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Recognizing Schizophrenic Symptoms in People With Depression

Posted on November 18, 2021
Medically reviewed by
Paul Ballas, D.O.
Article written by
Brooke Dulka, Ph.D.

  • Symptoms of schizophrenia can overlap with symptoms of mood disorders, such as depression or bipolar disorder, which can complicate diagnosis.
  • People who are initially believed to have major depression may sometimes have their diagnosis changed to bipolar disorder, schizophrenia, or schizoaffective disorder after further evaluation.
  • Openly communicating with your health care team about the symptoms you — or a loved one — experience is the best way to reach an accurate diagnosis and treatment plan.

Schizophrenia and schizoaffective disorder are disorders of psychosis best known for symptoms of hallucinations and delusions. Symptoms of schizophrenia spectrum disorders can sometimes overlap with symptoms of depression. People with schizoaffective disorder may also experience mood swings (between mania and depression) or periods of depression.

It can be difficult to identify schizophrenic symptoms in people with depression. However, it is important to be aware of the different types of schizophrenic symptoms. If you recognize them in a loved one or yourself, a proper diagnosis and treatment can be sought.

What Are the Positive Symptoms of Schizophrenia?

Schizophrenic symptoms can be divided into three categories: positive, negative, and cognitive. Also called “psychotic symptoms,” positive symptoms add something to a person’s perception of reality — like seeing or hearing something that isn’t actually there. Positive symptoms are the symptoms people tend to associate most closely with schizophrenia, but they can be difficult to recognize. They include hallucinations, delusions, and thought disorder.

Hallucinations

A hallucination is when a person hears (auditory), sees (visual), smells (olfactory), or feels (tactile) something that isn’t actually there.

  • Auditory hallucinations are the most common type of hallucination. Typically, auditory hallucinations involve one or more voices that may tell the hallucinating person things to do. People may also hear other sounds, like whispering.
  • Visual hallucinations involve seeing people, objects, or lights that aren’t really there.
  • Olfactory hallucinations can involve tastes that don’t relate to anything being consumed. They can be hallucinations of good or bad tastes.
  • With tactile hallucinations, a person might feel as if things are crawling across their skin or inside of them.

Hallucinations can occur during schizophrenia, schizoaffective disorder, and other mental health disorders, such as bipolar disorder and depression. Hallucinations can also be a symptom of Parkinson’s disease. People under the influence of drugs or alcohol can hallucinate as well.

Delusions

Delusions are a common psychotic symptom of schizophrenia. Delusions are beliefs that conflict with reality. Delusions tend to fall into one of several types, including persecutory, grandiose, somatic, or erotomanic.

  • Persecutory delusions are beliefs that a person, a group of people, or an organization are out to get you.
  • Grandiose delusions are beliefs that involve an inflated sense of self-importance, such as believing one has special abilities or superpowers.
  • Somatic delusions are beliefs that something is wrong with one’s body.
  • Erotomanic delusions are delusions of love. People with erotomanic delusions usually believe someone in a position of power (such as a celebrity) is in love with them.

Delusions can also occur as a component of many mental illnesses, including mood disorders like depression and bipolar disorder. Like hallucinations, they can occur in people with Parkinson’s disease.

Thought Disorder

Thought disorder, called disorganized speech in the Diagnostic and Statistical Manual of Mental Disorders, refers to speech- and thought-related symptoms. Signs of impaired reasoning or talking may involve a person switching from topic to topic, giving answers that aren’t relevant to the question asked, or expressing what’s known as “word salad.” Word salad is when words are combined in ways that don’t linguistically make sense. Although less common, thought disorder has also been noted in cases of severe depression.

What Are the Negative Symptoms of Schizophrenia?

Negative schizophrenic symptoms are symptoms that describe typical, normal behaviors which are now absent. Negative symptoms are actually considered to have a greater impact on schizophrenic individuals’ functioning than positive symptoms. There are several types of negative symptoms:

  • Blunted affect or flat affect is when someone doesn’t display emotions, including reduced facial expressions, gestures, and vocal expressions.
  • Alogia (or poverty in speech) is a reduction in the overall number of words spoken.
  • Avolition refers to reduced goal-directed activity due to decreased motivation.
  • Asociality (social withdrawal) is when a person doesn’t engage in the relationships and activities they used to.
  • Anhedonia refers to a reduced experience of pleasure. In other words, activities once found to be fun now bring the person little joy.

Negative symptoms aren’t limited to schizophrenia and schizoaffective disorder. Many of these symptoms also overlap with mood disorders, such as depression and bipolar disorder.

Could It Be Bipolar Disorder?

Because there are many shared symptoms between schizophrenic spectrum disorders and mood disorders, it can be difficult to discern the correct diagnosis. Therefore, it is helpful to understand what distinguishes psychotic disorders and mood disorders.

The key difference is that a schizophrenia diagnosis requires the presence of delusions, hallucinations, or disorganized speech without simultaneous manic or depressive episodes. If mood disorders do happen during schizophrenia, they will be present for only a small part of the total episode of schizophrenia. People with bipolar disorder can also experience psychotic episodes, but they occur during a manic episode.

Sometimes, people may be initially diagnosed with major depression only for a doctor to later realize that it could be bipolar disorder, schizophrenia, or schizoaffective disorder. Someone with depression may be prescribed antipsychotics. Individuals who are initially diagnosed with either depression or schizophrenia may end up with a diagnosis of schizoaffective disorder, depending on how their symptoms present themselves. These conditions overlap so readily, in part, because they share some risk factors. Stress or abuse are risk factors for these conditions.

Researchers are testing ways to diagnose schizophrenia versus a mood disorder based on functional magnetic resonance imaging of the brain. Tests like this may one day be used more frequently in the clinic to make a diagnosis.

Only a psychiatrist, clinical psychologist, or other qualified mental health professional can make an official diagnosis of schizophrenia or schizoaffective disorder. However, understanding your own symptoms — or those of your loved one — can help your doctor find the most appropriate treatment. If you or a loved one are experiencing any of the symptoms described in this article, be sure to discuss them with your doctor.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 138,000 members come together to ask questions, give advice, and share their stories with others who understand life with depression, schizophrenia, and schizoaffective disorder.

Are you — or a loved one — experiencing symptoms of schizophrenia or mood disorders? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Schizophrenia — National Institute of Mental Health
  2. Schizoaffective Disorder — National Alliance on Mental Illness
  3. Schizophrenia — Mayo Clinic
  4. Hallucinations in Schizophrenia — Acta Psychiatrica Scandinavica
  5. Hallucinations in Bipolar Disorder: Characteristics and Comparison to Unipolar Depression and Schizophrenia — Bipolar Disorders
  6. Schizophrenia: The Characteristic Symptoms — Schizophrenia Bulletin
  7. Insight Into Illness in Patients With Mania, Mixed Mania, Bipolar Depression and Major Depression With Psychotic Features — Bipolar Disorders
  8. Definition and Description of Schizophrenia in the DSM-5 — Schizophrenia Research
  9. Thought Disorder in Depression — The American Journal of Psychiatry
  10. Negative Symptoms Have Greater Impact on Functioning Than Positive Symptoms in Schizophrenia: Analysis of CATIE Data — Schizophrenia Research
  11. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment — Neuropsychiatric Disease and Treatment
  12. Depression (Major Depressive Disorder) — Mayo Clinic
  13. Bipolar Disorder — Mayo Clinic
  14. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) — Psychiatry Online
  15. Antipsychotic Prescriptions Among Adults With Major Depressive Disorder in Office-Based Outpatient Settings: National Trends from 2006 to 2015 — The Journal of Clinical Psychiatry
  16. The Stress-Vulnerability Model; How Does Stress Impact on Mental Illness at the Level of the Brain … and What Are the Consequences? — European Psychiatry
  17. Individualized Differential Diagnosis of Schizophrenia and Mood Disorders Using Neuroanatomical Biomarkers — Brain
  18. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health: Table 3.22. DSM-IV to DSM-5 Schizophrenia Comparison — Substance Abuse and Mental Health Services Administration

Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance writer at MyHealthTeams. Learn more about her here.

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