Schizophrenia (A comprehensive understanding)

In this brief guide, we are going to define Schizophrenia, its symptoms, diagnosis types and course of illness.

What is Schizophrenia?

Schizophrenia is a condition of disturbed reality contact.

The person loses control over their environment. The concern of most people is regarding the treatment of schizophrenia.

They wonder if the hallucinations people experience is in a person’s control or not.

The answers to the questions related to nature, diagnosis, types, and causes of schizophrenia are collectively compiled here.

Schizophrenia is a lifelong disorder and treatment takes time, but with early treatment, the severity can be controlled to improve the quality of life.

Overview of Schizophrenia symptoms

Some of the symptoms of schizophrenia are a loss of touch with reality and the person reacts to the surroundings in unusual ways.

Some of them report being suspicious, having false claims regarding their existence, or they may hear or see things which are not actually there.

Furthermore, the symptoms extend to the behavioural symptoms as well and can be shown in the unusual posturing, silliness, agitation, as well as resistance to commands or excessive motor activity.

Their speech can get disturbed as well and there are times when people start noticing that the conversations are no more fluent and they jump from one context to the next to the point which the other person is unable to grasp the content or context of the conversation.

Along with that their expression of emotions and understanding the feelings of another person also gets disturbed. They become socially withdrawn.

Diagnostic Criteria of Schizophrenia

The following diagnostic criteria are consisting of Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5, 2012).

A. More than two symptoms are required to be present in a 1-month period at least (one of them must be from a-c):

a. Delusions

b. Hallucinations

c.  Disorganized Speech

d. Grossly Disorganized Catatonic Behaviour

e. Negative Symptoms

B. The functioning of the person is disturbed in his life domains e.g. work, social, self-care, academic, or personal life.

C. The duration of experiencing these symptoms must be 6 months or more

D. Schizoaffective or other mood disorders are not present

E. The symptoms are not because of any medication or substance abuse.

Symptoms of Schizophrenia

There are negative and positive symptoms of schizophrenia.

The positive symptoms include: unrealistic perceptions or actions and have the altered reality.

Positive Symptoms of Schizophrenia:

Below are some of the positive symptoms of schizophrenia.

Hallucinations: 

Hallucinations are the first positive symptoms of schizophrenia.

What are Hallucinations?

Hallucinations are when a person hears, sees, smells and feels the things which are actually not here. 

There are different types of hallucinations:

Below are the different types of hallucinations.

Auditory hallucinations:

In this, the person hears voices and thinks that someone is talking to them.

These voices sometimes give them commands or orders or keep giving messages. 

Initially, these voices are not forceful and interfering, but with the passage of time they get demanding and sometimes become dangerous for the person’s life.

They can command the person to commit suicide or sometimes just leads them to harm themselves.

At other times to avoid the constant voices people attempt suicide. 

There are variations in voices, some report hearing one voice, some report hearing more than one voice, either they are in conversation with each other or with the person being affected.

Visual hallucinations:

The visual hallucinations are consisting of seeing images and seeing lights, objects, people or pattern when they are actually not there.

They can be about anyone they love or friends. 

This type of hallucinations is less common than auditory hallucinations.

Olfactory hallucinations:

In this type, the person is able to smell what just doesn’t exist in reality.

They may believe that they are having the smell of particular disgusting or loveable things even when it is not around.

Gustatory hallucinations:

People will begin to experience the taste which they haven’t eaten and claim that they just had a meal which has this taste.

Tactile hallucinations:

People experiencing these hallucinations experience the sensation of something moving on their body, the tingling sensation or that something is crawling on their skin.

Delusions: 

Delusions are the second positive symptoms of schizophrenia.

What are delusions?

Delusions are false beliefs that are rigid and cannot be easily challenged.

These delusions are true to the person experiencing them that they believe in them, as the normal functioning person believes in the existence of God, or the existence of the sun and moon. 

There are different types of delusions as well:

Below are the different types of delusions

Persecutory Delusions:

These delusions are related to the fear that someone is stalking, haunting or getting tricked into something dangerous.

Referential Delusions:

In these, the person believes that the information being shared on TV, radio, Podcasts, Movies or songs are related to them and are giving them some important message, designed for them only.

Somatic Delusions: 

A person starts believing that they are having some chronic or fatal illness.

The idea of illness is so bizarre that they believe that some creature is travelling within their skin or body and is incurable.

Erotomanic Delusions: 

People experiencing this sort of delusions think that some famous figure or celebrity is in love with them or their partner is not faithful.

They also believe that people are pursuing them.

Religious Delusions: 

They believe that they are having a special connection with God or are in a secret relationship with God, and maybe possessed by demons.

Grandiose Delusions: 

They have the false claims of superiority and consider themselves as the important figures or someone having a superior position in society.

Confused Thoughts and disorganized speech: 

Confused thoughts and disorganized speech are the third positive symptoms of schizophrenia.

People with schizophrenia experience irrational thinking patterns as well as an inability to make sense of their thoughts.

This confusion of their thoughts is manifested in their speech as well.

They easily get distracted while talking or in conversations with other people.

Trouble Concentrating: 

The disturbance in their concentration is also prominent, they lose the understanding of the situation and cannot follow the conversations or memorize the important things.

Which in result affects their participation in the environment around them.

Disorganized Movement: 

A person will get disorganized in their motor behaviour as well.

They experience the spur of energy at one time and show excessive motor activity, while at other times become completely still for hours and stay in any absurd posture.

Negative Symptoms

The negative symptoms are related to the unusual mental functioning related to the emotions, feelings, perception and behaviour of the person. These include the following:

Lack of Pleasure:

The person stops enjoying the activities which they used to enjoy before, and are not excited about their pleasurable activities anymore.

This condition is also called anhedonia and people simply lose interest in doing anything.

Trouble with their speech:

In this condition, people completely avoid any social interaction and are not interested in talking to other people, as well as expressing their own feelings.

This condition is also called alogia.

Flattening:

They go monotone and completely flat in their expressions.

When they are talking their tone seems flat as well as their emotions and facial expressions are not expressive.

They seem blank and usually don’t smile, along with that they also show inappropriate facial expressions.

Withdrawal:

They are interested in staying aloof and away from socialization.

They avoid friends and when someone tries to talk to them, they make them uncomfortable and irritable by their lack of responses.

They will never acknowledge the feelings of another person or show concern. This condition is also called apathy.

Difficulty in daily living:

They are unable to complete their daily activities and do regular home chores.

They are unable to maintain their basic hygiene and arranging meals for themselves.

Lack of goal: 

These people are unable to make any goal-directed activity and are not following a routine.

They get distracted and disorganized easily while going for one thing and are unable to finish what they have started.

This condition is usually known as avolition.

Prevalence of Schizophrenia

There are studies done on the number of incidents and approximately 0.3% -0.7% were reported in the US.

Males usually have a longer duration of negative symptoms.

Course of Schizophrenia

It has been seen that most cases emerge in late teens and mid 30’s. Whereas early onset is quite rare.

The earlier the onset the worst prognosis.

Whereas, the earlier symptoms of schizophrenia in children are hard to notice.

Married females usually have more chances of having late-onset after 40 years of age.

Suicide Risk

There are chances of suicide as the condition matures and the intensity of symptoms increases.

The figures given in researches quote that 5%-6% of people with schizophrenia die as a result of suicide and more than 20% attempt suicide anytime in their lives.

Causes of Schizophrenia

There have been a lot of researches done on the topic of causes of schizophrenia, and the answer is still unknown.

There are a number of factors which impact the development of the condition.

These include genetics, physical, psychological and environmental conditions.

The brain development is different in people with schizophrenia, as well as the levels of neurotransmitters in the brain which can create some symptoms of schizophrenia.

The psychological triggers could be stress, which can lead to extreme emotional pressure and results in the manifestation of symptoms.

The life stresses for example divorce, losing loved ones, emotional, sexual abuse etc. are the common stresses.

Along with this drug abuse can sometimes replicate the symptoms of schizophrenia and the continuous use of drugs may lead to or trigger the condition.

Types of Schizophrenia

There were a number of different types of schizophrenia in the past, but these types are not considered in the updated version of mental disorders manual published by the American Psychiatric Association (APA).

Before schizophrenia was recognized having multiple forms as under:

1. Catatonic Schizophrenia

2. Childhood Schizophrenia

3. Paranoid Schizophrenia

4. Schizoaffective Schizophrenia

5. Disorganized or hebephrenic Schizophrenia

According to the latest gradation, all these types are merged into one and named as the Schizophrenia spectrum disorder.

This advancement was made because of the low reliability and poor validity of the diagnosis.

The separate diagnosis was not a predictor of better treatment or prognosis.

Subtypes of Schizophrenia:

There are a number of subtypes of schizophrenia which are listed here, some of them are obsolete and are combined into the spectrum of schizophrenia:

a. Schizoaffective Disorder:

As its name says that it is the combination of schizophrenia symptoms of delusions and hallucinations as well as the mood disorder symptoms like elated mood or low mood.

b. Catatonia:

This type has extreme behaviour, and excessive motor activity is involved.

Along with that the person is involved in absurd or unusual body posturing and get stuck in one position for longer periods of time.

c.   Childhood-onset schizophrenia:

It is extremely rare and occurs at the age of 10 years or younger. If the onset is early, the prognosis or chances of recovery will be less.

d. Disorganized schizophrenia:

With this diagnosis people experience difficulty in performing daily activities, for example maintaining daily hygiene, and taking care of themselves.

As well as being difficult to understand their speech.

This is now considered to be a symptom of schizophrenia and not the subtype anymore.

e. Paranoid Schizophrenia:

This subtype is also the part of schizophrenia diagnosis and not the separate type.

Schizophrenia is a deliberating condition causing the derailment and loss of touch with reality.

The diagnostic criteria discussed is the widely used criteria to be used for diagnosis by the professionals in the field of mental health.

The symptoms and the significant information regarding the causes and course of the disorder can help the person to deal with them easily.

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Frequently asked questions about Schizophrenia

Below are some of the most frequently asked questions about schizophrenia;

What are the first signs of schizophrenia?

The first signs of schizophrenia are depression, social isolation, suspiciousness, lack of interest, crying forgetfulness, inability to focus and sleep disturbance.

What is a Schizophrenic person?

A Schizophrenic person is a person who is at a loss of touch with reality.

They are experiencing hallucinations, delusions, confusion, impaired behaviour and disturbed functioning.

What can trigger schizophrenia?

The triggers of schizophrenia are not known, but researchers claim that there are different factors which play their role in triggering the condition.

Some of these factors are physiological, psychological, or environmental.

How does a person with schizophrenia feel?

A person with schizophrenia feels confused, and difficulty in keeping in touch with reality, because sometimes what they see, hear or smell doesn’t exist and they are unable to assess what is real and what is imagined.

Please make sure to let us know what you think about this guide as well as any comments and suggestions regarding the condition, below in the comments section.

What we recommend for Schizophrenia

Professional counselling

If you have Schizophrenia, then ongoing professional counselling may be your ideal first point of call. Counselling will allow you to practice various habits that improve your overall quality of life.

References:

Web MD Schizophrenia symptoms

Mental health UK: Types of Schizophrenia

Medical News Today 

Recommended Readings:

Abnormal psychology: An Integrative Approach, 7th Edition

Schizophrenia: Understanding Schizophrenia, and how it can be managed, treated, and improved

 Surviving Schizophrenia, 7th Edition: A Family Manual

I Am Not Sick, I Don’t Need Help! How to Help Someone with Mental Illness Accept Treatment. 10th Anniversary Edition.

 A Beautiful Mind: The hitting Script 

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