Schizophrenia

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Schizophrenia, as described by mental health professionals, is a chronic, severe, and disabling mental disorder. It affects about 1 percent of Americans.

  • ... schizophrenics are the victims of lives filled with trauma, sometimes subtle but usually obvious. Professionals have tried not to listen. But if one investigates, most of the bad things patients talk about or symbolize in their symtpoms are not delusional, but real traumas. It helps to face the truth. [1]

It has been recognized by the American Psychiatric Association and throughout recorded history.

People with schizophrenia may hear voices other people don't hear or they may believe that others are reading their minds, controlling their thoughts, or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal, or extreme agitation.

People with schizophrenia may not make sense when they talk, may sit for hours without moving or talking much, or may seem perfectly fine until they talk about what they are really thinking.

Because many people with schizophrenia have difficulty holding a job or caring for themselves, the burden on their families and society is significant as well.

Available treatments can relieve many of the disorder's symptoms, but most people who have schizophrenia must cope with some residual symptoms as long as they live. Nevertheless, this is a time of hope for people with schizophrenia and their families. Many people with the disorder now lead rewarding and meaningful lives in their communities. Researchers are developing more effective medications and using new research tools to understand the causes of schizophrenia and to find ways to prevent and treat it.

The symptoms of schizophrenia fall into three broad categories:

  • Positive symptoms are unusual thoughts or perceptions, including hallucinations, delusions, thought disorder, and disorders of movement.
  • Negative symptoms represent a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life. These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression.
  • Cognitive symptoms (or cognitive deficits) are problems with attention, certain types of memory, and the executive functions that allow us to plan and organize. Cognitive deficits can also be difficult to recognize as part of the disorder but are the most disabling in terms of leading a normal life.

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Positive symptoms

Positive symptoms are easy-to-spot behaviors not seen in healthy people and usually involve a loss of contact with reality. They include hallucinations, delusions, thought disorder, and disorders of movement. Positive symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment.

  • Hallucinations: A hallucination is something a person sees, hears, smells, or feels that no one else experiences. "Voices" (auditory hallucinations) are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices that may comment on their behavior, order them to do things, warn them of impending danger, or talk to each other (usually about the patient). They may hear these voices for a long time before family and friends notice that something is wrong. Other types of hallucinations include seeing people or objects that are not there (visual hallucinations), smelling odors that no one else detects (olfactory hallucinations - although this can also be a symptom of certain brain tumors), feeling things like invisible fingers touching their bodies (tactile hallucinations)when no one is near and tasting things when there is no substance present in the person's mouth (gustatory hallucinations).
  • Delusions: Delusions are false personal beliefs that are not part of the person's culture and do not change, even when other people present proof that the beliefs are not true or logical. People with schizophrenia can have delusions that are quite bizarre, such as believing that neighbors can control their behavior with magnetic waves, people on television are directing special messages to them, or radio stations are broadcasting their thoughts aloud to others. They may also have delusions of grandeur and think they are famous historical figures or that they are highly important. People with paranoid schizophrenia can believe that others are deliberately cheating, harassing, poisoning, spying upon, or plotting against them or the people they care about. These beliefs are called delusions of persecution. In addition, individuals may experience ideas of reference, whereby they may experience messages from the TV, radio or newspaper meant specifically for them, that no-one else can see/hear or understand. Ideas of reference can also include "secret signals" from other people, such as the way an innocent person across the road stops to let someone pass, or the way in which a receptionist holds the telephone.
  • Thought Disorder: People with schizophrenia often have unusual thought processes. One dramatic form is disorganized thinking, in which the person has difficulty organizing his or her thoughts or connecting them logically. Speech may be garbled or hard to understand. Another form is "thought blocking," in which the person stops abruptly in the middle of a thought. When asked why, the person may say that it felt as if the thought had been taken out of his or her head. Finally, the individual might make up unintelligible words, or "neologisms." In addition, some people experience having their thoughts "removed" from their minds (thought withdrawal), that others are putting thoughts into their head (thought insertion) or that everyone can hear the indvidiual's thoughts (thought broadcast).
  • Disorders of Movement: People with schizophrenia can be clumsy and uncoordinated. They may also exhibit involuntary movements and may grimace or exhibit unusual mannerisms. Such movements are often side effects of the anti-psychotic medications used to treat the primary symptoms of schizophrenia (Tardive Dyskinesia - TD - or Extra-Pyramidal Side Effects - EPSEs). They may repeat certain motions over and over or, in extreme cases, may become catatonic. Catatonia is a state of immobility and unresponsiveness. It was more common when treatment for schizophrenia was not available; fortunately, it is now rare.

Negative symptoms

The term "negative symptoms" refers to reductions in normal emotional and behavioral states. These include the following:

  • Flat affect: immobile facial expression, monotonous voice
  • Lack of pleasure in everyday life
  • Diminished ability to initiate and sustain planned activity
  • Infrequent speaking: even when forced to interact
  • Demotivation: a lack of interest in life in general
  • Hygiene neglect: People with schizophrenia often neglect basic hygiene and need help with everyday activities.

Because it is not as obvious that negative symptoms are part of a psychiatric illness, people with schizophrenia are often perceived as lazy and unwilling to better their lives.

Cognitive symptoms

Cognitive symptoms are subtle and are often detected only when neuropsychological tests are performed. They include the following:

  • Poor "executive functioning": Person lack the ability to absorb and interpret information and make decisions based on that information
  • Inability to sustain attention
  • Problems with "working memory": Person lacks the ability to keep recently learned information in mind and use it right away)

Cognitive impairments often interfere with the patient's ability to lead a normal life and earn a living. They can cause great emotional distress.

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