All You Need to Know About Schizophrenia
Diagnosis of Schizophrenia
In order to meet the criteria for the diagnosis, the symptoms must have been present for a six month period or longer, with at least one month of active symptoms.
- Disorganized speech
- Disorganized behavior
- Negative Symptoms
Delusions are related to thought. However, they’re specifically related to the content of thought i.e. content and form. Delusions involve people having a false belief, so the content of their thought is inaccurate or false. There are several different types of delusions. Two examples are delusions of persecution, and delusions of grandeur.
Delusions of persecution have a paranoid flavor to them, with a theme of others being out to get you. Grandeur Delusion is where someone believes that they possess qualities or attributes that make them superior to other people – for instance, money, fame, talent, intelligence or perhaps a special relationship with someone in a position of power.
Disorganized speech: this symptom reflects a disturbance in the form of thought as opposed to the content of thought. When somebody’s thoughts, the form and the process of them, are very disorganized and disturbed, their speech is also going to be affected.
For people with schizophrenia though, their speech disturbance involves prolonged patterns of disorganized speech that are much more extreme.
Now there are lots of ways in which speech can be disordered.
The first speech disturbance is a neologism. This is when a person makes up a word.
This word has no meaning in mainstream language and is often a combination of two words that do have recognized meaning or a distortion of a word that has meaning.
e.g. sliderope, “Sliderope”. It’s a reflection of chaotic thought processes.
Other one Tangentiality, it reflects a disturbance in a person’s associative thought patterns. They might start off talking about one topic, and then move to another topic that has little apparent relevance to the original topic.
Interestingly, even those people without schizophrenia may demonstrate slightly tangential speech at times.
As a diagnostic symptom for schizophrenia, tangentiality is more extreme.
Other differences include a failure to ever return to the original topic of conversation
and a lack of insight into this behavior.
For example, the association between the original and second topics is typically less substantial – often the link for the individual might be a single word only.
Hallucinations: Disturbances of perception, having a false sensory experience, believing that we are experiencing something through one of the five senses when in fact they are not. For people with schizophrenia, by far the most common sensory modality in which hallucinations are experienced is the auditory sense.
The most common type of auditory hallucination that people with schizophrenia experience is hearing voices. Typically, when a person is experiencing auditory hallucinations and hearing voices, the voices are very derogatory and negative about the person in question. A person may hear one or more voices, but generally, they’re saying awful, mean things to the person – for example, “he’s worthless”, "he's useless". It’s very unusual for the voices to say anything positive about the person experiencing them.
Sometimes, when a person says they are hearing voices, they are actually talking about their own thoughts or internal monologue.
The key difference between thoughts and an auditory hallucination in the form of ‘a
voice’ is whether the individual feels that the words being spoken are coming from inside or outside of their own mind.
If the words or voices are coming from inside your mind, we’re usually talking about a
thought or self-talk. Whereas, if the words or voices are coming externally, as though someone else is talking to you, we’re usually talking about an auditory hallucination.
Visual hallucinations refer to the experience of seeing something that is not actually there. Visual hallucinations can be a product of organic brain disease.
Olfactory hallucinations involve the sense of smell – so this is where someone has
the experience of smelling something that in fact is not there.
Gustatory hallucinations involve the sense of taste. A common example is an experience that the food you are eating tastes rotten when it tastes fine to others who are eating the same food.
Tactile hallucination refers to a false sensory experience in relation to the sense of touch. When a person has a tactile hallucination, there is a sense of physical contact with a stimulus that is not real.
One of the most common tactile hallucinations is the experience of something crawling on or under your skin. For example, maggots or cockroaches.
Disorganized or abnormal motor behavior
Disorganized or abnormal motor behavior- grossly disorganized behavior or disturbances in motor activity. For example, Psychomotor agitation or Catatonia or a person’s behavior might be characterized by childish silliness or a complete lack of focus.
Psychomotor agitation, such as restlessness and an inability to stay still.
Or, an excessive purposeless activity that is unrelated to anything going on in the environment – for instance, twirling round and round on the spot.
We might also see a complete lack of response to all stimuli – for example, not responding when someone talks to you, prods you and so on.
Catatonia refers to neurogenic motor immobility, or behavioral abnormality manifested as stupor. This is where people can literally become rigid in their movement and become immobile. Catatonia is not particularly common.
Course of Schizophrenia
There are typically three phases to a psychotic episode in schizophrenia.
There’s a prodromal phase. Generally, this is characterized by a decline in functioning.
During the prodromal phase, negative symptoms such as lack of motivation, social withdrawal, and a decline in self-care appear.
The prodromal phase is essentially the lead into the active phase of the episode.
The first time a person experiences a psychotic episode, it’s often unclear exactly what
is going on. Sometimes this is because family and friends think that the negative symptoms that make up the prodromal phase fall within the broad parameters of what is developmentally normal.
The prodromal phase may last for days, weeks, or months. A longer, more chronic onset, or prodrome is associated with a worse prognosis. In the active phase, the positive symptoms begin to appear. However, each person’s symptom profile is different, with some people having a symptom profile that is dominated by positive or negative symptoms and others having a symptom profile that is more of a mixture of positive and negative symptoms.
The last phase of the episode is the residual phase where the person presents as significantly better compared to the active phase.
The positive symptoms have typically remitted––usually with the help of medication––but some negative symptoms remain.
Negative symptoms- these symptoms reflect normal behaviours that are actually in deficit. It’s the fact that these behaviours are not occurring enough that’s the problem,
rather than the behaviours occurring too much.
Some of the key domains or areas––in which people with schizophrenia might demonstrate negative symptoms––including the expression of affect or emotion, speech, and motivation.
There are a number of ways in which a person’s affect, or expression of emotion, may be disturbed. One of the most common is what’s referred to as ‘flat affect’, where the expression of emotion through tone of voice and facial expression is significantly reduced.
Alogia is also known as poverty of speech and involves a lack of spontaneous speech, which reflects impoverished thought processes.
Avolition is a negative symptom that you actually see across a number of different disorders. Depression springs to mind straightaway because what we’re talking about here is a lack of motivation and along with that, often social withdrawal from a person’s family, from their friends, and so on. Another common negative symptom involves lack of self-care around personal hygiene.
The front-line intervention for schizophrenia is medication.
People who have a symptom profile dominated by positive symptoms are more likely to have a good response to antipsychotic medication compared to people whose symptom profile is dominated by negative symptoms. Although medications are very helpful in managing the symptoms of schizophrenia for many people, up to one-quarter of people with schizophrenia fail to demonstrate much improvement on medication.
Both older and more recently developed antipsychotic medications are associated with negative side effects, including weight gain, and Tardive Dyskinesia––which is an involuntary neurological movement disorder usually affecting the lower face.
From a psychological point of view, one of the most important elements of treatment is Psycho-education.
We need to educate people who are directly impacted by the illness about the signs of relapse, and what to do if and when that happens.
Other psychological interventions include using behavioral strategies to help people with schizophrenia develop their social skills, with a view to promoting the development and maintenance of social relationships and friendships.
Cognitive behavioral therapy is a therapeutic approach that has been recommended for individuals with well-managed or stable schizophrenia by organizations such as the National Institute for Health and Care Excellence (NICE) in the UK and the American Psychiatric Association.
Finally, it is also vitally important to support the families of people with schizophrenia, both in terms of their own coping and well-being, and also in terms of how to best help their unwell family member.