Schizophrenia Symptoms Clinical Picture: Schizophrenia

Schizophrenia Symptoms

Clinical picture: Schizophrenia is defined in this text as "a psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of strange perceptions, disturbed thought processes, unusual emotions, and motor abnormalities" (p, 435). A primary symptom is psychosis, or a break with reality. About 1 in 100 people have schizophrenia.

Symptoms: Positive symptoms (pathological excesses) to the person's behavior. They can include:

Delusions: things a person believes but which have no basis in reality. These delusions can be frightening, or the person can feel that he or she has some special knowledge. Persecution delusions are common; they believe people are trying to them some kind of harm. Or they may show delusions of reference, as in the example in the book of the woman who thought the TV shows were all about here.

Thought disorders: they make loose associations between words causing difficulty with thinking logically and in communication with others. Often, responses focus on one word and then go off on an unrelated tangent.

Heightened perceptions and hallucinations: auditory hallucinations actually cause activity in the person's language center. Hallucinations can also involve touch or any other sense. Often delusions and hallucinations happen at the same time.

Inappropriate affect: they may react with happiness to sad news, or sadly to good news.

Negative symptoms (things missing in the person): poverty of speech. They talk less, may think and say very little.

Blunted, flat affect: they simply don't feel as many emotions as others, and show very little in the way of emotions. Some don't feel the emotions, but some do but just don't show them.

Loss of volition: difficulty taking action. It may involve difficulty making decisions.

Social withdrawal: they tend to avoid other people. That and their other peculiarities isolate them from others. Very often they won't know as much about current events as others.

Psychomotor: they may walk with an odd gait or show facial grimaces. In the extreme form, the person is catatonic, or completely motionless for long periods of time.

Course: Usually appears in late adolescence or early adulthood. The condition has three phases: prodromal, active, and residual. During the first phase, prodromal, the person begins to act a little pecularly. He or she may withdraw socially, start speaking a little oddly, or show little in the way of emotions. Sometimes some life stressor triggers the change. In the active phase, symptoms become obvious. In the residual phase, the symptoms lessen but are still present. The amount of time each phase takes can vary greatly from person to person. Very rarely a person seems to recover, but usually, symptoms remain for the rest of his or her life.

Diagnosing: requires that the symptoms be present for at least six months. In addition, the condition must affect major life activities negatively, such as work, social, or self-care.

There are five kinds: hebephrenic (disorganized), catatonic, paranoid, undifferentiated, and residual. The disorganized kind is marked by confusion and inappropriate or absent emotional reaction with silliness and inappropriate laughter often present. The catatonic type shows gross motor changes, which may involve a stupor or markedly agitated movements. Paranoid schizophrenics develop an organized set of delusional beliefs supported by auditory hallucinations. If the person is schizophrenic but doesn't fit one of those categories, it is called undifferentiated.

In addition, schizophrenia is broken down into Type I and Type II. Type one shows primarily positive symptoms while Type I shows primarily negative symptoms. Type I patients typically have better adjustment prior to onset of the illness than Type II's, and are more likely to improve over time. Type I is also most closely linked to biochemical disturbances while Type II is tied to structural abnormalities in the brain.

Clinical explanations for schizophrenia: Likely that a variety of factors work together including a biological disposition and life circumstances that serve as a trigger.

Biologic view: Growing evidence of a genetic link, and the disease is more common in relatives of those with schizophrenia than in the general population. In identical twins, 47% of the second twin develops schizophrenia if one does; for fraternal twins, it's only 17%. Both are markedly higher than for the general population. It is suspected that neurotransmitters play a role in some cases, while abnormal brain structure may play a role in others. CAT scans have confirmed the differences in brain structure in those with Type II schizophrenia. Some research hints at a possible viral connection. In particular, maternal influenza during pregnancy appears to correalate with increased rates of schizophrenia.