SCHIZOPHRENIA:Prodromal Phase, Residual Phase, Negative symptoms

<< ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Integrated Systems

SCHIZOPHRENIA:Related Psychotic Disorders, Causes of Schizophrenia >>

Abnormal Psychology PSY404

Lesson 38

SCHIZOPHRENIA

Schizophrenia

Schizophrenia is a psychotic disorder. The most common symptoms of schizophrenia include changes

in the way a person thinks, feels, and relates to other people and environment. Psychosis is a state in

which individuals lose contact with reality. It frequently appears in the form of schizophrenia, a

disorder in which previously adaptive levels of social, personal, and occupational functioning deteriorate

into distorted perceptions, disturbed thought processes, deviant emotional states, and motor

abnormalities. Approximately 1 percent of the world's population suffers from this disorder. Many

clinicians believe that schizophrenia is a group of distinct disorders that share some common feature

1- Loss of contact with reality.

2- Deterioration at social, personal, and occupational level of functioning.

3-Distorted perceptions, disturbed thought processes, deviant emotional states, and motor

abnormalities.

4- Delusions defined as false beliefs based on incorrect inferences about reality.

5- Hallucinations are sensory experiences that are not caused by actual external stimuli.

Examples

i) Mr. A was first hospitalized for hearing voices ten years ago when he was in senior school. His

medications have now seemed to prevent his bizarre beliefs and odd behavior but he has never been

able to stay at school or work.

ii) Mr. B had his first psychotic episode during college, he manifested paranoid delusions that his mind

was controlled by forces that broadcast to him through radio waves and that he was sure that there was

a plot to kill him.

iii) A homeless woman collects empty bottles, cans and cartons from trash and last week she set up a

camp under a tree and spent days there. Regardless of the weather she wears in layers all the clothing

she possesses.

iv) A student reported to the department chairperson that one of her professors is plotting against her,

all the students are after her and the university doctor has plans to kill her.

These are all examples of people suffering from Schizophrenia.

Is Schizophrenia a disease like diabetes?

Or some overwhelming stress leads to Schizophrenia?

Do Schizophrenic people perceive and experience reality differently?

Can Schizophrenia be cured?

Why study Schizophrenia?

The answer to all these questions is complex and difficult.

· The most common symptoms of schizophrenia include changes in the way a person thinks, feels,

and relates to other people and the outside environment.

· No single symptom or specific set of symptoms is characteristic of all schizophrenic patients.

· Schizophrenia is officially defined by various combinations of psychotic symptoms in the absence

of other forms of disturbance, such as mood disorders (especially manic episodes), substance

dependence, delirium, or dementia.

Is Schizophrenia a disease like diabetes?

· Schizophrenia is a devastating disorder for both the patients and their families.

· It can disrupt many aspects of the person's life, well beyond the experience of psychotic symptoms.

Why study Schizophrenia?

· Schizophrenia also has an enormous impact on society.

187

Abnormal Psychology PSY404

Among mental disorders, it is the second leading cause of disease burden.

The onset of schizophrenia typically occurs during adolescence or early adulthood.

The period of risk for the development of a first episode is considered to be between the ages of 15

and 35.

The problems of most patients can be divided into three phases of variable and unpredictable duration:

prodromal, active, and residual.

1- Prodromal Phase

· The prodromal phase precedes the active phase and is marked by an obvious deterioration in role

functioning as a student, employee, or homemaker.

· Prodromal signs and symptoms are similar to those associated with schizotypal personality

disorder.They include peculiar behaviors (such as talking to one's self in public), unusual perceptual

experiences, outbursts of anger, increased tension, and restlessness.

· Social withdrawal, indecisiveness, and lack of willpower are often seen during the prodromal phase.

· Symptoms such as hallucinations, delusions, and disorganized speech are characteristic of the active

phase of the disorder.

2- Residual Phase

· The residual phase follows the active phase of the disorder and is defined by signs and symptoms

that are similar in many respects to those seen during the prodromal phase.

· At this point, the most dramatic symptoms of psychosis have improved, but the person continues

to be impaired in various ways.

· The symptoms of schizophrenia can be divided into three dimensions: positive symptoms, negative

symptoms, and disorganization.

a) Positive symptoms, also called psychotic symptoms.

· They are active manifestations of abnormal behaviors or an excess or distortion of normal behavior

include hallucinations and delusions.

· The symptoms of schizophrenia can be divided into three dimensions: positive symptoms, negative

symptoms, and disorganization.

· Positive symptoms are characterized by the presence of an aberrant response (such as hearing a

voice that is not really there).

b) Negative symptoms, on the other hand, are characterized by the absence of a particular response

(such as emotion, speech, or willpower).

· Hallucinations are sensory experiences that are not caused by actual external stimuli.

· Although hallucinations can occur in any of the senses, those experienced by schizophrenic patients

are most often auditory.

· Hallucinations should be distinguished from the transient mistaken perceptions that most people

experience from time to time.

· Hallucinations strike the person as being real, in spite of the fact that they have no basis in reality.

· They are also persistent over time.

· Many schizophrenic patients express delusions, or idiosyncratic beliefs that are rigidly held in spite

of their preposterous nature.

· Delusions have sometimes been defined as false beliefs based on incorrect inferences about reality.

· This definition has a number of problems, including the difficulty of establishing the ultimate truth

of many situations.

· In the most obvious cases, delusional patients express and defend their beliefs with utmost

conviction, even when presented with contradictory evidence.

· Delusional patients typically are unable to consider the perspective that other people hold with

regard to their beliefs.

188

Abnormal Psychology PSY404

Common delusions include the belief that thoughts are being inserted into the patient's head, that

other people are reading the patient's thoughts, or that the patient is being controlled by

mysterious, external forces.

Many delusions focus on grandiose or paranoid content.

In actual clinical practice, delusions are complex and difficult to define.

Their content is sometimes bizarre and confusing.

In contrast, negative symptoms involve deficits in normal behavior in the areas of speech

emotion and motivation, such as lack of initiative, social withdrawal.

Some additional symptoms of schizophrenia, such as incoherent or disorganized speech, do not fit

easily into either the positive or negative types.

Negative symptoms of schizophrenia are defined in terms of responses or functions that appear to

be missing from the person's behavior.

In that sense, they may initially be more subtle or difficult to recognize than the positive symptoms

of this disorder.

Negative symptoms tend to be more stable over time than positive symptoms, which fluctuate in

severity as the person moves in and out of active phases of psychosis.

Blunted affect, or affective flattening, involves a flattening or restriction of the person's nonverbal

display of emotional responses.

Another type of emotional deficit is called anhedonia, which refers to the inability to experience

pleasure.

Many people with schizophrenia become socially withdrawn.

The withdrawal seen among many schizophrenic patients is accompanied by indecisiveness,

ambivalence, and a loss of willpower.

This symptom is known as avolition.

A person who suffers from avolition becomes apathetic and ceases to work toward personal goals

or to function independently.

Another negative symptom involves a form of speech disturbance called alogia, which refers to

impoverished thinking.

In one form of alogia, known as poverty of speech, patients show remarkable reductions in the amount

of speech.

In another form, referred to as thought blocking, the patient's train of speech is interrupted before a

thought or idea has been completed.

c) Disorganization

· Verbal communication problems and bizarre behavior represent this third dimension, which is

sometimes called disorganization.

· Some symptoms of schizophrenia do not fit easily into either the positive or negative type.

· Thinking disturbances and bizarre behavior represent a third symptom dimension, which is

sometimes called disorganization.

· One important set of schizophrenic symptoms, known as disorganized speech, involves the

tendency of some patients to say things that don't make sense.

· Signs of disorganized speech include making irrelevant responses to questions, expressing

disconnected ideas, and using words in peculiar ways.

· This symptom is also called thought disorder, because clinicians have assumed that the failure to

communicate successfully reflects a disturbance in the thought patterns that govern verbal

discourse.

· Common features of disorganized speech in schizophrenia include shifting topics too abruptly,

called loose associations or derailment; replying to a question with an irrelevant response, called

tangentiality; or persistently repeating the same word or phrase over and over again, called

perseveration.

· Schizophrenic patients may exhibit various forms of unusual motor behavior.

189

Abnormal Psychology PSY404

Catatonia most often refers to immobility and marked muscular rigidity, but it can also refer to

excitement and overactivity.

Catatonic posturing is often associated with a stuporous state, or generally reduced responsiveness.

Another kind of bizarre behavior involves affective responses that are obviously inconsistent with

the person's situation.

The most remarkable features of inappropriate affect are incongruity and lack of adaptability in

emotional expression.

Brief Historical Perspective

· Descriptions of schizophrenic symptoms can be traced far back in history, but they were not

considered to be symptoms of a single disorder until late in the nineteenth century.

· At that time, Emil Kraepelin, a German psychiatrist, suggested that several types of problems that

previously had been classified as distinct forms of disorder should be grouped together under a

single diagnostic category called dementia praecox.

· This term referred to psychoses that ended in severe intellectual deterioration (dementia) and that

had an early or premature (praecox) onset, usually during adolescence.

· Kraepelin argued that these patients could be distinguished from those suffering from other

disorders (most notably manicdepressive psychosis) largely on the basis of changes that occurred

as the disorder progressed over time, primarily those changes involving the integrity of mental

functions.

· In 1911, Eugen Bleuler published an influential monograph in which he agreed with most of

Kraepelin's suggestions about this disorder.

· He did not believe, however, that the disorder always ended in profound deterioration or that it

always began in late adolescence.

· Kraepelin's term dementia praecox was, therefore, unacceptable to him.

· Bleuler suggested a new name for the disorder--schizophrenia.

· This term referred to the splitting of mental associations, which Bleuler believed to be the fundamental

disturbance in schizophrenia.

· DSM-IV-TR lists several specific criteria for schizophrenia.

· The first requirement (Criterion A) is that the patient must exhibit two (or more) active symptoms

for at least 1 month.

· The DSM-IV-TR definition also takes into account social and occupational functioning as well as

the duration of the disorder (Criteria B and C).

190

Abnormal Psychology PSY404

The DSM-IV-TR definition requires evidence of a decline in the person's social or occupational

functioning as well as the presence of disturbed behavior over a continuous period of at least 6

months.

The final consideration in arriving at a diagnosis of schizophrenia involves the exclusion of related

conditions, especially mood disorders.

Subtypes

DSM-IV-TR recognizes five subtypes of schizophrenia.

i) The catatonic type is characterized by symptoms of motor immobility (including rigidity and

posturing) or excessive and purposeless motor activity.

ii) The disorganized type of schizophrenia is characterized by disorganized speech, disorganized

behavior, and flat or inappropriate affect.

iii) The most prominent symptoms in the paranoid type are systematic delusions with persecutory or

grandiose content.

iv) The undifferentiated type of schizophrenia includes schizophrenic patients who display

prominent psychotic symptoms and either meet the criteria for several subtypes or otherwise do

not meet the criteria for the catatonic, disorganized, or paranoid types.

191

Abnormal Psychology PSY404

v) The residual type includes patients who no longer meet the criteria for active phase symptoms but

nevertheless demonstrate continued signs of negative symptoms or attenuated forms of delusions,

hallucinations, or disorganized speech. They are in "partial remission."

Schizoaffective disorder is defined by an episode in which the symptoms of schizophrenia partially

overlap with a major depressive episode or a manic episode.

People with delusional disorder do not meet the full symptomatic criteria for schizophrenia, but they

are preoccupied for at least 1 month with delusions that are not bizarre.

Brief psychotic disorder is a category that includes those people who exhibit psychotic symptoms--

delusions, hallucinations, disorganized or grossly speech.

Course and Outcome

· Schizophrenia is a severe, progressive disorder that most often begins in adolescence and typically

has a poor outcome.

· Follow-up studies of schizophrenic patients have found that the description of outcome can be a

complicated process.

· Many factors must be taken into consideration other than whether the person is still in the hospital.

Disorganized or catatonic behavior--may last for at least 1 day but no more than 1 month.

· One of the most informative ways of examining the frequency of schizophrenia is to consider the

lifetime morbidity risk--that is, the proportion of a specific population that will be affected by the

disorder at some time during their lives.

· Most studies in Europe and the United States have reported lifetime morbid risk figures of

approximately 1 percent.

· Most epidemiological studies have reported that across the life span men and women are equally

likely to be affected by schizophrenia.

· The average age at which schizophrenic males begin to exhibit overt symptoms is younger by about

4 or 5 years than the average age at which schizophrenic women first experience problems.

· Male patients are more likely than female patients to exhibit negative symptoms, and they are also

more likely to follow a chronic, deteriorating course.

Cross-Cultural Comparisons

· Schizophrenia has been observed virtually in every culture that has been subjected to careful

scrutiny. Two large-scale epidemiological studies, conducted by teams of scientists working for the

World Health Organization (WHO), indicate that the incidence of schizophrenia is relatively

constant across different cultural settings.

192

Table of Contents: