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The Training and Education Center Network Mental Health Association of Southeastern Pennsylvania SCHIZOPHRENIA
A brain syndrome characterized by difficulties in thinking, perceiving reality, social functioning and self-care. There is currently no laboratory test which can tell us for sure that a person has Schizophrenia. To deal with this problem, American psychiatrists use a common set of conditions that must be present in a patient before they diagnose him/her as having Schizophrenia. These criteria are listed in a book called the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (widely known as the D S M – I V).
The term „Schizophrenia‟ is technically incorrect because it implies a single disease. It has come to be believed by some researchers that Schizophrenia may actually consist of a group of different diseases with different causes. SYMPTOMS OF SCHIZOPHRENIA:
See attached for DSM-IV criteria for diagnosing schizophrenia.
There is a wide variety of symptoms of schizophrenia, not all of which are mentioned in the DSM-IV. The following list of
symptoms is according to Dr. E. Fuller Torrey: Over sensitivity of the senses, e.g. normal Under sensitivity of the senses, e.g. inability to feel Flooding of the mind with thoughts and memories. Inability to interpret and respond to incoming sensations, and therefore, an inability to respond Loosening of associations or inability to sort out thoughts or coordinate them with the senses or Misinterpretation of visual or hearing cues, e.g., misidentifying people, inability to understand what Inability to select appropriate responses, e.g., Making up words, called neologisms. Stringing together series of unrelated words, called Hallucinations (sensory experiences with no external stimuli… most commonly, hearing voices.) Delusions (false ideas believed by the person, but not by other people in his/her culture.) Delusions experienced by persons with schizophrenia can Paranoid delusions: beliefs that one is being Grandiose delusions: beliefs that one owns wealth, special power, or that one is a famous Religious delusions: beliefs that one has Nihilistic delusions: beliefs that reality does horrible disease or a disease other than what Mind control: beliefs that one can control something else is putting thoughts into one‟s Thought withdrawal: delusion that someone or something else is taking one‟s thoughts. Thought broadcasting: delusion that one‟s thoughts are radiating out of one‟s head and events going on around one all relate to one in Difficulty distinguishing one‟s self from other Disassociation and detachment from one‟s body parts, e.g., believing one‟s arms and legs are separate from one‟s body and that they go their Exaggerated feelings, particularly guilt and fear, e.g., fear that a small thread from a sweater may Emotions inappropriate to a particular situation. Flattening of emotions, difficulty feeling one‟s feelings. Increased or decreased speed in movement. Repetitious movements, e.g., tics, tremors, sucking Catatonic behavior (remaining in one place or posture for a long time without responding to external stimuli). Ritualistic behaviors, postures, or gestures, e.g., walking through all doors backwards, rhythmically Socially inappropriate behaviors, e.g. walking THE CONCEPT OF POSITIVE AND NEGATIVE SYMPTOMS:
It has become increasingly popular for researchers to divide the symptoms listed above into two categories: Positive Symptoms: Experiences which are present, but should be absent, e.g., hallucinations, oversensitivity of the senses, loosening of associations, delusions. abilities which are absent, but should be present, e.g., lack of initiative, blunted feelings, poor personal hygiene, social withdrawal, inappropriate social behavior, poor See attached for a more complete list of positive and negative symptoms. Unfortunately, the traditional antipsychotic medications used to treat Schizophrenia can only control the positive symptoms. They do not affect and can sometimes worsen the negative symptoms. The Food and Drug Administration has approved Clozaril and Risperdal as drugs which can reduce both positive and negative symptoms in some patients who have not responded to the A particular person with schizophrenia may have only positive symptoms, only negative symptoms, or both at a particular point in time. The presence of positive and negative symptoms in a particular person can also change over the course of his/her illness. Selzer and his colleagues criticize the practice of grouping the negative symptoms together as if they have a common cause and will respond to a common treatment. Instead they propose the following five categories of “negative symptoms”, based on their ideas about all the possible factors that cause or contribute to negative symptoms, some of which can be influenced by the active effort of the patient and some by manipulation of Frontal brain dysfunction due to the illness (e.g., poor performance in tasks and interpersonal situations. Psychological responses to the illness (e.g., social Interaction of frontal brain dysfunction and psychological responses to the illness (e.g., lack of motivation, apathy, poor personal hygiene). Side effects of treatment (e.g., side effects of antipsychotic medications, effects of not being involved in Symptoms of Depression overlapping Schizophrenia (e.g., RECURRENCES OF THE ACUTE SYMPTOMS (“RELAPSE RATE”):
This question is difficult to answer because there have been many different conclusions, but the following statistics represent a summary of many different long-term follow-up studies of people hospitalized for schizophrenia: a. 25% were much improved, relatively independent. 25% were improved, but still required an 15% were improved, but still required an A common principle traditionally used by American psychiatrists to summarize the research on relapse rate is Approximately 1/3 of persons with Schizophrenia will completely recover without needing medication Approximately 1/3 of persons with Schizophrenia will improve, but not completely recover even when maintained on medication. However, the medication controls their symptoms and reduces relapse rate. An unfortunate 1/3 of persons with Schizophrenia will NOT improve. Their symptoms do not respond As someone who cares about an individual with Schizophrenia, is there anything I can do to help prevent relapse? YES!! You can start by learning as much as you can about Schizophrenia so that you know what it is that you, your relative, and the rest of your family are dealing with. The onset of the early or acute symptoms usually occurs when the person is experiencing emotional stress. Research shows that the risk of relapse is significantly higher during the 3 weeks after a stressful life change, whether positive or negative. Therefore, you can help by: Learning (and encouraging other family members to learn) ways to create a low-stress atmosphere Noticing sleeplessness for at least two consecutive nights, as sleep disturbance can be one of the Getting to know what your relative does and/or If you suspect your relative‟s condition is relevant) in case s/he wants to change the Attempting to pinpoint what stresses may be aggravating the illness, then reducing any of relative who acknowledges and manages the illness, let him/her know any signs of relapse you‟ve observed so s/he can take appropriate action, e.g., calling his/her treating professionals. CAUSES OS SCHIZOPHRENIA
Can I or anyone else cause schizophrenia? Recent research using modern brain technology supports the theory that Schizophrenia is a group of brain diseases that can be affected by, but not caused by the family or significant others. The type and extent of disease vary with each individual and may have different causes. Some research indicates that Schizophrenia primarily affects the brain‟s switchboard technically known as the limbic system. Other research indicates dysfunction in the brain‟s frontal lobe. It tends to run in families, but follows no simple mode of genetic transmission. Therefore, except for identical twins or children of 2 schizophrenic parents, the chances that blood relatives of a person with Schizophrenia will NOT have Schizophrenia are much, much greater than their chances of having it. (See genetic risk statistics It tends to begin between the ages of 16 and 25 (usually between 16 and 20 for males and between 20 and 25 for In the northern hemisphere, 5 – 15% more persons with Schizophrenia than could be expected are born during the peak season for the flu, in the late winter and early spring months. This and other data support the notion that some cases of Schizophrenia begin with damage to the brain early in life, possibly even by a virus, while the CAT scans of some persons with Schizophrenia show enlargement of some of the brain‟s fluid canals (ventricles). This enlargement does not seem to progress past age 20 and correlates with poorer response to We do not yet know for sure what causes Schizophrenia. However, many theories of cause have been proposed. These theories vary widely in the amount of research data that supports them: Theories which best explain what we know about Schizophrenia and are supported by research data that schizophrenia inherit brains that are “allergic” to stress, so that too much stress triggers the brain to malfunction. Schizophrenia is transmitted through the parents‟ genes and is then set off by some factor(s) in the environment, e.g., stress, diet, pollutants. Current research indicates that an individual‟s risk of developing Schizophrenia correlates with his/her genetic relatedness to a relative with Schizophrenia. person with schizophrenia schizophrenia having schizophrenia
Niece, nephew, aunt or uncle
virus which does not attack the brain until late adolescence. Biochemical Theories: The brains of persons with Schizophrenia have too much of certain chemicals that transfer nerve signals from one brain cell to another, e.g., the Dopamine Hypothesis: The overabundance of one of these chemicals called dopamine causes parts of the brain to malfunction. immune systems of persons with Schizophrenia, but the impact of this impairment has not yet been identified. Theories which are not supported by valid research data, Nutrition Theories (or orthomolecular psychiatry): The brain malfunction is caused by too much or too little of certain substances in one‟s diet. Schizophrenia as a result of emotional trauma in childhood caused by interactions with parents. Family Interaction Theories: Rather than suffering from an illness, a person with Schizophrenia is merely acting “crazy” as a way of surviving confusing communication or interaction patterns in the family. TREATMENT OPTIONS (for control of Schizophrenia):
Approximately 70% of persons with Schizophrenia clearly improve on these drugs, 25% improve slightly or not at From their 1986 comprehensive review of antipsychotic medication effectiveness studies, Anderson, Reiss, and About 10 – 20% of persons with Schizophrenia could avoid a relapse for 2.5 years without antipsychotics, but there is currently no way of effectively identifying these persons ahead of time. About 30% of persons with Schizophrenia who would relapse without antipsychotics remain well while taking them. About 40 – 50% of persons with Schizophrenia relapse within 2 years in spite of antipsychotics. The risk of the potentially serious and potentially irreversible side effect of tardive dyskinesia must be weighed against the likelihood of increased relapse without antipsychotic medication. Clinical studies indicate that clozapine leads to significant improvement in 30 to 60% of patients who have not responded to traditional antipsychotic medication. These improvements can include: Clozapine is also associated with a significantly lower incidence of tardive dyskinesia, a potentially irreversible neurological disorder caused by Weekly blood counts are required of patients on clozapine because of its potential to lower the white blood cell count (called agranulocytosis). This effect can lead to death if not detected early so the medication can be stopped. However, this blood monitoring adds to the considerable expense of Clinical studies indicate that Risperidone has the following beneficial effects for some patients: Few movement side effects, with substantial side effects in some individuals who had been It is not yet known whether Risperidone can cause Risperidone does not seem to cause lowering of the white blood cell count, as clozapine can, so blood monitoring is not necessary and this added Lithium in combination with antipsychotics can reduce hallucinations, delusions, and thought disorders in about Lithium is another alternative for persons with Schizophrenia who do not respond to antipsychotics. Regular blood counts are required of patients on Lithium because the therapeutic level in the blood is close to the toxic level. The patient‟s potential to manage this Tegretol in combination with antipsychotics can reduce hallucinations, delusions, thought disorders, and agitation in schizophrenic patients who are either violent or responsive to Lithium, but cannot be maintained on it As with Clozapine, blood counts are required of patients on Tegretol (at least initially) because of its potential to lower the white blood cell count. This effect can lead to Other potential serious side effects of Tegretol include aplastic anemia, hepatitis, and cardiac toxicity. The effects of therapy seem to depend on the form of Therapy * which focuses on restructuring the personality through the exploration of the patient‟s unconscious conflicts with significant others in early childhood has been found to be useless and in some cases harmful to persons with Schizophrenia. *(referred to as insight-oriented, psychodynamic, intensive, or exploratory therapy or psycho- Supportive therapy which focuses on the teaching of skills so that the patient can manage his/her daily activities in spite of the symptoms and disabilities of the illness can be very helpful, Therapy also varies in terms of who is included in the Family therapy: One patient and his/her family Multiple family therapy: Several patients and their Psychiatric or Psychosocial Rehabilitation: “The goal of psychiatric rehabilitation is to assure that the person with a psychiatric disability possesses those physical, emotional, and intellectual skills needed to live, learn, and work in his or her own particular environment. The major interventions by which this goal is accomplished involve either developing in clients the particular skills that they need to function in their environments and/or developing the environmental resources needed to support or strengthen the present level of functioning.” (Anthony, Cohen and Cohen, p. 70) Focuses on developing or maintaining vocational skills: Transitional or supported employment programs. Residential Programs for Transitional Living: Supervised living arrangements that focus on developing independent living skills at various levels of care. Focuses on developing social skills and/or providing opportunities for peer relationships to develop. Educational or “Psychoeducational” Approaches: Focus on educating patients and/or their families about the illness, medication, coping skills for managing the illness, and/or coping skills for managing the mental health system. National Mental Health Consumers Association, call National Alliance for the Mentally Ill (NAMI), call National Mental Health Association, call (703) 684-7722. National Depressive and Manic-Depressive Association, Focus is on developing a diet and/or vitamin regimen thought to reduce or eliminate symptoms of Schizophrenia. However, this treatment alone has had questionable results in controlling


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