Symptoms
- Positive symptoms
- Delusions: false beliefs that are firmly and consistently held. May be deeply irrational, and lack insight. People often lack self awareness, most especially of asociality, delusions, reduced affect, hallucinations and thought disorders. Common delusions include:
- Delusions of grandeur
- Delusions of control (being controlled)
- Delusions of thought broadcasting
- Delusions of persecution (paranoid ideation)
- Delusions of reference (self is the centre)
- Delusions of thought withdrawal
- Capgras delusion: (rare) A significant other has been replaced by a doppelgänger.
- Delusions: false beliefs that are firmly and consistently held. May be deeply irrational, and lack insight. People often lack self awareness, most especially of asociality, delusions, reduced affect, hallucinations and thought disorders. Common delusions include:
- hallucinations:
- auditory (hearing voices is common, may be malicious, benevolent or both)
- visual
- olfactory
- tactile
- gustatory
- disordered thinking:
- Difficulty focusing on one topic,
- continuously shifting from topic to topic without a logical or meaningful connection between thoughts.
- May also struggle to grasp abstractions, like metaphors and figures of speech.
- miscategorization: overinclusiveness – seeing things as belonging together that most people would not put together.
- incoherent communication
- bizarre behavior
- Psychomotor abnormalities
- Catatonia:
- Lack of responsiveness to environment
- peculiar body movements and postures
- strange gestures and facial expressions
- Excited catatonia may include agitation, hyperactivity and uninhibited behavior – may become violent and dangerous
- Withdrawn catatonia: Long periods of non-responsive stupor, immobility, or mutism – can be life threatening if the person does not eat.
- Catatonia:
- negative symptoms: inability or reduced ability to act, communicate or enjoy life. Sometimes the major symptoms experienced are these ones. Associated with poor prognosis.
- avolition: unable to act or persistent in goal-directed behavior
- alogia: lack of meaningful speech
- asociality: lack of desire for relationships with others
- anhedonia: lack of pleasure
- diminished emotional expression: lack of facial expression, vocal intonations, and general emotional responsiveness
Diagnostic Criteria for Schizophrenia
At least 1 of the following:
- delusions
- hallucinations
- disorganized speech
And at least 2 of the following
- delusions
- hallucinations
- disorganized speech
- gross motor disturbances
- negative symptoms
There also needs to be a deterioration in ability to function
Symptoms must be present most of the time for a month or more, and must persist for at least 6 months if not treated.
3 Phases
Most typical course:
- Prodromal: The onset stage – there may be social withdrawal and isolation, neglect of personal grooming, inappropriate behavior, affect or communication during this time.
- Active: Full symptoms present.
- Residual: symptoms decline and the person may return to the prodromal phase.
Biological dimension
Multiple gene pathway rather than single genes. Tendency is inherited to a large extent. General population has a 1% prevalence. If you have a blood relative with schizophrenia, you have a 16% chance of developing the disorder.
Decreased cortical volume and increased ventricles (spaces) in the brain.
Abnormal neurotransmitters such as dopamine, serotonin, GABA , glutamate. It is possible that schizophrenia is associated with excessive dopamine in the brain, because
- antipsychotics block dopamine receptor sites
- L-dopa is a drug for Parkinson’s that increases dopamine, and can trigger schizophrenic symptoms.
- Amphetamines increase dopamine availability. They can trigger schizophrenic-like symptoms in users, and trigger worse symptoms in people with schizophrenia.
Using cocaine, amphetamines, alcohol, LSD and cannabis in particular increase the chances of developing a psychotic disorder.
Around pregnancy and childbirth, risk factors include head trauma, a difficult birth and prenatal infections.
Psychological Dimension
A certain level of social disconnection – lack of empathy and a focus on one’s own thoughts and feelings, seem to increase a person’s vulnerability to developing schizophrenia.
Early cognitive deficits also seem to be correlated with later development of schizophrenia and related disorders.
Negative expectancy appraisals may be associated with the negative symptoms of schizophrenia.
Social Dimension
Childhood trauma increases the risk of developing schizophrenia, especially bullying and maltreatment from peers or caregivers.
Expressed emotion is a negative family communication pattern that increases the relapse rate for people with schizophrenia amongst some cultures but not in others.
Sociocultural Dimension
Prevalence is possible correlated with discrimination, because it is higher amongst, immigrant groups -especially African people in Europe and also amongst African-Americans. But this may be due to bias amongst the diagnosticians.
Also correlates with poverty.
The Recovery Model
A collaborative and optimistic approach to recovery for people living with schizophrenia:
- improvement is possible (Significantly true for about 40% of all people diagnosed with Schizophrenic Disorders.)
- You are not your disorder
- You can find ways to cope with symptoms
- empowerment helps to correct the sense of hopelessness and dependence which comes with traditional diagnosis and treatment
- Establish or strengthen social connections to support healing
- Cultivate and discover themes of hope, optimism, self-determination, self-respect, happiness and engagement in life to change your experience of your life and your identity for the better.
Treatment
Antipsychotic medication
The newer atypical antipsychotics have less Parkinsonian side effects, but have other side effects and may be less effective.
Both conventional and atypical antipsychotics seem to help with the positive symptoms, such as hallucinations, but less for the negative ones.
They also do not help everyone.
A lot of people (50 – 75%) stop taking their medication, mainly because of the side effects – 80%
Others believe they don’t need the medication – 58%. There is about 30% who stop taking the meds due to mistrust of the mainstream medical system/practitioner, and 20% because others advised them to stop.
Side effects of antipsychotics
The side effects of long term use of conventional anti-psychotics are around 90% prevalent over the long term, and some are permanent and life-threatening.
They include:
- extra-pyramidal symptoms:
- Parkinsonism (tremors, shakiness, immobility)
- dystonia (slow and continued involuntary movements of the limbs and tongue)
- akathisia (motor restlessness)
- neuroleptic malignant syndrome (potentially fatal autonomic instability and muscle rigidity)
- loss of facial expression, shuffling gait, tremors, rigidity, loss of balance.
- Increased risk of metabolic syndrome
Cognitive behavioral therapy can help people
- develop coping skills,
- a safe space where clients can engange with their symptoms and stressors,
- help assessing and identifying negative beliefs
- and helpful and unhelpful responses to symptoms,
- normalization of symptoms can help
- collaborative analysis of symptoms and beliefs that go with them
- for example, clients can learn to disregard hostile and threatening voices
Family interventions
Family support and acceptance makes or breaks the situation for many people with schizophrenic disorders.
In order to facilitate this intervention programs can help with families that have good communication patterns as well as families that do not.
- normalizing
- demonstrating concern, empathy and sympathy for all family members
- educating about schizophrenia
- avoiding blame or pathologizing the families coping styles
- identifying strengths and competencies
- developing problem-solving skills and stress management
- teaching coping strategies for coping with the symptoms and how they affect the family
- strengthen the communication skills of all family members.
Other schizophrenia spectrum disorders
- Delusional disorder – delusions for up to a month
- Brief psychotic disorder – delusions, hallucinations and/or disordered speech for 1 day to 1 month
- schizophreniform disorder – 2 or more symptoms for 1 to 6 months
- schizoaffective disorder
Delusional Disorder
Persistent delusions for at least one month without other unusual or odd behaviors.
Quite rare, and people may not seek help, because apart from the delusions, they can live quite normally.
Common delusions may include:
- erotomania – believing someone is in love with you (affects women more than men)
- grandiosity – believing one is a great person of great significance
- Jealousy – believing your partner is cheating on you
- persecution – believing others are plotting against you (affects men more than women).
- somatic complaints – believing you smell bad, are deformed or infected with disease or parasites
- Nihlistic – Belief that a major catastrophe will occur.
- Referential – believing that things that are happening around you are about you -eg gossip, coincidences etc
- Religious – believing you are Jesus etc
- Loss of control – Belief of loss of control over mind or body/being manipulated by others, and includes thought withdrawal/insertion/control.
Brief Psychotic Disorder
Delusions, hallucinations and/or disordered speech for 1 day to 1 month – no longer. May possibly include other psychotic symptoms as well.
May be triggered by pregnancy or for up to a month after childbirth.
Often abrupt and distressing, requiring hospitalization. May be triggered by sudden or cumulative stressors.
10% of all psychotic symptoms are due to this disorder, and it is twice as common in women.
Schizophreniform Disorder
Delusions, hallucinations and/or disordered speech for 1 to 6 months. There must be 2 or more symptoms which may also include gross motor disturbances or negative symptoms.
Occurs equally in both men and women
One third of people recover. Especially likely if
- the onset is sudden,
- they were doing well before the onset,
- and there are no negative symptoms.
Two thirds go on to develop schizophrenia.
Schizoaffective Disorder
Schizophrenia in conjunction with major depression/ bipolar symptoms. To get a positive diagnosis, the schizophrenic symptoms must persist even when the manic/ depressive symptoms are not present for at two weeks.
Quite rare, and more prevalent in women.
