Skip to content 
Key Takeaways
- Positive does not mean good here. It means added, so these are experiences layered on top of normal thinking.
- Hearing voices is the most common form, and it feels completely real to the person, so arguing about it never works.
- Added symptoms respond to medication faster than the quiet ones, like flat mood and low drive.
- Waiting makes things harder. A long gap between first symptoms and first treatment leads to worse outcomes.
- Nothing you did as a parent caused this, and no single cause explains it in anyone.
A person you know begins talking about hearing a voice in the room next door, but no one is there. Perhaps it’s your brother, perhaps it’s your son, perhaps it’s you wondering if you should speak up.
Our guide will explore what the positive symptoms of schizophrenia are, how they are different from the negative symptoms, what hallucinations and delusions in schizophrenia might actually look like, why it’s so difficult to follow the flow of disorganized speech patterns, what causes these symptoms, and what treatments work best.
Nashville Mental Health
What Are the Positive Symptoms of Schizophrenia?
Positive here does NOT mean good and that is what fools everybody the first time they hear it. The positive symptoms are superimposed on normal ways of thinking; we’re not talking about things disappearing. The National Institute of Mental Health notes that people are usually diagnosed between the ages of 16 and 30, after a first episode of psychosis.
How Positive Symptoms Differ From Negative Symptoms
Once you know the difference between psychotic and negative symptoms, it is a big help to understand a lot of confusing behavior. One group adds experiences that were never there, and the other takes away things that used to be. The simplest way of separating them is demonstrated here.
| Positive Symptoms | Negative Symptoms |
| Hearing voices that no one else hears | Using fewer words or very few words |
| Believing things that are not true | Disinterest in others and activities |
| Speech that skips and is disconnected | A lack of emotions or a flat face and voice |
| Odd or frozen body movements | Demonstrates difficulties initiating or completing basic activities |
It’s the added symptoms that families are first to notice. The quieter ones are assumed to be lazy or in a bad mood, and this can continue for years.
Common Types of Positive Symptoms in Schizophrenia
Not all of these symptoms occur at the same time, and no two people have the same combination. Clinicians look for a fairly short list.
- Hallucinations – your sense of hearing, seeing, smelling, or feeling something that isn’t actually there.
- Delusions (beliefs which remain despite contrary evidence).
- Thought disorders and paranoia, when thinking becomes muddled, and when others are no longer safe.
- Catatonic symptoms of psychosis – in which a person may hold a single posture for several hours or fail to respond at all.
Hallucinations and Delusions in Schizophrenia
Two of the symptoms of schizophrenia are most commonly known to the general public, and these two are the ones that TV has got most wrong: hallucinations and delusions. Delusion is a belief that can’t be changed, and it may be that the neighbors are watching or that the food is poisoned. MedlinePlus health library has information on all of these symptoms in layman’s terms.
How Auditory and Visual Hallucinations Manifest
The most prevalent form is hearing voices. The voices may be commenting on what the person is doing, fighting with each other, or saying hurtful words all day, and it’s tiring to hold a job with that. Some see things as well, though that is less common, and some experience smells or sensations that are not actually present.
Disorganized Speech Patterns and Thought Disorders
When thinking doesn’t have a thread, disorganized speech patterns occur. Often, a sentence starts out right and then takes a turn in another direction (or a question is asked about dinner, and then one describes a car from 10 years ago). It does not feel difficult from the inside, because the words sound connected to the person speaking. Only the listener hears the break.
Recognizing Fragmented Communication in Daily Conversations
You’ll know this before everyone does, at a clinic, at the kitchen table. The ideas lack order and do not flow from one to the next; use of unfamiliar words that are not used by others, and a sentence may simply come to a halt without any conclusion. Others have one word or one phrase that they repeat over and over.
What Causes Positive Schizophrenia Symptoms?
Every family asks the same thing: why did this happen? There is no single answer, and no one cause explains it in any one person. Genes play a part, and so do complications at birth, heavy cannabis use in the teenage years, and long stretches of serious stress.
Brain Chemistry Imbalances and Neurotransmitter Dysfunction
The most popular theory is that the brain uses a neurotransmitter called dopamine to signal what’s important. If there’s excess dopamine in one of those pathways, everyday occurrences can feel like they’re taking on significance, like a passing car or a word that you hear on the street is somehow targeting you. Another messenger, glutamate, appears to be involved as well, and it is through this chemistry that drugs work.
Nashville Mental Health
Treatment Approaches for Managing Psychotic Symptoms
Management of the positive symptoms of schizophrenia typically involves a combination of medication, psychotherapy and social assistance; the earlier treatment is initiated, the more effective it will be. NIMH notes that there’s a significant lag time between when symptoms first appear and the first treatment, and that delay can impact health in the long term. Team-based care, also known as coordinated specialty care, is provided by a doctor, a therapist and a job or school counselor around one person rather than by the family piecing together the care.
How Antipsychotic Medication for Hallucinations Works
It is with this foray into abnormal dopamine activity that we see the principle of the effectiveness of antipsychotic drugs for hallucination: they work primarily by dampening that activity. It takes a few days or even weeks for some people to experience a change, and it may take some trial and error to determine which drug and dosage works best for them. It is important to discuss side effects with the prescriber as they are one of the common causes of stopping treatment and typically include the following: weight gain, drowsiness, and stiffness. The typical route back to a relapse occurs when someone stops abruptly.
Transform Your Life With Nashville Mental Health
Nashville Mental Health helps individuals with psychosis, and the families who want to help, from that initial odd encounter to the diagnosis, the medication regimen, the therapy, and the real-world work of getting to school, getting to work, or getting to a normal Tuesday. It doesn’t matter if you are not exactly right about what’s going on, and it doesn’t matter if you aren’t sure whether it is schizophrenia. This is the reason for an evaluation.
Call and schedule an appointment and discuss with a clinician what typically occurs next. Early support tends to make a real difference in how the following months go. If someone is in immediate danger, call 911. For urgent support any time, call or text 988.
Nashville Mental Health
FAQs
-
How do positive symptoms of schizophrenia differ from negative symptoms in treatment response?
Voices and fixed beliefs are usually improved by medicines and many people notice the added symptoms improve within weeks. The negative symptoms, like flat feeling and low drive, take much longer to improve and typically require therapy, skills work, and consistent support in addition to the medication.
-
Can antipsychotic medication for hallucinations reduce all types of psychotic symptoms?
It is most useful for most hallucinations, delusions, and tangled thinking, as these are also closely associated with dopamine activity. It isn’t very useful for low motivation or social isolation and isn’t always the entire picture.
-
What causes positive schizophrenia symptoms to worsen during stressful periods?
When we are stressed, we activate the same brain circuits that are overactive in the illness, and symptoms that were dormant may become more pronounced. The stress, coupled with lost sleep, drug or alcohol use, and skipped doses, can make a flare more likely.
-
Why do hallucinations and delusions in schizophrenia vary so much between individuals?
The brain constructs these experiences from what it already knows; this means that the culture, faith and the memories and worries of a person all influence the content. Completely different voices and beliefs can be heard by two people with the same diagnosis.
-
Which therapies work best alongside medication for managing positive symptoms of schizophrenia?
CBT for psychosis teaches the individual to challenge distressing beliefs and to learn to manage their voices without engaging with them. Family education and supported employment/schooling also clearly make a difference, particularly from an early age.
References
- National Institute of Mental Health. (2024). Schizophrenia. National Institutes of Health. https://www.nimh.nih.gov/health/topics/schizophrenia
- National Institute of Mental Health. Understanding psychosis. National Institutes of Health. https://www.nimh.nih.gov/health/publications/understanding-psychosis
- MedlinePlus. Schizophrenia. U.S. National Library of Medicine. https://medlineplus.gov/schizophrenia.html
