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Schizophrenia

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Schizophrenia- A group of disorders characterized by loss of contact with reality, marked disturbances of thought and perception, and bizarre behavior. At some phase delusions or hallucinations almost always occur.

Schizophrenia is among the most debilitating and complex of the psychoses. Approximately 1% of the world population is afflicted with this mental illness.

"Emil Kraeplin first identified the illness in 1896 when he distinguished it from the mood disorders. Kraeplin believed that all psychiatric disorders were caused by organic factors, and his experience suggested to him that the onset of the disease occurred early in the life of the individual. Hence, he called it dementia praecox, which means a premature deterioration of the brain." 

Emil's thoughts were later disputed by many psychiatrists. One of these was Eugene Bleuler, an eminent Swiss psychiatrist, who, in 1911 found that the onset of the disease could in fact occur in the later years. He also reported that schizophrenia was not characterized by the progressive deterioration over the life of the patient, but rather that most patients, after an original severe deterioration, tend to stabilize and remain at the same point in their psychosis for extended periods of time. Bleuler also felt that in order to avoid any misunderstanding of the nature of the illness by the now obvious misnomer attached to it, the disease would be much better served if it was referred to as "schizophrenia." Bleuler invented the word by combining two Greek words meaning "split" and "mind." This emphasized a splitting apart of the patient's affective and cognitive functioning, which are heavily affected by the aforementioned disease.


Types

There are two types of schizophrenia accordingly enumerated Type I (Reactive or Acute Schizophrenia) and Type II (Process Schizophrenia) :

Reactive or Acute Schizophrenia: Reactive schizophrenia is usually sudden and seems to be a reaction to some life crisis. Since the premorbid history is usually good, when the disease does manifest itself, it is in the early phases. Reactive schizophrenia is a more treatable form of the illness than process or chronic schizophrenia.

Process Schizophrenia :  Also reffered to as poor premorbid schizophrenia, this type is characterized by lengthy periods of its development with a gradual deterioration and only exclusively negative symptoms. It doesn't seem to be related to any major life change or negative event. Usually this type of schizophrenia is associated with "loners" who are rejected by society and tend to not develop social skills and don't excel out of high school.

Symptoms

Positive Symptoms of Schizophrenia
 
Positive Symptoms Negative Symptoms
  • Delusions
  • Hallucinations
  • Disorganized thinking
  • Agitation
  • Lack of drive or initiative
  • Social withdrawal
  • Apathy
  • Emotional unresponsiveness

Delusions are firmly held erroneous beliefs due to distortions or exaggerations of reasoning and/or misinterpretations of perceptions or experiences. Delusions of being followed or watched are common, as are beliefs that comments, radio or TV programs, etc., are directing special messages directly to him/her.

Hallucinations are distortions or exaggerations of perception in any of the senses, although auditory hallucinations (“hearing voices” within, distinct from one’s own thoughts) are the most common, followed by visual hallucinations.

Disorganized speech/thinking, also described as “thought disorder” or “loosening of associations,” is a key aspect of schizophrenia. Disorganized thinking is usually assessed primarily based on the person’s speech. Therefore, tangential, loosely associated, or incoherent speech severe enough to substantially impair effective communication is used as an indicator of thought disorder by the DSM-IV.

Grossly disorganized behavior includes difficulty in goal-directed behavior (leading to difficulties in activities in daily living), unpredictable agitation or silliness, social disinhibition, or behaviors that are bizarre to onlookers. Their purposelessness distinguishes them from unusual behavior prompted by delusional beliefs.

Catatonic behaviors are characterized by a marked decrease in reaction to the immediate surrounding environment, sometimes taking the form of motionless and apparent unawareness, rigid or bizarre postures, or aimless excess motor activity.

Other symptoms sometimes present in schizophrenia but not often enough to be definitional alone include affect inappropriate to the situation or stimuli, unusual motor behavior (pacing, rocking), depersonalization, derealization, and somatic preoccupations.

Negative Symptoms of Schizophrenia
Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact, and body language.

Alogia, or poverty of speech, is the lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts, and often manifested as laconic, empty replies to questions.

Avolition is the reduction, difficulty, or inability to initiate and persist in goal-directed behavior; it is often mistaken for apparent disinterest

 
The positive symptoms are things like bizarre behavior, hallucinations, or delusions. Negative symptoms refer to the absence of any adjustive behavior in the important areas of life, a chronic maladaptiveness, flatness of effect, and absence of developed interpersonal relationships (social skills).

Paranoid versus non-paranoid  - These symptoms are more easily defined, as the presence of heavily paranoid behavior or the absence thereof. The presence of paranoid symptoms early in the disease apparently suggest a good prognosis. There is a relationship between reactive schizophrenia and paranoid thinking.

Content of thought - The principal disturbance in the schizophrenic's thought processes is multiple delusions. This is divided into two sub-categories, persecutory delusions (in which the schizophrenic believes that he/she is being talked about, spied upon, or their death being planned) and delusions of reference (which is when the schizophrenic gives personal importance to completely unrelated incidents, objects, or people. Others include common delusions which primarily includes thought broadcasting (they believe their thoughts are visible to the outside world) and thought insertion, which is what most people perceive schizophrenia as consisting of (their thoughts are not their own and are in truth being inserted into their minds by some outside force. Other delusions such as believing is jesus may appear in extreme cases.

Form of thought - Either schizophrenics express their thoughts in a loose manner, where ideas shift from one subject to another with seemingly no purpose, or "poverty of content," where communication is so vague, abstract, or repetitive, that it is meaningless to the listener. Made up words, or illogically stringed together phrases, may appear in writing or speech as well.

Perception  - As we well know, the perception of the world is distorted in the experience of a schizophrenic. This may occur with any of the afflicted's senses, but most often appear as auditory, with voices in the patients head or commands from high authorities which are obeyed at high risk to others or the patient themselves. Visual hallucinations happen less often. This symptom is easiest described as an excessive lack of corellation between what an individual is saying and what emotion they are expressing (i.e. recounting an experience of serious horror while chuckling).

Volition - Simply the occurence of paralyzation on the patient's will to act out on a decision by their ambivalence.

Sense of self - Schizophrenics generally are not aware of their individuality to an extent that they maintain a perplexity about who they are.

Relationship to the external world -Although obvious, most schizophrenics are so preoccupied with the effects of their illness, that they tend to be unavailable to others, which is reffered to as autism. They don't notice the world that is happening before them.

Different Types of Schizophrenia:

Paranoid schizophrenia a person feels extremely suspicious, persecuted, grandiose, or experiences a combination of these emotions.

Disorganized schizophrenia a person is often incoherent but may not have delusions.

Catatonic schizophrenia a person is withdrawn, mute, negative and often assumes very unusual postures.

Residual schizophrenia a person is no longer delusion or hallucinating, but has no motivation or interest in life. These symptoms can be most devastating.

Undifferentiated Schizophrenia - Used when the patient's symptoms clearly point to schizophrenia but are so clouded in that classification into the different types of schizophrenia is very difficult.

 

Schizophreniform Disorder - Best understood as a schizophrenic disorder that has lasted for more than two weeks but less than six months. A less serious diagnosis, as it has a likelyhood for the patient to return to a normal citizen of society.

 

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