- Mental Health
A Case Study of Undifferentiated Schizophrenia
A Case Study in Undifferentiated Schizophrenia
According to the DSM-IV-TR in order to diagnose schizophrenia, a person must exhibit two of the following symptoms for at least one month: hallucinations, delusions, catatonic disorganized or grossly disorganized behavior, disorganized speech and/or negative symptoms such as affective flattening, alogia, a decrease in speech or avolition, the lack of motivation (Meyer, Chapman & Weaver, 2009). If the hallucinations involve a running commentary of the individuals behavior or two or more voices conversing or if the delusions are bizarre, then only one symptom is needed to diagnose schizophrenia. Although the symptoms must be present for only one month, signs of the disorder must last at least six months.
There are five subtypes of schizophrenia listed in the DSM-IV-TR: paranoid, disorganized, catatonic, undifferentiated and residual. The paranoid subtype is usually the less severe, and which the predominant symptoms are delusions or auditory hallucinations. The disorganized subtype is the most severe with markedly disorganized speech, a flat affect and disorganized behavior. In the catatonic subtype, the person is afflicted with strange psychomotoric symptoms such as rigid physical immobility and unresponsiveness. A person afflicted with catatonic schizophrenia may also exhibit extreme behavioral agitation, muteness. In the residual subtype, a person has met the diagnostic criteria of schizophrenia in the past, and there is ongoing evidence of the disorder but there is a lack of current psychotic symptoms. The final subtype is undifferentiated schizophrenia. In this subtype, a person meets the general criteria for schizophrenia, but does not fit into any of the four categories, than the subtype of undifferentiated schizophrenia applies.
In the following case study, Sally is an example of undifferentiated schizophrenia subtype. She exhibits characteristics of catatonic, paranoid and disorganized schizophrenia, but does not conform to any of the three subtypes completely. This case study was taken from Chapter 6 of Case Studies in Abnormal Behavior written by Robert Meyer, Kevin Chapman and Christopher Weaver.
Sally’s mother was a two pack a day smoker when she was pregnant with Sally. There are significant findings in research that prenatal health and development play a large role in the cause of schizophrenia. Sally’s mother’s smoking habits may have contributed to Sally’s mental health issues. According to the Center for Disease Control (CDC) maternal smoking can cause problems with placenta, which is the source of the baby’s food and oxygen during pregnancy. This could lead to the baby to suffer from a lack of oxygen or anoxia, which will lead to a buildup of carbon dioxide in the blood and tissues of the fetus. This buildup of carbon dioxide could lead to a metabolic condition that could result in some tissue damage. This in turn can lead to neurological disorders or chemical imbalances in the brain (Meyer, Chapman & Weaver, 2009).
An even more important biological component to Sally’s schizophrenia is the severe bout of the flu, which Sally’s mother had in her fifth month of pregnancy. According to that National Institute on Mental Health (NIMH), a factor that contributes to schizophrenia is exposure to viruses or malnutrition during birth. Research studies show that trauma from a virus or from malnutrition, especially in the second trimester, interrupts the migration of cells to the neural subplate which is responsible for directing neurons to their proper location in the cerebral cortex (Meyer, Chapman & Weaver, 2009). Therefore any interruption of in the process may be possibly problematic for the developing fetus.
Another biological component of schizophrenia is genetics. Family history is one of the best clues regarding mental health. Schizophrenia tends to run in families, and family history may be an indicator in mental illnesses. Research indicates that if an individual has a family member with bipolar disorder, they have a 10 percent chance of being diagnosed with a mood disorder, such as bipolar disorder (Gershon et al., 1982). There is a 15 times greater chance of developing schizophrenia when a blood relation is a schizophrenic (Meyer, Chapman & Weaver, 2009) In Sally’s case, her “eccentric “grandfather may have suffered from schizophrenia, since he developed a number of unique religious beliefs and placed unusual mechanisms on the roofs of his barns in order to help his livestock grow. But unfortunately he was never formally diagnosed since he thought mental health professionals were “nuts”.
Family disorder or psychological conflict can also be an integral component in the development of schizophrenia. Although it may not be a cause of schizophrenia, family disorder and psychological conflict can exacerbate the symptoms of schizophrenia. Research indicates that two environmental factors contribute to schizophrenia: interfamilial expressed emotion and communication deviance (Meyer, Chapman & Weaver, 2009). Both these factors can be found in Sally’s case history. Sally’s mother was over involved and over protective of Sally, while her father was over critical (expressed emotion). Sally’s history also showed communication deviance, the degree to which an individual is not capable of establishing and maintaining a collective focus of attention with another person while in a conversation (Meyer, Chapman & Weaver, 2009).
Theorists have developed a number of different ideas about the function that cognitive processes play in schizophrenia (Hansell & Damour, 2008). Some theorists focus on attentional processes. Some symptoms of schizophrenia may be related to a problem of overattention, in which individuals with schizophrenia are unable to filter out irrelevant stimuli. This may result in positive symptoms of schizophrenia such has hallucinations and delusions.
Sally’s case file does not mention many of the positive symptoms such as delusions or hallucinations; Sally’s case file is full of examples of negative symptoms. Researchers believe that these negative symptoms are related to a problem of underattention to important stimuli. Studies have shown that individuals with prominent negative symptoms do not have a normal orienting response to novel stimuli (Hansell & Damour, 2008). On one occasion, Sally was found in her dorm room in a catatonic state, staring at the floor, not responding to any stimuli, which prompted her first hospitalization. Although she improved quite rapidly and was discharged, she became more and more reclusive when she returned to school, so much so that her mother dismissed her from college so she could take care of Sally at home. Sally declined rapidly to the point where she was exhibiting signs of totally unresponsive behavior.
Behavioral theorists concentrate on the role that learning plays in abnormal behavior. According to this perspective, an individual will need to learn different adaptive behaviors that will in turn lessen some of the problems such as social withdrawal that schizophrenics undergo. Behaviorists center their focus on biological causes of maladaptive learning and stress the reinforcement of new behaviors that help the person reshape their cognitive outlook (Frey, 2003). In Sally’s case, her mother’s unusually close attachment may have played a role in Sally’s symptoms of schizophrenia. Sally did not have many close friends as a child, and if she did start to form a relationship with someone, her mother’s overprotectiveness would drive people away. Because of the lack of interpersonal relationships and social activities Sally developed even more odd interests and mannerisms. These in turn pushed her further away from being socially acceptable. It was a never ending circle. Her mannerisms, odd interests and mother’s overprotection kept Sally from developing friendships, which in turn reinforced her withdrawal from social activities.
Through Sally’s case history, she showed different aspects of the different subtypes of schizophrenia, but she did not fit into any of the three major subtypes: paranoid, catatonic or disorganized and since she still exhibits current psychotic symptoms, Sally would be classified as undifferentiated schizophrenia.
A total cure of schizophrenia is rare, but many individuals can be returned to a level of at least adequate functioning in their jobs and communities, but a multidisciplinary approach is needed. Prescribing of psychotropic medication is necessary in most cases, but there are drawbacks to these medications, including severe side effects and dosage issues. Group psychotherapy is also employed especially with family members as it helps reduce possible excessive expressed emotion, and helps keeping the patient on a regular medication schedule. A crucial step in treatment is making an effective transition back into the family and community.
When it comes to Sally’s treatment, her mother’s intrusions in her first two hospitalizations set her back. On her third hospitalization, Sally was prescribed psychotropic medications which did help with some of her symptoms, but failed to help her with the disturbances in her thinking and attention. She was eventually released from the hospital to live back with her mother. She did continue outpatient therapy, but little progress was made. Sally’s symptoms became varied although not as obvious as her first symptoms and there were many relapses. Sally was eventually re-hospitalized, and the prognosis for any significant cure was poor. It is likely that Sally will continue the pattern of going in and out of hospitals, struggling with her symptoms.
Center for Disease Control (CDC). (2011). Tobacco use & prenatal health. Retrieved from http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/
Frey, R. J. (2003). Schizophrenia. Gale Encyclopedia of Mental Disorders. Retrieved from http://www.ask.com/health/galecontent/schizophrenia-7/2
Gershon E.S., Hamovit J., Guroff J.J., Dibble E., Leckman J.F., Sceery W., Targum S.D., Nurnberger J.I. Jr, Goldin L.R., Bunney W.E. Jr. A family study of schizoaffective, bipolar I, bipolar II, unipolar, and normal control probands. Arch Gen Psychiatry. 1982 Oct: 39(10):1157-67. PMID: 7125846.
Hansell, J. & Damour, L. (2008). Abnormal psychology (2nd ed.). Hoboken, NJ: Wiley.
Meyer, R. G., Chapman, K., & Weaver, C. M. (2009). Case Studies in Abnormal Behavior (8th ed.). Boston, MA: Pearson Education.
National Institute of Mental Health (NIMH). (2010). Schizophrenia. Retrieved from http://www.nimh.nih.gov/health/publications/schizophrenia-easy-to-read/schizophrenia-easy-to-read.shtml#What%20causes%20schizophrenia?