#PSYCH Schizophrenia (1)

Schizophrenia is a psychotic disorder that affects the thought process by creating a lack of contact with reality. It has positive symptoms that add on to ‘normal’ thoughts and behaviour e.g. hallucinations; and negative symptoms that reduce ‘normal’ activity e.g. loss of drive.

Acute schizophrenia (type |) is severe but not necessarily life-long, it is mainly positive symptoms that can be treated with drugs.
Chronic schizophrenia (type ||) is permanent because it has more episodes and is mainly negative symptoms which a patient is less likely to recover from as there is no sure cure yet.
Schizophrenia is mainly developed in men (can affect women) aged 15-35 as at these ages people are more susceptible to drugs and alcohol abuse which can lead to schizophrenia. It could also be because those ages go through more stress from education or work.
Paranoid schizophrenia is the most common subtype; it consists of delusions of persecution (being spied upon), threatening voices and negative symptoms present yet not dominant.

Catatonic schizophrenia has dominant negative symptoms; such as patient in catatonic state, extreme loss of/constantly hyperactive motor skills, holding rigid poses for hours whilst ignoring external stimuli or even stereotyped repetitive movements. This can cause patients to suffer from exhaustion if not treated.

POSITIVE SYMPTOMS
Delusions are strange, unjustifiable beliefs; for instance delusions of grandeur makes patient believe they have magical powers or are someone important/famous. There is also delusions of persecution which the patient believes people ranging from neighbours to MI5 are directly victimizing them.
Hallucinations are strange perceptual experiences; one example is auditory hallucinations which causes patient to hear voices that threaten or command them in absence of external stimuli. Another example is tactile hallucinations, perceiving something/someone is touching their skin e.g. fromication is a sensation of insects crawling on your skin.
Thought disorder is odd, illogical reasoning such as disordered thinking/derailment/knight’s move thinking which is when discourse and thoughts seem to jump from one topic to another, for no apparent reason and show no logical flow of discussion schizophrenics may become frustrated with communication as speech might be muddled and incoherent causing others to find it hard to follow conversation. There is also thought insertion for when schizophrenics report that thoughts in their head is not their own, they believe it has been placed by a third party.
NEGATIVE SYMPTOMS
Alogia is reduced fluency of speech or poverty of speech; lack of meaning and even simple short answers can be a problem.
Anhedonia does not let patient react appropriately to pleasurable experiences e.g. rugby fan does not show pleasure if team wins.
Apathy is a loss of interest in normal goals.
Avolition is when there is a difficulty in initiating things, indifferent or are unconcerned with surroundings, no will or desire for work or personal activities even past enjoyed activities; distinct lack of goal directed behaviour e.g. staying at home, no motivation to eat or drink or get dressed.
Cataleptic stupor is standing motionless like a statue in bizarre postures, as well as making fast repetitive and useless movements e.g. energetically pacing or wandering in circles.
Disorganised speech is when there is very monotonous, inappropriate speech e.g. “it’s raining fruit trees in Summer”, no steady rise and fall in speech.
Disorganised behaviour is a severe disruption in ability to perform daily living activities such as showering, dressing, etc.
Echolalia is repeating others’ speech or accentuated imitation of other people’s mannerisms.
Echopraxia is mimicking movements of others around them.
Flat emotions is when no emotional response is given to any stimulus, immobile face, lifeless eyes, toneless speech, often staring vacantly.
Flattened affect is a reduction in range and intensity of emotions e.g. less eye contact, immobile face.
Inappropriate affect is out of context silliness and laughter e.g. laughing at terrible news.
Loss of drive is feeling drained of energy and unable to initiate or complete a course of action.
Reduced motor activity is a lack of spontaneous movement e.g. remaining still for hours (catatonia).

Reduced fluency of speech is rapid shifts from one topic to another e.g. repeat sounds, invent words.

ICD-10 International Statistical Classification Of Diseases (10th edition) is a medical classification list by WHO (World Health Organisation) for clinical practices in Europe, focusing on both physical and mental illnesses.

ONE very clear symptom from a-d
TWO less clear symptoms from e-h present for at least a month

A) thought echo, thought insertion/withdrawal and thought broadcasting
B) delusions of control, influence/passivity, specific thoughts, actions/sensations
C) hallucinatory voices commenting on patient’s behaviour
D) persistent inappropriate delusions e.g. superhuman abilities like controlling weather
E) persistent hallucinations as well as delusions for a long period of time
F) incoherent or irrelevant speech from breaking train of thought
G) Catatonic behaviour such as excitement, posturing or stupor and flexibility
H) negative symptoms
I) significant and consistent change in overall quality of some aspect of personal behaviour e.g. aimlessness, loss of interest or social withdrawal

LACK OF INSIGHT: Schizophrenics have difficulty accepting their diagnosis because they believe their hallucinations and delusions are real so they do not have the ability to see the impact of schizophrenia on their psychological functioning.

STIGMA: Schizophrenia is exaggerated in the media, causing it to be misunderstood, there are charities such as ‘time to change’ trying to defeat the negative stigma of mental illnesses.

DEPRESSION: It is difficult to state which behavioural characteristics are schizophrenia and which are depression as many symptoms (especially negative) are similar to mood disorders like depression.

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