Schizophrenia

9 Key excerpts on "Schizophrenia"

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  eBook - ePub

  Abnormal Psychology

  • Alan Carr(Author)
  • 2003(Publication Date)
  • Psychology Press

    (Publisher)

  Chapter 4 Schizophrenia

  • Introduction
  • Clinical features
  • Epidemiology and classification
  • Etiological theories
  • Biological theories
  • Cognitive theories
  • Social and family systems theories
  • An integrative approach
  • Schizophrenia and split personality
  • Controversies
  • Summary
  • Further reading

  Introduction

  THE TERM Schizophrenia REFERS to a Collection of Seriously debilitating conditions characterized chiefly by hallucinations, delusions and thought disorder. Hallucinations involve experiencing a sensation in the absence of an external stimulus. For example, with auditory hallucinations people report hearing voices that others cannot hear. Delusions are unfounded and culturally alien beliefs. For example, with persecutory delusions individuals may believe that a group of people are conspiring to harm them. Thought disorder refers to disorganized and illogical speech. When negative symptoms are present, the person may live a restricted lifestyle involving very little activity, and little social interaction with others and may express a very narrow range of emotions. People diagnosed with Schizophrenia may also show negative symptoms such as restriction of activity, speech and affect.

  After considering the clinical features and epidemiology of Schizophrenia, theoretical explanations of this condition will be presented later in the chapter. Each of these specific explanations has been developed within the context of one of three broad theories. These are the biological, cognitive-behavioural and family systems theories of psychological problems. In Chapter 6, these three broad theories of psychological problems, along with the psychodynamic model, are reviewed with reference to their main attributes, their contributions to our understanding and treatment of psychological problems, and their limitations.

  Case example

  Julian was referred for assessment and advice by his GP. His parents were worried about him because he had been behaving strangely since returning to the family home after studying in London for a year. Julian had failed his exams and came home, he said, ‘to sort his head out’. He lacked concentration and his conversation was incoherent much of the time. Also his behaviour was erratic. He had gone jogging one morning the previous week and not returned. His parents had found him in his training shoes and running shorts 35 miles away later that day. He was exhausted and dehydrated. He explained that he was on his way to the car ferry to Holland on a secret mission.

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  Psychopathology

  History, Diagnosis, and Empirical Foundations

  • W. Edward Craighead, David J. Miklowitz, Linda W. Craighead(Authors)
  • 2017(Publication Date)
  • Wiley

    (Publisher)

  Chapter 10

  Schizophrenia and the Psychosis Spectrum

  Arthur T. Ryan Hanan D. Trotman Vijay A. Mittal Kevin D. Tessner Elaine F. Walker

  I can't find the words to describe it. Schizophrenia is like a disconnect. My thoughts and my feelings are not connected. I'm not connected with other people. I don't understand them and they don't understand me. It is like life is just passing me by, and it is out of my control. My mind is out of my control and it is frightening.

  —Schizophrenia patient

  The preceding words are from a man in his 40s who was diagnosed with Schizophrenia during his 20s. Schizophrenia is a brain disorder whose symptoms typically show up by young adulthood and continue as a chronic condition, albeit waxing and waning over time. It has affected nearly every aspect of this man's life, including making friends, getting married, and holding down a job. This chapter will attempt to explain how this complex and often misunderstood illness can have such pervasive effects upon those who suffer from it.

  Schizophrenia falls into the broader category of psychotic disorders. The defining symptoms of psychotic disorders involve a disconnect from reality. Psychotic symptoms include hallucinations (perceiving things that aren't there), delusions (strange fixed beliefs that are not amenable to change despite exposure to contradictory evidence), disorganized and illogical thinking, and bizarre behavior. Schizophrenia is probably the disorder most closely associated with psychotic symptoms in the minds of clinicians and the general public alike. Other psychotic disorders include bipolar I disorder, major depressive disorder with psychotic features, and delusional disorder. As this chapter will go on to explain, however, Schizophrenia's psychotic symptoms are just one component of this complex and often misunderstood disease.

  Symptoms and Diagnostic Criteria

  The modern conceptualization of Schizophrenia divides its symptoms into three major categories. The names of some of these categories may be confusing at first, but once one understands the underlying logic, the categories can help to sensibly organize Schizophrenia's wide array of symptoms. The three categories are positive symptoms, negative symptoms, and cognitive symptoms.

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  Psychopathology and Psychotherapy

  DSM-5 Diagnosis, Case Conceptualization, and Treatment

  • Len Sperry, Jon Carlson, Jill Duba Sauerheber, Jon Sperry(Authors)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  So what exactly is Schizophrenia and the psychotic process? In brief, Schizophrenia is a syndrome consisting of a highly altered sense of inner and outer reality to which individuals respond in ways that impair their lives. This altered sense of reality, which is the core of this disorder, shows itself in disturbances of speech, perception, thinking, emotion, and physical activity. The most common form of psychosis is Schizophrenia. The term literally means “splitting of the mind,” which in popular parlance connotes a “split personality” or multiple personality. Technically, however, Schizophrenia refers to the incongruity between different mental functions; that is, between thought content and feeling, or between feeling and overt activity. For example, an individual diagnosed with Schizophrenia may talk of being sad or terrified by a specific event, while laughing or showing no affect whatsoever. The case of John Nash and the other case examples in this chapter demonstrate these and other clinical features and dynamics.

  This chapter consists of sections which describe the following psychotic disorders: Schizophrenia and Schizophreniform Disorder; Delusional Disorder; Schizoaffective Disorder; Brief Psychotic Disorder; and Substance- and Medication-Induced Psychotic Disorders. The plan for each section is to begin with a clinical description of the disorder and its DSM-5 characterization. Next, a biopsychosocial-Adlerian conceptualization of that disorder is provided. This is followed by a brief discussion of treatment considerations. Finally, a case example rounds out the discussion of the disorder. However, before turning to specific psychotic disorders, the chapter begins with a general Adlerian conceptualization of psychosis and the psychotic process.

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  The Greening of Pharmaceutical Engineering, Applications for Mental Disorder Treatments

  • M. R. Islam, Jaan S. Islam, Gary M. Zatzman(Authors)
  • 2017(Publication Date)
  • Wiley-Scrivener

    (Publisher)

  Chapter 6 Schizophrenia as a Tangible Expression of Mental Disorder

  6.1 Introduction

  In Chapter 5, we characterized depression and Schizophrenia as the codrivers of mental ailments. We also described Schizophrenia as the tangible segment of the tangible-intangible yin yang. The word ‘Schizophrenia’ is derived from the Greek roots ‘schizein’ (σχίζειν, «to split») and phrēn (φρήν, φρεν-, «mind»). It literally refers to disconnection of intangible (e.g., thinking) and tangible aspect (e.g., bodily function). Scientifically, we characterized Schizophrenia as a disconnection pertaining to the malfunction of the brain (Islam et al., 2016). We also called deliberate use of ‘crazy logic’ in order to deceive others or to promote self-interest in the shortest term as ‘deliberate Schizophrenia’. Of importance is the consideration that Schizophrenia is not a disease of the heart (or conscience). In fact, a person inflicted with Schizophrenia is not in control of his or her intention and as such doesn’t have access to conscience. Of course, it doesn’t mean a person with symptoms of Schizophrenia will opt for anti-conscience activities, it rather means that he or she is not capable of acting on conscience.

  Schizophrenia is a mental disorder that affects more than 21 million people worldwide (WHO, 2017). The most important feature of Schizophrenia is the distortion of reality through perception that is detached from objective truth. This includes false perception, hearing voices, delusions, and other symptoms. Even though it is mainly a mental disease, people with Schizophrenia are 2-2.5 times more likely to die early than the general population. This is often due to physical illnesses, such as cardiovascular, metabolic and infectious diseases. Among all mental ailments, Schizophrenia is the one most disconnected to a person’s diet, environment or genetic history. As such, this is the most debilitating condition in terms of remedy.

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  Adult Psychopathology and Diagnosis

  • Deborah C. Beidel, B. Christopher Frueh(Authors)
  • 2018(Publication Date)
  • Wiley

    (Publisher)

  DSM-5 were met because these difficulties lasted longer than 6 months. In addition, with respect to the D and E diagnostic criteria for Schizophrenia, other diagnoses were ruled out (e.g., mood disorders, substance abuse, developmental disorders). In addition to illustrating some of the symptoms and characteristic impairments of Schizophrenia, this vignette illustrates that people with this illness are often able to lead rewarding and productive lives, usually with the help of pharmacological and psychological treatments, as well as social supports, despite continued symptoms and impairment due to the illness.

  Summary

  Schizophrenia is a severe, long-term psychiatric illness characterized by impairments in social functioning, the ability to work, self-care skills, positive symptoms (hallucinations, delusions), negative symptoms (social withdrawal, apathy), and cognitive impairments. Schizophrenia is a relatively common illness, afflicting approximately 1% of the population, and tends to have an episodic course over the lifetime, with symptoms gradually improving over the long term. Most evidence indicates that Schizophrenia is a biological illness that may be caused by a variety of factors, such as genetic contributions and early environmental influences (e.g., insults to the developing fetus).

  Despite the biological nature of Schizophrenia, environmental stress can either precipitate the onset of the illness or symptom relapses. Schizophrenia can be reliably diagnosed with structured clinical interviews, with particular attention paid to the differential diagnosis of affective disorders. There is a high comorbidity of substance use disorders in persons with Schizophrenia, which must be treated if positive outcomes are to accrue. Psychological assessment of Schizophrenia is most useful when it focuses on behavioral, rather than dynamic, dimensions of the illness. Thus, assessments and interventions focused on social skill deficits and family functioning have yielded promising treatment results. Biological assessments are useful at this time, primarily for descriptive rather than clinical purposes. Finally, there are a great many issues related to gender and racial or ethnic factors that remain unexplored.

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  Surviving Schizophrenia, 7th Edition

  • E. Fuller Torrey(Author)
  • 2019(Publication Date)
  • Harper Perennial

    (Publisher)

  2

  Defining Schizophrenia: View from the Outside

  To one who is mad, the world is still real, but it has a new meaning; people are real too, close and powerful and perhaps dangerous, but among them all the individual is alone. That is the central feature when we penetrate insanity. Not that the world is less with us, but that another world pervades it too, and we, seeing and experiencing life upon a different plane, are cut off from communication with the sane around us: the sane and blinkered folk who do not see and must not know or would never believe the vast, vital, urgent and perhaps cataclysmic truths of which we, alone among them, are aware.

                          Morag Coate, 1965

  The definition of most diseases of mankind has been accomplished. We can define typhoid fever by the presence of the bacteria that cause it, kidney failure by a rise in certain chemicals in the blood, and cancers by the appearance of the cells under the microscope. In most diseases there is something that can be seen or measured, and this can be used to define the disease and separate it from nondisease states.

  Not so with Schizophrenia! Although there are numerous abnormalities in brain structure and function, there is no single thing that can be measured and from which we can then say: Yes, that is Schizophrenia. Because of this, the definition of the disease is a source of continuing debate. This situation is exacerbated because of the probability that Schizophrenia includes more than one disease entity.

  Since we do not yet have any definitive measures for Schizophrenia, we must define it by its symptoms. This may be misleading, however, for different diseases may cause the same symptoms. For example, a pain in the abdomen is a symptom, but the diseases that may cause this symptom number well over one hundred. Thus, to use symptoms to define diseases is risky. Such is the state of the art with Schizophrenia; yet precise diagnosis is of utmost importance. It both determines the appropriate treatment for the patient and provides the patient and family with an informed prognosis. It also makes research on the disease easier because it allows researchers to be certain they are talking about the same thing.

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  First Person Accounts of Mental Illness and Recovery

  • Craig W. LeCroy, Jane Holschuh(Authors)
  • 2012(Publication Date)
  • Wiley

    (Publisher)

  1 Schizophrenia and Other Psychotic Disorders INTRODUCTION

  We begin this book with the first person accounts (FPAs) written by people who have been diagnosed with or have experienced the symptoms of a psychotic disorder. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR ) groups together under this category disorders that involve a variety of serious symptoms that have considerable impact on people’s daily lives. Of these disorders, Schizophrenia is the prototype. Earlier versions of the DSM took a unitary approach that conceptualized psychopathology on a continuum; neurosis reflected a higher level of functioning and psychosis signified the greatest impairment in functioning. Arieti’s (1974) concept of a “break with reality” defined psychosis more narrowly and is why the first signs/symptoms or episode of Schizophrenia has been termed a first break. Psychosis represented an inability to distinguish between internal and external stimuli. The break with reality referred to this loss of ability to reality test, or to tell whether, for example, the voices a person hears are real and are being heard by others or not. This way of thinking about psychosis has endured. In neurotic disorders as defined by the first two DSM s, this capacity remained intact. Beginning with DSM-III, the manual abandoned the unitary approach and, instead, defined psychopathology as discrete or distinct categories of disorders and developed a core set of criteria for each disorder.

  People who have been diagnosed with any of the psychotic disorders may experience problems in perception (hallucinations in any of the five sensory areas, but most often auditory or visual hallucinations), delusions or false beliefs, disorganized speech (and thought), and/or disorganized or catatonic behavior. While these psychotic symptoms are common across the disorders in this category, such symptoms are not thought of as the core parts of every disorder in this section, and there is variation in the symptoms that are considered psychotic for different disorders in this category. In Schizophrenia, schizophreniform disorder, schizoaffective disorder , and brief psychotic disorder , the following are psychotic symptoms: delusions, any hallucinations (with or without accompanying insight) that are prominent, disorganized speech, and disorganized or catatonic behavior. In substance-induced psychotic disorder and psychotic disorder due to a general medical condition, only delusions and hallucinations with no insight are considered to be psychotic. In delusional disorder and shared psychotic disorder

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  Selecting Effective Treatments

  A Comprehensive, Systematic Guide to Treating Mental Disorders

  • Lourie W. Reichenberg, Linda Seligman(Authors)
  • 2016(Publication Date)
  • Wiley

    (Publisher)

  A good prognosis for schizophreniform disorder depends on a brief prodromal period (4 weeks or less), the presence of confusion during the active phase, and good premorbid functioning. The presence of negative symptoms, flat affect, and poor eye contact are related with poorer outcomes.

  Schizophrenia

  Symptoms of Schizophrenia are the same as for schizophreniform disorder, except for the duration criteria, which must last at least 6 months. Hallucinations and delusions are the symptoms of Schizophrenia that seem to distinguish the disorder from other diagnoses. But it is the other symptoms that accompany this chronic condition that are more persistent and pervasive that have a much greater effect on quality of life. The so-called “negative symptoms,” named for the absence of traits, include flat affect, monotone voice, lack of eye gaze, and inability to feel pleasure. Long term, these symptoms are far more likely to prevail and to impact the ability to develop social relationships, maintain employment, and live independently.

  Description of the Disorder

  For a diagnosis of Schizophrenia, at least two of the following symptoms must be present during a 1-month period: delusions, hallucinations, disorganized (incoherent or frequently derailed) speech, catatonic or grossly disorganized behavior, and negative symptoms (anhedonia, avolition). Delusions, hallucinations, or disorganized speech must comprise at least one of the symptoms. The person's level of functioning must have decompensated from their previous level of functioning in one or more major life areas (e.g., work, home, interpersonal relationships, self-care).

  The Schizophrenia subtypes of paranoid, disorganized, catatonic, undifferentiated, and residual have been eliminated in DSM-5 because they were not determined to provide any meaningful distinction between diagnoses. Also eliminated in DSM-5 is the requirement that delusions must be bizarre.

  Schizophrenia can run an erratic course, impacting social and occupational functioning. Most people with Schizophrenia are employed at levels below their parents, and most men in particular never marry or develop social relationships beyond their immediate families (APA, 2013). A reduced life expectancy is also common, due to comorbid medical conditions (e.g., diabetes, cardiovascular conditions), alcohol or nicotine use, poor compliance with health-maintenance activities (exercise, weight control, poor health screening), and the effects of long-term use of antipsychotic medications. About 20% of people with Schizophrenia attempt suicide at least once in their lives, and 5% to 6% of attempts have a fatal outcome. The suicide rate is higher in those who are unemployed, in younger men who also use substances, and after discharge from the hospital for an episode of psychosis.

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  Lecture Notes: Psychiatry

  • Gautam Gulati, Mary-Ellen Lynall, Kate E. A. Saunders(Authors)
  • 2013(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  12 Schizophrenia Learning objectives

  To be able to describe the presentation, aetiology, assessment and management of Schizophrenia

  Schizophrenia is at the heart of psychiatry and is closest to the public conception of madness. Although not the most common disorder, it accounts for a significant proportion of psychiatric morbidity and the workload of psychiatric services.

  • In 2008/09 patients with Schizophrenia occupied 2.85 million NHS bed days; higher than for any other condition in any medical specialty.
  • The economic burden of the disorder in England runs into several billions of pounds annually.

  Clinical features Schizophrenia is a psychosis, typically presenting in young adults. It is distinguished from other psychoses by:

  • the presence of specific types of delusions, hallucinations and thought disorder;
  • the primary disorder is not one of affective (mood) or organic aetiology;
  • the clinical course.

  The clinical picture of Schizophrenia is complex. Here, the acute and the chronic stages of the disorders are described in turn – though in practice there is a continuum of features.

  • Before proceeding, review the basic assessment (Chapter 2) and the diagnosis-focused assessment for psychosis (p. 22). These earlier sections include definitions of the cardinal symptoms of Schizophrenia.

  Clinical features of acute Schizophrenia

  The diagnostic features are shown in Table 12.1

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