Schizophrenia is a mental disorder that Encarta (2001) describes as an illness that results in delusional thought patterns, hallucinations, and inappropriate effect. It literally means “split-mind’, but is not a multiple personality disorder. According to DSM-IV (1996) schizophrenia is categorized under the diagnostic code, ICD-9-CM or International Classification of Diseases, Ninth Revision, Clinical Modification of 295. xx. Symptoms of schizophrenia can be positive, which occur during the active phase, and negative, which are present before the onset of the disorder. Positive symptoms of the disease include delusions of grandeur (a belief that one is a famous admired individual), delusion of control (when they believe something wants to control them), delusions of broadcasting (belief that another can read their minds or their thoughts are being aired on the radio), delusions of persecution, and thought withdrawal (belief that their thoughts have been removed from their brain).
Negative symptoms include (the inability to feel pleasure), a logia (disorganized speech), and flat affect (when the individual does not show any emotion even in situations that strong reactions are expected). According to the DSM-IV (1996) one must fall under these explicit categories in order to be diagnosed with schizophrenia: A. Characteristic Symptoms: Two (or more) of the following, each present for a significant portion of time during a one-month period (or less if successfully treated): 1. Delusions 2.
Hallucinations 3. Disorganized speech (e. g… Frequent derailment or incoherence) 4. Grossly disorganized or catatonic behavior 5. Negative symptoms, i.
e. , affective flattening, a logia, or avolitionNote: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other. B. Social / occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement). C. Duration: Continuous signs of the disturbance persist for at least six months.
This six month period must include at least one month of symptoms (or less if successfully treated) that meet Criterion A (i. e. , active-phase symptoms- and may include periods of or residual symptoms. During these or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e. g.
, odd beliefs, unusual perceptual experiences). D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods. E. Substance / general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e. g.
, a drug abuse, a medication) or a general medical condition. F. Relationship to a Pervasive Developmental Disorder: If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated). Once an individual is diagnosed with schizophrenia they are placed into a subtype that is defined by the predominant symptomatology at the time of evaluation. These subtypes are DSM-IV classified as 295.
xx. A. 295. 30 Paranoid Type: A type of schizophrenia in which the following criteria are met: .
Preoccupation with one or more delusions or frequent auditory hallucinations… None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect. B. 295.
10 Disorganized Type: A type of schizophrenia in which the following criteria are met: . All of the following are prominent: disorganized speech, disorganized behavior, and flat or inappropriate affect… The criteria are not met for Catatonic Type. C.
295. 20 Catatonic Type: A type of schizophrenia in which the clinical picture is dominated by at least two of the following: . Motori c immobility as evidenced by catalepsy (including waxy flexibility) or stupor… Excessive motor activity (that is apparently purposeless and not influenced by external stimuli)… Extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism… Peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing…
Echolalia or echopraxia NIMH (1999) reports that people with this disease are prone to perceive reality in a manner that fluctuates from the way a healthy human being perceives it. The ill individual can be one of the two extremes: catatonic or hyperactive. Furthermore, NIMH and Encarta (2001) agree that this illness is a frightening and lonely experience because of the various hallucinations, illusions, delusions, disordered thinking, and emotional expressions that plague the individual. Hallucinations are that occur without the presence of a valid source.
The most common hallucination schizophrenics encounter is hearing voices that others are not privy to. Although it has been documented that hallucinations can occur in any of one’s five senses. An illusion is when a schizophrenic misinterprets a sensory stimulus. Delusions are a misconception of schizophrenics that vary from the norm of the culture concepts and logical reasoning, for example a schizophrenic may have delusions of grandeur, control, broadcasting, and persecution. Disordered thinking, or thought disorders can lead to a social ostracism because it leads to a logia making it very difficult to converse with the individual. Encarta (2001) claims that many sane individuals laugh uncomfortably when they find themselves in this position, but the experience for the schizophrenic is distressful.
Emotional expression, referring back to NIMH (1999), is when the schizophrenic suffers from the flat affect, which is when they don’t show any emotion even in situations that strong reactions are expected. The may suffer from, isolations, as well as neglecting personal hygiene. It should be known to those around this individual that these are symptoms of the disease- not character flaws. It should also be taken into account that schizophrenics can come across as perfectly normal even when they are hallucinating. Over the years there have been many attempts to find the cause of schizophrenia, and although one cause has not been found, there have been many findings that bring researchers closer to the origin of the illness. In 1956, Howard F.
Searles wrote a paper on his clinical experience claiming that the a etiology of schizophrenia is partly by reason of a long-continued effort, a wholly unconscious effort, on the part of some person (s) highly important in his / her upbringing, to drive him / her crazy. A guardian, is supposed to nourish the child and help them grow as an individual. Searles (1956) claims that there are situations where the custodian in fact does the opposite, hence inflicting insanity upon the child. One of such methods is assault by the parents in the sense of eliminating their own psychosis by inflicting it upon the child.
Another method is when a parent sexually arouses the child which causes and internal conflict for him; One the one hand, his sexual needs and on the other hand, the “super-ego relations”, or the cultural view against incest. Furthermore, parents of schizophrenics have often pleaded for sympathy and understanding. And yet rejected the child’s attempts to be helpful, leaving the child to feel worthless. “Neuropsychiatric studies using modern brain-imaging techniques are rapidly redefining schizophrenia. Physical and chemical changes found in the brain have largely discredited beliefs that environment, attachment, family interactions, or stress causes schizophrenia.” Edward H. Taylor (1986) states contradicting Searles.
Modern techniques are engaged in learning how the brain’s frontal lobes, temporal lobes, and limbic system affect schizophrenia. The is responsible for organizing, screening, and synthesizing the information it receives from the rest of the brain. So far research indicates that “abnormalities in the limbic system of human beings may produce… distortions of perception, illusions, hallucinations, feelings of depersonalization, paranoia, and catatonic like behaviors… in short, the symptoms of schizophrenia.” These new revelations are due to innovations in technology such as the CAT scan, the MRI, the PET scan, the rCBF, and the BEAM. The CAT scan provides a two-dimensional black and white x-ray style photograph of the surface and inner tissue of the brain.
CAT scan researches have found that schizophrenics have enlarged lateral and third ventricles and a decrease in the size of the brain (cortical atrophy). Those schizophrenics with more prominent differences have on an average a higher neurological impairment, a poorer potential of rehabilitation and possibly a higher suicide risk. The MRI is replacing the CAT scan because in its two dimensional cross-sectional pictures, it is able to focus on more restricted areas of the brain. PET scan’s have proven that schizophrenics have reduced frontal lobe functioning because this machine shows brain activity by portraying it as a color. The rCBF is a technique that records the rate and volume that blood moves throughout the brain. This confirms the theory that schizophrenia is caused by alterations in the frontal lobe, as research using this technique show that medicated and non-medicated schizophrenics demonstrated notably low frontal lobe activity during problem-solving question and answer sessions.
The BEAM confirms the hypothesis even further as it detects high levels of delta activity in the frontal cortex of schizophrenics. Although no single reason has been developed, Encarta (2001) agrees with both Searles and Taylor, in that heredity and / or being raised by a parent with a disorganized personality can develop into schizophrenia. NIMH (1999) reports that schizophrenia runs in families, an identical twin of a schizophrenic has a 40% to 50% chance of obtaining this disease. The child of a schizophrenic has a 10% chance. Furthermore, it is argued that prenatal problems and dysfunctions in chromosomes 13 and 6 can lead to schizophrenia. This is a logical deduction considering the fact that schizophrenia does not emerge until early adulthood.
The human brain does not completely develop until this time, especially in the frontal lobe, which is why the disease that is present from birth does not appear until the said age. Bearing in mind the fact that the causes of schizophrenia are not known, only assumed, current treatment for the disease rely on clinical research and experience. NIMH (1999) states that anti-psychotic medications reduce the psychotic symptoms of the illness and permit the individual to act normally. It should be emphasized that these medications do not cure the disease or ensure that there will be no outbreaks in the future, hence why it is important for the individual to adhere to their doctor’s instructions on amount and frequency of taking their medications. Newer anti-psychotic drugs such as (Risperdal) and (Zyprexa) are safer and tolerated better than older drugs. These drugs treat hallucinations and delusions, but not so much a schizophrenic’s reduced motivation and emotional expressiveness.
Of course there are many cases of schizophrenic who stop taking their medication because a) they believe they are not sick and do not need them, b) they think or are told that they are better and do not need them anymore, or c) because of the disease they forget to take them. The reduction or termination of the medication will surface the psychotic symptoms. If these produce a problem, one can get a shot of H aldol, Prolizin, or Tri lafon so that the schizophrenic cannot stop taking the medication or do not have to take pills daily. Encarta (2001) proclaims that long-term side effects can include an incurable disease called tar dive, which is evident by peculiar movements of the mouth and tongue, or other body parts. NIMH (1996) claims that medications also cause weight gain, social withdrawal, and symptoms resembling Parkinson Disease.
In addition to medication, a schizophrenic and his or her family can get psychosocial treatment. This is important because medication does not reduce the behavioral symptoms of schizophrenia. NIMH (1996) lists four forms of treatment: rehabilitation, individual psychotherapy, family education, and self help groups. Rehabilitation programs provide assistance in vocational and social aspects. Since the disease appears in between 18 and 35 years of age many schizophrenics have problems in these areas. Generally these programs include occupational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training.
Overall it helps the individual live a life outside of a mental institution. Individual psychotherapy is counseling between the sick individual and a psychiatrist, psychologist, or psychiatric social worker. Sessions with a mental health professional can help the individual learn more about their illness as well as a comfortable ‘free’ area a patient can go to discuss any problems he or she might be having. Family education is important for the family members of the sick individual as most schizophrenics are released into their family’s care. It helps the family members learn to see “early warning signs” of probable relapse as well as different methods of problem solving. Self-help groups are for both the schizophrenic individual as well as their families.
These groups are not led by professionals, but rather are groups of schizophrenics and their families leaning on each other for psychological support. Works Cited American Psychiatric Association (1996). Diagnostic Criteria from DSM-IV (4 th ed. ). Washington, DC: Author.
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133-148. Taylor, Edward H. The Biological Basis of Schizophrenia (1986). New York University School of Social Work-Journal of Human Behavior in the Social Environment. 51-57. National Institute of Mental Health.
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