Schizophrenia & Hallucinations - What you should know

What are schizophrenia hallucinations?

Hallucinations are one of the positive symptoms of schizophrenia, alongside delusions and thinking disorders ^[1]. Many people think of visual hallucinations when it comes to hallucinatory experiences, but there are many different types. Schizophrenia hallucinations occur when a person sees, hears, tastes, smells, or feels something that is not present. While these hallucinations do not represent reality, for a person with schizophrenia, they are vivid and real ^[2].

While different types of hallucinations can occur within any of the five senses, the most common type experienced in people with schizophrenia are auditory hallucinations. People often have the experience of “hearing voices” when they have schizophrenic hallucinations ^[2].

Are hallucinations the same as delusions?

Both hallucinations and delusions are considered positive or psychotic symptoms of schizophrenia, so people often wonder if they are the same symptom. It turns out that they are different symptoms. While hallucinations involve sensing things that are not present, delusions occur when a person has false beliefs that remain fixed, even when they are provided with evidence that the belief is not true. The most common delusions with schizophrenia are the belief that a person is being harmed or harassed ^[2].

Can you have schizophrenia without hallucinations?

Hallucinations are one of the symptoms of schizophrenia, but a person does not have to experience hallucinations to be diagnosed with this mental health disorder. The diagnostic criteria for schizophrenia state that to be diagnosed, a person must show two or more of the following symptoms ^[3]:

• Hallucinations
• Delusions
• Disorganized speech (this refers to incoherent speech)
• Disorganized or catatonic behavior
• Negative symptoms such as lack of emotions or loss of motivation 

The diagnostic criteria also stipulate that at least one of a person’s symptoms must be hallucinations, delusions, or disorganized speech. In other words, a person does not need to experience hallucinations to be diagnosed with schizophrenia. However, if they do not experience hallucinations, they must at least experience delusions or disorganized speech ^[3].

What causes hallucinations?

There is not one specific cause of hallucinations in schizophrenia, but psychiatric research has provided some explanation. Hallucinations are believed to be caused by abnormalities and heightened brain activity in the cerebral regions responsible for processing sensory information ^[4].  

Stress and abnormal activity associated with the brain chemical dopamine can also contribute to hallucinations in schizophrenia ^[4].

Beyond risk factors for schizophrenic hallucinations, some general risk factors that are associated with schizophrenia include genetic predisposition, as well as problems during pregnancy and childbirth (e.g., low birth weight, being born by caesarian section, and preeclampsia or gestational diabetes in the mother) ^[1].

How to treat hallucinations in patients with schizophrenia

Symptoms of psychosis, including hallucinations, are typically treated with antipsychotic drugs, which are administered orally in the acute stage of psychosis. Once symptoms are under control, a patient may be given a long-lasting injectable form of antipsychotics to prevent a relapse to hallucinations and other symptoms of psychosis ^[1].

Newer second-generation antipsychotics are generally recommended for the treatment of hallucinations. Drugs under this class include ^[1]:

• Aripiprazole
• Olanzapine
• Risperidone
• Quetiapine
• Asenapine
• Lurasidone
• Sertindole
• Ziprasidone
• Brexpiprazole
• Molindone
• Iloperidone 

While not the first choice for treating symptoms of psychosis, older first-generation antipsychotics may be used in some cases. This category includes trifluoperazine, fluphenazine, haloperidol, pimozide, sulpiride, flupentixol, and chlorpromazine ^[1].

Medication, therapy, and supportive services can help a patient integrate into the community and can reduce the risk of relapse. A specific form of therapy called CBT (cognitive behavioral therapy) can help patients with schizophrenia correct dysfunctional thinking patterns ^[1].

Other symptoms of schizophrenia

Hallucinations are not the only symptoms associated with schizophrenia. Some additional symptoms of this mental disorder include ^[5]:

• Delusions: These are irrational, untrue beliefs that a person with schizophrenia holds to be true, even when given evidence that the beliefs are false.
• Disorganized speech: Also labeled as being a “thought disorder,” disorganized speech occurs when a person with schizophrenia thinks in an illogical fashion. Because of the thought disorder, a person’s speech will become disorganized. They may make up words, jump from one topic to the next when speaking, or stop talking mid-sentence.
• Movement disorder: A movement disorder refers to the inability to move the body normally. A person with schizophrenia may repeat the same movement over and over, for no reason.
• Negative symptoms: Negative symptoms of schizophrenia include a lack of motivation, withdrawing socially, failingto show emotions, and lacking interest in daily activities. A person experiencing negative symptoms of schizophrenia may show limited facial expression or have very low energy levels. In extreme cases, they may become catatonic, which means they do not move or speak at all.
• Cognitive symptoms: These symptoms include problems with memory, thinking, and concentration.