A 28-year-old man with a 3-year history of schizophrenia presents to the psychiatry outpatient clinic. On detailed examination, which of the following is the most common positive symptom observed in schizophrenia?

Explanation

## Most Common Positive Symptom in Schizophrenia **Key Point:** Auditory hallucinations, particularly second-person (addressing the patient) or third-person (discussing the patient) voices, are the most frequent positive symptom in schizophrenia, occurring in 60–80% of patients. ### Prevalence of Hallucinations in Schizophrenia | Type of Hallucination | Prevalence | Clinical Characteristics | |---|---|---| | Auditory | 60–80% | Most common; often voices commenting or conversing | | Visual | 20–30% | Less common; may coexist with auditory | | Olfactory | 5–10% | Rare; usually unpleasant odours | | Tactile | 5–10% | Rare; formication (insects crawling on skin) | **High-Yield:** Auditory hallucinations in schizophrenia are typically: - Second-person ("You are worthless") or third-person ("He is a spy") voices - Often experienced as distressing or commanding - Frequently accompanied by delusions of reference or persecution **Clinical Pearl:** Visual hallucinations, while less common in primary schizophrenia, are more prominent in organic psychoses (substance intoxication, delirium, dementia). Their presence should prompt investigation for medical/neurological causes. **Mnemonic — POSITIVE symptoms in schizophrenia (DH):** **D**elusions, **H**allucinations (auditory most common), **D**isorganized speech, **D**isorganized behaviour, **N**egative symptoms. Auditory hallucinations dominate the positive symptom cluster. ### Why Auditory Hallucinations Are Most Common 1. Dysfunction in Wernicke's area and superior temporal gyrus (language processing regions) 2. Abnormal activity in the default mode network 3. Hyperactivity of mesolimbic dopamine pathways affecting auditory processing centres [cite:DSM-5 Schizophrenia Spectrum and Other Psychotic Disorders]