Understanding Schizophrenia

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The 2002 Academy Award winner for Best Picture, A Beautiful Mind, brought schizophrenia into the public eye, depicting the true story of the progression of the illness in a brilliant Nobel prize winner. As the film illustrated, schizophrenia makes It difficult for a person to distinguish between what is real and unreal, to think clearly, and to behave in socially acceptable ways. These obstacles can have a severe impact on one’s work, relationships, and day-to-day functioning. But as A Beautiful Mind also showed, with treatment and support, a person with schizophrenia can still lead a productive life.

What is schizophrenia?

Schizophrenia is a brain disorder that affects the way a person acts, thinks, and sees the world. People with schizophrenia have an altered perception of reality, often a significant loss of contact with reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. With such a blurred line between the real and the imaginary, schizophrenia makes it difficult—even frightening—to negotiate the activities of daily life. In response, people with schizophrenia may withdraw from the outside world or act out in confusion and fear.

Most cases of schizophrenia appear in the late teens or early adulthood. For men, the average age of onset is 25. For women, typical onset is around the age of 30. However, schizophrenia can appear for the first time in middle age or even later. In rare cases, schizophrenia can even affect young children and adolescents, although the symptoms are slightly different. In general, the earlier schizophrenia develops, the more severe it is. Schizophrenia also tends to be more severe in men than in women.

The most common early warning signs of schizophrenia include:

  • Social withdrawal
  • Hostility or suspiciousness
  • Deterioration of personal hygiene
  • Flat, expressionless gaze
  • Inability to cry or express joy
  • Inappropriate laughter or crying
  • Depression
  • Oversleeping or insomnia
  • Odd or irrational statements
  • Forgetful; unable to concentrate
  • Extreme reaction to criticism
  • Strange use of words or way of speaking

While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.

Delusions

A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of patients. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include:

  • Delusions of persecution — Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).
  • Delusions of reference — A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them.
  • Delusions of grandeur — Belief that one is a famous or important figure, such as Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).
  • Delusions of control — Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts.”).

Hallucinations

Hallucinations are sounds or other sensations experienced as real when they exist only in the person’s mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.

Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.

Disorganized speech

Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. 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 in schizophrenia 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 the patient.
  • 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.”).

Disorganized behavior

Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as:

  • A decline in overall daily functioning
  • Unpredictable or inappropriate emotional responses
  • Behaviors that appear bizarre and have no purpose
  • Lack of inhibition and impulse control.

Negative symptoms

The negative symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Important negative symptoms of schizophrenia include:

  • Flattened or blunted affect: Lack of emotional expression, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
  • Avolition: Lack of interest or enthusiasm; no ability to pursue goal-driven activities.
  • Catatonia: Apparent unawareness of the environment, near total absence of motion and speech, aimless body movements and bizarre postures, lack of self-care.
  • Alogia: Difficulties with speech, inability to carry a conversation, short and sometimes disconnected replies to questions, lessening of fluency.

“Positive” Symptoms of Schizophrenia

In contrast to the negative symptoms of schizophrenia, which refer to normal behaviors that are absent, positive symptoms refer to abnormal behaviors that are present. Delusions, hallucinations, disorganized speech, and disorganized behavior

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