Schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. For a diagnosis, symptoms must have been present for six months and include at least one month of active symptoms.
The word schizophrenia comes from Greek roots, schizo meaning split and phrenia meaning mind, to describe the fragmented thinking of people with the disorder. Schizophrenia was actually first identified in 1887, but can be traced back to thousands of years ago, which means that it has been recurring throughout history. Schizophrenia was coined in 1911 by the Swiss psychiatrist, Eugen Bleuler.
Symptoms of schizophrenia
Positive symptoms of schizophrenia
Positive symptoms are when something added to individual experience that is not experienced by other people.
Delusions are fixed beliefs that are not amenable to change in the light of conflicting evidence.
A delusion is a belief that is completely false and that indicates a problem in an individual thoughts content. This false belief is not due to person’s cultural or religious background or his or her level of intelligence. The important feature of a delusion is the degree to which the person is convinced that the belief is true. A person with a delusion strongly believed on his/her beliefs without any evidence. A person with a delusion is absolutely convinced that the delusion is real.
There are two categories of delusions
A bizarre delusion is a type of delusion that is completely impossible; in the example of a bizarre delusion would be that, a person thinks that aliens removed the brain.
Types of bizarre delusions
Nihilistic delusion. Nihilistic delusion involve the conviction that a major catastrophe will occur. For example; a person with this type of delusion may have the false belief that the world is ending.
Delusions of control. Belief that one’s thoughts or actions are being controlled by outside, alien forces.
Thought broadcasting. People with this type of delusion believe that “My own thoughts are being transmitted to others”.
Thought insertion. With this type of delusion people think that “another person or external force puts thoughts into mind.
Thought withdrawal. This type of delusion include belief that one’s thoughts have been removed by some outside force.
Types of non-bizarre delusions
Persecutory delusion. This is the most common type of delusion that involve the theme of being followed, harassed, cheated, poisoned or drugged, or attacked by an individual organization or other group. People with this delusion sometimes isolated and fragmented due to the false belief that co-workers are harassing. A person with a set of persecutory delusions may be believe, for example, that he or she is being followed by government organizations because the “persecuted” person has been falsely identified as a spy.
Delusion of reference. A person falsely believes that insignificant remarks, events, or objects in surrounded environment have personal meaning or significance. For example, a person may believe that he or she is receiving special messages from the news anchorperson on television. They usually assigned negative meaning to these events or messages.
Erotomania. A delusion in which individual believes that another person usually with higher status, is in love with him or her.
Grandiose delusion. An individual believes that he or she has some exceptional powers, talents, or abilities. Sometimes, and the individual believe that he or she is a famous person (for example, a rock star, famous writer and business man etc). More commonly, a person with this delusion believes he or she has accomplished some great achievement for which they have not received sufficient recognition.
Delusional jealousy. People with this delusion falsely believes that his or her spouse or lover is having an affair or he or she is not fair with them.
Somatic delusion. A delusion whose content pertains to bodily functioning, bodily sensations, or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal, or changed. An example of a somatic delusion would be a person who believes that his or her body is infested with parasites.
Hallucination are perception like experiences that occur without an external stimulus. They are vivid and clear with full force and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia and other psychotic disorder. Visual hallucinations are also relatively common.
Peoples with schizophrenia have problem in organizing ideas and in speaking so that a listener can understand. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech include:
• Loose associations. Rapidly shifting from topic to topic, with no connection between one thought and the next.
• Neologisms. Made-up words or phrases that only have meaning to you.
• Perseveration. Repetition of words and statements; saying the same thing over and over.
• Clang. Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head”).
Schizophrenia negatively impacts goal-directed behavior. A person with disorganized schizophrenia is likely to have difficulty beginning a specific task or difficulty finishing a task. Independent functioning is exceptionally difficult due to this gross disorganization.
Disorganized behavior can manifest as the following:
• A decline in overall daily functioning
• Unpredictable or inappropriate emotional responses
• Lack of impulse control
• Behaviors that appear bizarre or lack purpose
• Routine behaviors such as bathing, dressing, or brushing teeth can be severely impaired or lost.
Negative symptoms of schizophrenia
Negative symptoms mean absence of a behavior from individual behaviors.
Avolition. Apathy or avolition, refers to a lack of motivation and a seeming absence of interest in or an inability to persist in what are usually routine activities, including daily work, hobbies, or social activities.
Asociality. Asociality refer to impairment in social relationships. People with schizophrenia may have few friends, poor social skills, and very little interest in being with other people. People lost interest in close relationships and they wish to spend much of their time alone.
Anhedonia. Loss of the capacity to experience pleasure. The inability to gain pleasure from normally pleasurable experiences.
Blunted Affect. Blunted affect refers to a lack of outward expression of emotion. A person with symptom may stare vacantly, the muscle of the face motionless, the eyes lifeless. When spoken to the person may answer in a flat and toneless voice and not look at his or her conversational partner.
Alogia. Alogia refers to a significant reduction in the amount of speech. A person with this symptom may answer a question with one or two words and will not be likely to elaborate answer.
Stages of schizophrenia
Prodromal Stage. Prodromal stage is the first stage and refers to the period of a time before the illness begins to manifest. The term ‘prodrome’, which is derived from ‘prodromos’ – is a Greek term which means something that appears before an event that give the signal for the occurrence of the event.
People in this stage of schizophrenia isolate themselves from others, they will prefer to stay in their rooms, and they sleep most of the day and not want to see friends or family. Their performance in school or workplace goes worst due to their low motivation level as well as a loss of interest in things they once found joy in.
At this stage, close friends and family of individuals are able to feel that something is wrong with the person and they may predict that he or she will develop schizophrenia. They may suspect the changes in personality and behavior.
Acute Stage. The acute or active stage of a disorder is when someone is starting to show symptoms of schizophrenia that are psychotic in nature. These include delusions, hallucinations and/or extremely disorganized behavior. This stage represents the full development of schizophrenia – and it can be said that the disorder has ‘activated’.
In this stage diagnosis is possible due to psychosis. The behavior of the patient may become serious enough to require hospitalization. When symptoms treated, many of the symptoms can disappear. If this stage is not treated, the symptoms of disorder can last from several weeks to months, or even indefinitely. For many people with schizophrenia, this stage is characterized by symptoms that are positive for schizophrenia.
Residual Stage. This is known as the final stage of schizophrenia. These symptoms are very similar to those of the prodromal stage. Patients in this stage are often not seen to be psychotic, but their symptoms shift from positive to negative. These symptoms are:
• Lack of enthusiasm, energy or interest, experiencing extreme apathetic emotions.
• Lack of social activities.
• Lack of initiative and drive.
Although the symptoms in this stage may not be psychotic, the person suffering from schizophrenia may still express beliefs that are strange.
A 20 years old girl starts to act out, sleep more and isolates herself from her friends (prodromal stage), some of her family and friends think that maybe she has a study issue. She then starts to believe that her teacher don’t like her and will harm her. Her friends make fun of her beliefs and refused to agree with her thoughts. After this she becomes quiet and afaired from her teacher and avoid to face her teacher. Her mom then notices that she may need help and takes her to see a doctor. He then diagnoses her with schizophrenia after hearing about her bizarre beliefs (acute/active stage).
Then she gets the treatment that she needs, her symptoms are managed and she is somewhat able to return to a normal life. She now only believes that the teacher does not like her but he will not harm her. (Residual stage).
Biopsychosocial Model of Schizophrenia
Schizophrenia is a serious psychotic disorder. Many factors contribute in developing schizophrenia, and they may be biological, psychological and social factors. Researchers state that no single factor found that cause schizophrenia.
Risk for schizophrenia appears to begin as early as the first trimester in pregnancy, with exposure to influenza associated with increased risk of later developing schizophrenia (Brown et al., 2004). Other prenatal factors are also implicated in the second and third trimesters. These include maternal rubella and respiratory infections, low socioeconomic class, maternal deprivation resulting from war or famine, urban birth, obstetric complications, and birth in late winter/early spring (Dohrenwend, 1992; Murray, 1987; Marcelis, 1999; & Susser, 1996).
A risk for schizophrenia is inherited. Twin studies have been pivotal in verifying a genetic predisposition: The more closely one is related to an individual with schizophrenia, the greater the risk of contracting the illness. The prevalence in the general population is 1 %. The disease occurs in all cultures and people around the world (with rare exceptions), and with similar genetic risk estimates. The monozygotic twin of a person with schizophrenia, who shares the same genome, has a 40% to 50% risk of contracting the illness; this number represents not only a 50% genetic risk, but also a 50% non-genetic risk, each operating in the manifestations of the illness. (Kendler, Diehl, 1995)
Catastrophic pre- or perinatal events, like exposure to famine, radiation, or a maternal viral illness, especially during the second trimester, are significant risk factors for schizophrenia. As researches shown that perinatal events like toxemia and hypoxia at birth are also risk factors for schizophrenia, and those children who are born in the winter season. (Hirsch SR et al., 1995)
Another factor explain in the biological explanation of schizophrenia is loss of brain tissues. As research shows that in MRI studies of schizophrenia, the most consistent findings include reduced gray matter volumes of the medial temporal, superior temporal, and prefrontal areas. These are regions on which episodic memory, processing of auditory information, and short-term memory/decision making, respectively, are critically dependent. Gray matter abnormalities in schizophrenia are partially hereditary, as shown in twin and candidate gene studies, and they are partially modulated by intrauterine risk exposures such as fetal hypoxia. ( Bradbury & Miller, 1985).
Due to loss of brain tissues thalamic shrinkage occur which causes enlargement of first and third ventricles which is also hypothesized as a cause of Schizophrenia. It is also hypothesized that schizophrenia is caused by some chemical changes in brain. When increased level of dopamine released to brain pathways, cause positive and negative symptoms of schizophrenia. It’s also found that any traumatic brain injury or neurological disfunctioning can contribute to development of schizophrenia.
In the development of psychotic problems there are also many psychosocial factors that trigger the problem. Maternal stress during pregnancy and unwanted pregnancy cause schizophrenia in offspring in later life. (Myhrman et al., 1996). Exposure to environmental stressors or changes during prenatal can cause schizophrenia in children. (Duursen et al., 1999). Prenatal loss of the father or any loved one has also been examined as a form of prenatal stress. As the research shows that there was a significantly higher number of individuals diagnosed with schizophrenia in a psychiatric hospital whose fathers died before their birth than a control group whose fathers died during the first year of their lives. ( Huttunen ; Niskanen, 1978). Birth of child in urban areas increase risk for schizophrenia in child’s later life, research prove that, the risk for a psychotic disorder was linearly associated with the level of urbanicity of place of birth: the incidence of psychotic disorder was found to be the highest in the most urbanized areas.( Marcelis, Mateu, & Murray, 1998). A child who were abused before the age of 16 have higher risk for developing psychotic symptoms. (Bak et al., 2004). Childhood traumatic experiences were mostly associated with psychotic illness rather than other types of psychiatric illness. (Farrell et al., 2004). It is also observed that stressful life event at late age can trigger or relapse to schizophrenia. Many researches shown that there are high chances of developing schizophrenia in migrants and minorities, and it’s due to social isolation, discrimination and adjustment issues that may lead them towards the problem. (Cantor, 2005).
Socio economic status and family environment play important role in wellbeing of an individual. Low socio economic status and disturbed family environment leads an individual towards schizophrenia. People from low socio economic status face many problems like poor environment, improper diet, unavailability of health services, good education etc., which produce irritability social isolation and other problems which lead them to this problem. Many researches shown that children from separated family or those who have poor relationship with parents or family member are more vulnerable for schizophrenia in adult age.