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>Schizophrena |
| Schizophrenia |
" Suspicious and frightened, the
victim fears he can trust neither his own senses, nor the motives of other people…his
skin prickles, his head seems to hum, and 'voices' annoy him. Unpleasant odors choke him,
bright and colorful vision pass before his eyes. When someone talks to him, he hears only
disconnected words. When he tries to speak, his own words sound foreign to him."
(Yolles, 1967)
Schizophrenia is a disturbance of form and content of thought. It affects the mood of
the person and the sense of self in relationship to the external world. The behavior of
schizophrenics may be apparently purposeless. They distort reality, and withdraw from the
society. They have a disorganized and fragmented perception, thought and emotion. Often
schizophrenia develops slowly and insidiously. The early clinical picture may be dominated
by seclusiveness, gradual lack of interest in the surrounding world, excessive
daydreaming, blunting of affect, and mildly inappropriate responses. |
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Causes of
Schizophrenia |
| There is no conclusive evidence for the causes of
Schizophrenia. There are various theories to explain the development of this disorder. Biological
factors:Biological factors include heredity, biochemical factors and
neurophysiological factors.
Genetic factors play an important causal role. It has been found that the incidence of
schizophrenia among children of schizophrenic parent/s is very high.
The presence of some chemical agents in the bloodstream, even in minute amounts, can
produce profound mental changes. Lysergic acid (LSD) and mescaline can lead to a temporary
disorganization of thought processes.
Neurophysiological factors are due to abnormalities of brain chemistry.
Psychological factors: Psychic trauma, pathogenic parent child and family
interactions, destructive marital interactions, pseudo mutuality - where family
relationships often had the appearance of being mutual, understanding and open, but in
fact were not - and role inflexibility, that is, rigid and depersonalized family role
structure. Others include faulty communications between parent and child, faulty learning and
coping, deficient self-structure and exaggerated use of ego defense mechanisms.
Sociological factors: Though disorder of thought and emotion are common,
cultural factors also influence the type and symptom content of schizophrenic disorders
that occur. Defeat in close interpersonal relationships and split between an
individual’s false outer self and his true inner self results in psychotic breakdown,
which usually takes the form of schizophrenia.
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Types of
Schizophrenia |
| Acute type: Acute schizophrenia may be found
suddenly in a person whose behavior was previously relatively normal. Here the individuals
feel perplexed, confused, depressed, suffer emotional turmoil, and undergo delusions of
reference and excitement. They have a dreamlike dissociation, and sometimes are fearful,
experiencing qualities of nightmare. Individuals seem to undergo massive breakdown of
filtering processes. Though the individuals do not remain in the state of acute
schizophrenia for a sustained period and recover within few months, such episodes keep on
recurring. Paranoid type: Paranoid patients show a history of severe
suspiciousness and difficulties in interpersonal relationships. The attention that they
receive prompts them to develop delusions of grandeur and makes them believe that they are
extraordinary beings. They experience delusions and hallucinations and are impaired of
critical judgement. They behave in an erratic, unpredictable and sometimes dangerous
manner.
Catatonic type: Individuals having psychomotor disturbances with extreme
withdrawal or extreme excitement symptoms are said to have catatonic schizophrenia. In
withdrawal reaction the individuals may sit motionless for hours or even days in a
stereotyped position. Any efforts to change their position are confronted with stubborn
resistance. In extreme excitement reaction the individuals may talk or shout suddenly
incoherently, pace rapidly, and engage in uninhibited, impulsive, and frenzied behavior.
In this state, the individual may be dangerous. Some catatonic patients are very
suggestible and obey commands or repeat the actions of others (echopraxia) or
repeat the words in a particular way (echolalia).
Disorganized or hebephrenic type: Occurring at an early age, hebephrenic
reaction represents severe disintegration of personality. They have loose associations and
are frequently incoherent. Their emotional experience is shallow and is characterized by
inappropriate laughter, silliness, and peculiar mannerisms.
Simple Type: Simple schizophrenia is often found to begin in early adolescence.
Individuals having simple schizophrenia are insidiously depleted of thought, affect and
behavior. Their interest in external activities, interests and attachments progressively
decreases and they tend to withdraw from social relationships.
Childhood Schizophrenia: Preoccupation with fantasy, and markedly atypical and
withdrawn behavior prior to puberty is common. The individuals are immature, withdrawn,
and fail to develop an identity separate from mother. There may be symptoms of autism
(dominated with subjective self-centered thoughts).
Chronic undifferentiated type: Though chronic undifferentiated schizophrenia
definitely has symptoms in thought, affect, and behavior, it cannot be classified under
one of the other types (mentioned above).
Latent type: Individuals have various symptoms of schizophrenia but lack a
history of full-blown schizophrenic episode.
Residual type: Individuals in remission following a schizophrenic episode show
mild indications of schizophrenia.
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Symptoms |
Breakdown of perpetual filtering
By means of complex processes of filtering, individuals can selectively attend to and cope
with the great mass of incoming sensory information to which they are exposed. In this way
they perceive their world in an orderly and meaningful way. Schizophrenics, by contrast,
are apparently unable to screen out distractions or to discriminate between relevant and
irrelevant input. They are highly sensitive to stimuli of all kinds- from both internal
and external sources- and are unable to integrate their perceptions into a meaningful
pattern.Disorganization of thought and emotion
Schizophrenics have difficulty in concentrating, impaired ability to sort relevant from
irrelevant stimuli and to maintain order in the association of thoughts, and a marked
reduction in problem-solving and decision-making ability. Since emotions are strongly
influenced by cognitive processes it is not surprising that the disorganization of thought
is accompanied by distortions in affective responses.
Anxiety and panic
Individuals experience loss of control over their thoughts and feelings in the intense
anxiety and panic that characterize the acute schizophrenic reaction.This happens when the
individuals cannot filter incoming stimuli and attend selectively, when they are plagued
by racing thoughts or are 'locked in' on a particular theme, and when their thoughts don't
line up with their feelings. Not only does the disorganization of thought and emotion
involve the environment, it involves the self structure as well. The self, which normally
functions as the integrating core of the personality, become diffused, fragmented, and
chaotic. Individuals may experience varying degree of confusion concerning who and what
they are, accompanied by some measure of depersonalization. The loss of control over their
thoughts and feelings combined with the fragmentation of the self and a sense of
depersonalization adds up to acute panic.
Delusions and hallucinations
For many schizophrenics the inner turmoil and anxiety are accompanied by delusions
- beliefs maintained despite their logical absurdity or objective evidence showing
they lack any foundation in reality. The Schizophrenics may also evidence hallucinations-
the perception of objects and events without any appropriate stimuli. Thus they may hear
voices telling them what to do or commenting on or criticizing their actions. In some
instances the voices are ascribed to relative or friends, in others to 'enemies', and in
still other cases the messages received "from God" or from some organization and
tell them of great powers that have been conferred on them or of their mission to save
humanity.
Auditory hallucinations are the most common, visual and other sensory modalities are
also involved. Schizophrenics may see angels in heaven or some noxious gas that has been
injected into their room, or taste poison in their food. As in the case of delusions, the
disorganization and fragmentation of thoughts and experience distort their evaluations of
stimuli.
Withdrawal of reality
In acute Schizophrenic episodes, individuals tend to withdraw temporarily from interaction
with others and become preoccupied with their own inner world of experiencing. In chronic
cases, the withdrawal tends to be more enduring. Individuals withdraw themselves from the
aversive external world into their own private world.
This leads to a loss of interest in people and events in the 'real' world. Efforts to lead
or force the patient back into the world of reality may arouse negativistic and hostile
behavior.
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Treatment |
| Until recent times, a number of medications have been
brought in to reduce the biochemical imbalances close to normal. Antipsychotic medications
are very effective in the treatment of delusions and hallucinations. These include
antianxiety drugs or minor tranquilizers to decrease apprehension, antidepressants to
elevate mood, major tranquilizers to control thought disorders. Though these drugs are
effective in the treatment and are used in combination with each other, they cause a wide
range of side effects - constipation, dry mouth, weight gain, lethargy, restlessness,
impotence, menstrual irregularities, cramps, dizziness, and stiffness of the limbs.These
side effects can be corrected by altering the dosage or by other medications-
psychotherapy or a combination of chemotherapy and psychotherapy. Psychotherapy is used
to help individuals correct thought disorders, reestablish bonds with reality, and
eliminate specific psychotic symptoms. Behavioral techniques are used to help individuals
learn behavior that lead to social acceptance. In severe and chronic cases,
hospitalization is often required to prevent self-inflicted harm or harm to others, and to
provide for the patient's basic needs of food, rest, and hygiene. They are taken care of
and helped to meet the challenges of daily life and get along with others.
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