Schizophrenia spectrum and other psychotic disorders

Schizophrenia is a severe mental disorder characterized by abnormal interpretations of reality. Its main feature is the impossibility of distinguishing reality from the imaginary. It is a chronic condition necessitating life-long treatment. The term ‘schizo’ does mean ‘split’ as in having a ‘split mind’, but it should not be confused with multiple personality disorder.

Schizoaffective disorder is a disorder that represents a combination of schizophrenic symptoms and mood disorder features. The mood disorder is either bipolar or depression.

Causes

Schizophrenia

An exact cause is yet to be determined, but it is commonly agreed upon that responsible for the onset of the illness is a combination of factors:

Genetics – the disorder tends to run in families

Environmental factors – viral infections, highly stressful situations

Brain chemistry changes – in people with schizophrenia, issues related to certain neurotransmitters (dopamine and glutamate) have often been encountered

Differences in brain structure

Exposure to toxins or malnutrition in the womb, especially in the first and second trimesters

Inflammation or autoimmune diseases

Old age of father

Taking psychoactive or psychotropic drugs during teen years or young adulthood

 

Schizoaffective disorder

The same as in the case of schizophrenia

Symptoms and signs

Schizophrenia

Cognitive, behavioral and emotional problems indicating functional imparity

Episodes comprising hallucinations and delusions are termed psychotic in nature, meaning that a break from reality has been experienced

Delusions:

False beliefs not based on reality such as:

Believing external forces are controlling one’s thoughts, feelings and behavior

Believing external events or objects have personal meaning

Thinking one has special powers, or is on a special mission

 

Hallucinations:

Seeing or hearing things (most common symptom) that do not exist, rendering the full impact of an otherwise normal experience

Voices telling one to commit acts of violence or self-harm

Sensing ‘something is crawling under the skin’

Seeing someone taking the shape of something else

 

Disorganized thinking and speech:

Effective communication is impaired

Odd ramblings not related to the actual conversation

Meaningless words, randomly put together can rarely occur in speech

Disorganized or abnormal motor activity:

A wide range – from childlike behavior to unpredictable agitation

No focus on actual goals

Resistance to instructions, inappropriate posture, complete lack of response or useless and excessive movement

Negative symptoms (aforementioned signs are classified as positive):

Withdrawal from both family and friends

Lack of performance in work or at school, lack of motivation

Trouble sleeping

Irritability

Depressed mood

Suicidal ideation and behavior

 

Schizoaffective disorder

Delusions

Hallucinations

Major depression episodes

Possible periods of mania

Impaired social and occupational functioning

Problems in maintaining levels of cleanliness

Odd physical appearance

Paranoia

Suicidal thoughts and behavior

Advice

Medications are the most effective in the treatment of schizophrenia and schizoaffective disorder – antipsychotic drugs and atypical antipsychotic drugs (fewer side-effects)

Psychosocial interventions:

Individual therapy

Social skills training

Family therapy

Vocational rehabilitation and supported employment

Combining therapies usually results in a good management of the condition, though willingness to participate in the treatment is crucial

MISCONCEPTIONS
  • Schizophrenia is the same as multiple personality disorder

    Schizophrenics suffered from an abuse during childhood

    People with schizophrenia are easy to recognize due to their visibly eccentric behavior – those are classifiable as positive symptoms, while negative ones manifest in seeking little contact with the external environment

    People with delusions are aware of them

    The illness deteriorates in time – it is mostly episodic in nature and interspersed with periods of recovery

    People with schizophrenia are always violent – most seem to prefer withdrawing during psychotic episodes

    Hospitalization is required – in fact, outpatient treatment is the norm, while patients live independently

Statistics

Schizophrenia

Schizophrenia symptoms usually start in the early to mid-20s, in men, while in women signs usually start in the late 20s

It’s uncommon for children or people over 45 to be diagnosed with schizophrenia

The disorder affects about 1% of the world’s population

In the U.S. approximately 3.2 million people suffer from the illness

Peak of vulnerability in terms of onset – between the ages of 16 and 25

Males reach the above peak once during their lifetime

Females reach a peak between the ages of 25 and 30 and later, around the age of 40

 

Schizoaffective disorder

It occurs equally in men and women

Males usually experience onset earlier than females

It affects about 0.3 of the U.S.’s population

Did you know?

Full onset is typically preceded by a period called ‘prodromal’ – odd behaviors and experiences, anxiety, hallucinations begin to occur

It is generally recognized only after external confirmations from those around of definite changes in behavior and appearance

The schizophrenic symptom-rich period (since it seems to work on a cyclical basis) is called ‘florid’ psychosis

Schizophrenia should not be confused with schizoaffective disorder, which is a mix of mental health conditions

Schizophrenia should also not be confused with schizoid or schizotypal personality disorders, which are milder forms of disorders, and do share certain similarities with schizophrenia, while delusions and hallucinations rarely occur and are much less intense in manifestation

 

According to exhibited symptoms, the disorder can be classified as:

Paranoid schizophrenia – extreme suspicion, persecution, grandiosity

Disorganized schizophrenia – incoherence in thought and speech, but may not experience psychotic episodes

Catatonic schizophrenia – negative symptoms

Residual schizophrenia – no longer experiencing psychosis, but no interest in life

Schizoaffective disorder

 

Famous people with schizophrenic/schizoaffective disorders: John Nash, Zelda Fitzgerald, Vincent van Gogh, Vaslav Nijinski (ballet dancer), Ted Kaczynski (serial killer – “Unabomber”), Syd Barrett (founder of Pink Floyd), Rufus Watson (son of Nobel Prize Winner for co-discovering the DNA structure, Dr. James Watson), Philip K. Dick, Jack Kerouac, Elyn Sacks (high-functioning professor of Law, Psychology, Psychiatry, and Behavioral Sciences at the University of Southern California Gould Law School), Eduard Einstein (son of Albert Einstein), Adèle Hugo (daughter of Victor Hugo), Marilyn Monroe (suspected of schizoaffective disorder)