Schizophrenia: Course, Symptoms, Triggers

People afflicted with schizophrenia may have a sense of reality that is noticeably dissimilar from the reality perceived and shared by others around them. Schizophrenics, live in a world that is distorted by hallucinations and delusions, so those with schizophrenia may feel frightened, anxious, and confused (Smith et al, 2006).  Partly due to the different reality they experience, shizophrenics are known to behave differently at various times and events. At times they can be distant, detached or even seem preoccupied.  Some may sit rigidly, like a stone, unmoving and utterly silent.

Other times they may shift relentlessly – occupied, wide-awake, vigilant, alert, and even hyperactive. Schizophrenia is a severe, chronic, and generally disabling brain disease (Smith et al, 2006). While the term schizophrenia literally means "split mind", it should not be confused with a "split" or multiple personality. It is more accurately described as a psychosis -- a type of disease that causes severe mental turbulence that disrupts normal thinking, vocalizations, and deeds. Schizophrenia is supposed to be secondary to a combination of hereditary and environmental factors.

The course of schizophrenia, its symptoms, and triggers vary greatly among those who are affected. People with schizophrenia may demonstrate a varied combination of symptoms, triggers, and course. Each of these combinations may produce different clinical pictures. In fact, some clinicians have argued that schizophrenia is actually a group of separate disorders that share common features or symptoms.

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Comer (2007) notes that the indication of schizophrenia fall into three main categories:

Positive symptoms, which are unusual thoughts or perceptions that include hallucinations (disturbances of sensory perception), delusions (false beliefs) and thought disorder.

Delusions: Delusions are faulty interpretations of reality. Delusions may have bizarre content such as thoughts of being controlled by others, ideas of persecution by others, etc.

Disordered Thinking and Speech: These may include loose associations, neologisms, and clanging.

Heightened Perceptions: These are feelings of being flooded by sights and sounds, making it impossible to attend to anything important.

Hallucinations: Hallucinations are faulty sensory perceptions. Auditory hallucinations are the most common form of hallucinations.

Inappropriate Affect: Inappropriate affect is smiling when you are sad or angry or bearing a blank look when you should look happy. This may be related to the experience of hallucinations.

Negative symptoms, which stands for a loss or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure in everyday life (Comer 2007). These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression.

Cognitive symptoms (or cognitive deficits), which are problems with attention, certain types of recall, and the executive occupation that allow us to plan and organize. Cognitive deficits can also be difficult to recognize as part of the disorder but are the most debilitating terms of leading a normal life.

One may note that the cornerstone of schizophrenia is psychosis. Psychosis is a state characterized by loss of contact with reality (Comer, 2007). In this condition, the affected person's ability to perceive and respond to the environment is significantly disturbed, and it may affect the person's ability to function. Psychotic symptoms may include hallucinations, which are false sensory perceptions and/or delusions which are false beliefs. Psychosis may also be substance-induced or caused by brain injury, but psychosis most commonly appears in diagnoses of schizophrenia. Fowler (2000) notes that normally individuals with psychosis are not conscious of the consequential links between their symptoms, life experiences, disposition and beliefs. By helping someone understand his or her problem as partly one of belief and interpretation, rather than actual and current threat, can be beneficial

Treatments for Schizophrenia

Treatment is aimed at reducing symptoms and preventing psychotic relapses and is believed to be most effective when begun early in the course of the illness. Schizophrenia is initally treated with antipsychotic medication (Comer, 2007). Once acute symptoms have lessened, a combination of medicine and psychosocial/rehabilitation interventions can be beneficial. As a chronic condition, disease management is life-long process.

Barrow (2005) states that the most common modern medications currently prescribed are: risperidone (Risperdal®), olanzapine (Zyprexa®, Zydis®), quetiapine (Seroquel®), ziprasidone (Geodon®). And then there is aripiprazole (Abilify®), which acts in a different way on the brain than others. All these drugs block dopamine in those parts of the brain where excessive dopamine is causative to psychosis. They mainly diminish positive symptoms, but they may also help with negative symptoms.  Counseling, psychotherapy and social rehabilitation can help with more of what we call "negative symptoms." Although Barrow notes that this often gets lost at first because ‘positive symptoms’ gets therapists too busy,  but people also lose inspiration, the capacity to communicate socially, and the capacity to organize themselves as they used to do before.

References

Barrow, K (2005). Reality Distortions: Balancing the Mind in Schizophrenia. Healthology Online, retrieved 7 April 2008 from http://www.healthology.com/mental-health/article1007.htm?pg=2

Comer, R. J. (2007). Abnormal psychology (6th ed.), New York: Worth Publishers.

Fowler, D. (2000). Cognitive behaviour therapy for psychosis: from understanding to treatment. Psychiatric Rehabilitation Skills, 4(2), 199-215.

Smith B, Fowler D, Freeman D, Bebbington P, Bashforth H, Garety P Dunn G & Kuipers E., (2006) Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Retrieved 7 April 2008 from http://eprints.ucl.ac.uk/2182/1/Microsoft_Word_-_Schiz_Res_02_04_2006__2_.pdf

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