch with reality, you may find it hard to believe that your experiences are part of an illness.¹ Doctors call this a lack of insight.

For more information, see Psychotic symptoms.

People often think schizophrenia only means people hear voices or have delusions. But, some of the most upsetting symptoms can be when people don't feel or show any emotion. Doctors call these negative symptoms, because you're missing some of the emotions and behaviors that you used to have.

Here are some of the negative symptoms you can get with schizophrenia:¹

• Appearing to be in a very flat mood when you don't care about anything
• Not enjoying things that you used to enjoy
• Not showing any expression on your face
• Being unable to pay attention to anyone or anything.

If you have these symptoms, you may withdraw into yourself. You might sit still, doing and saying very little. If someone asks you a question, you might reply in just one or two words. You may lose all interest in work, hobbies or your friends. It is rare, but people with very bad negative symptoms can become totally withdrawn. They go into a sort of trance and can't react to anything that's going on. Doctors call this catatonia.

Unfortunately, antipsychotics don't work as well for negative symptoms as they do for hallucinations and delusions.²

Negative symptoms are not just caused by schizophrenia itself. They may be caused by other things that happen as a result of schizophrenia. They might happen because:²

• You're depressed
• You're frightened by hallucinations
• You're bored: for example, if you have to stay in the hospital and there isn't much to do.

It's important to understand that while antipsychotics don't work well for negative symptoms, there may be other things that can help. You may need treatment for depression. You may need reassurance and support if you are having hallucinations. And if you need to spend time in the hospital, doctors and nurses can make sure you have things to do so you don't get bored.

If you have schizophrenia, you may find it hard to think in an organized way. This can make it hard to concentrate, to speak to people or to solve problems. Here are some of the problems you can have if you have difficulties with your thinking and memory:

• Finding it hard to concentrate when you are reading or writing
• Finding it hard to learn new skills
• Having jumbled up speech that is hard for other people to follow. You might jump from one topic to another, making it hard for other people to follow what you're trying to say.
• Being very disorganized. This can make it hard for you to care for yourself. For example, you might not be able to cook a meal properly. You might dress in an odd or very scruffy way. Or you might not be able to wash and take care of how you look.

You are most likely to start getting symptoms of schizophrenia when you are in your mid-20s. You might have started getting symptoms gradually, over a period of weeks or months. Or you might have got symptoms suddenly.

The symptoms of schizophrenia can make life very difficult. You may find everyday tasks take much more effort than they did before. If you have schizophrenia, it's common to feel very anxious or to have angry outbursts. You may also find that you are thinking about death a lot, or even about committing suicide.³

The early signs of schizophrenia are usually the negative symptoms. You might:¹

• Become quiet when you're with people or spend most of the time alone
• Lose interest in work or studying
• Behave in a way that isn't normal for you: for example, getting angry and losing your temper
• Care less about how you look, so you don't wash or dress properly.

Of course, many young people go through times when they feel like that. So, if you or someone you know is acting like this, it doesn't necessarily mean they have schizophrenia. If someone is starting to get schizophrenia, they will probably also start to have beliefs that couldn't be true (delusions) or see, hear or feel things that aren't there (hallucinations) as well.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.