Schizophrenia Talk

Publish date: Tue Feb 8, 2005
Tags: archives mental-health paper

Preface

While this article is done in the style of a research paper it should not be be mistaken for one. This paper represents my understanding and personal experiences with schizophrenia as of February 2005.

i. Introduction

Schizophrenia is often referred to as a neurobiological disorder1 which is a way of saying that it is a disease of the brain which affects the mind. The term neurobiological disorder is probably better to use than mental illness when talking to those not familiar with diseases of the brain because most of the lay public who hear the term ‘mental illness’ think that it means that the illness is ‘all in your head’, or, for certain religious groups, possession. This paper will attempt to cover things that people with schizophrenia experience so that the reader or friend knows they are not alone, as well as to help you understand this illness and the hope that now exists.

I. The Experience of Schizophrenia

The following is an attempt to enumerate a large number of symptoms that schizophrenics experience. It cannot be complete because every individual has a different response to disease, but I hope this list will help. It is important to note that this is intended to give you a feel for what someone with schizophrenia experiences and not as a guide to diagnosis. The diagnostic criteria are very specific and can be found in the appendix (which is taken from http://www.mentalhealth.com/dis1/p21-ps01.html and, in turn, from the Diagnostic and Statistical Manual IV (DSM-IV) – the official guide to diagnosing mental illness in Canada and the U.S.)

While many explanations of schizophrenia divide symptoms into so-called ‘positive’ and ‘negative’ symptoms, this section of the paper will not use that terminology because it is about illuminating what schizophrenia feels like. In case you are wondering the ‘positive’/‘negative’ terminology doesn’t mean good and bad symptoms, but rather that ‘positive’ symptoms are additions to reality (like hallucinations and brightened or muted colours), while ‘negative’ symptoms subtract from reality (e.g. anhedenoia and lack of motivation).

A. Disordered Thinking

Thoughts tumble out one after the other, seem to have no space in between each one, and can’t be stopped.

E.g. When talking about what I had for breakfast, I think of monkeys, then zoos, and then extinction of species. This author’s personal experience includes a time when ill, he tried to write an essay for English and couldn’t because his mind kept going on on tangents that had nothing to do with topic of the essay.

B. Delusions

These often overlap with paranoia and problems of reference.

C. Hallucinations (Voices and/or Visual)

Problems of Reference & Paranoia

Other

Cause: Current Theories

Genetic

Viral

Pregnant Mother

Father’s Age

Brain Structure

Neurotransmitters

Immune system dysfunction

Stress-Vulnerability

Street Drugs

Treatment

Not psychotherapy only

Medication alone

Medication & Psychosocial

Types of medication

What now?

Coping with continued symptoms and/or side effects

‘Positive’ Symptoms

‘Negative’ Symptoms

Work/School

Other Topics

Self-care, Mornings, Stress, Depression, Alcohol, Social Life, Love Life

Appendix A

Diagnostic Criteria [DSM-IV]

  1. delusions
  2. hallucinations
  3. disorganized speech (e.g., frequent derailment or incoherence)
  4. grossly disorganized or catatonic behaviour
  5. negative symptoms, i.e., affective flattening [flatness of emotion], alogia [poverty of speech], or avolition [lack of energy, spontaneity and initiative].

–Note:– Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behaviour or thoughts, or two or more voices conversing with each other.

  1. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
  2. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
  3. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
  4. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
  5. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Diagnostic Criteria of Schizophrenia Subtypes

Paranoid Type

A type of Schizophrenia in which the following criteria are met:

  1. Preoccupation with one or more delusions or frequent auditory hallucinations.
  2. None of the following is prominent: disorganized speech, disorganized or catatonic behaviour, or flat or inappropriate affect.

Catatonic Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

  1. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
  2. excessive motor activity [that is apparently purposeless and not influenced by external stimuli]
  3. extreme negativism [an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved] or mutism
  4. peculiarities of voluntary movement as evidenced by posturing [voluntary assumption of inappropriate or bizarre postures], stereotyped movements, prominent mannerisms, or prominent grimacing
  5. echolalia [repeating the speech of another person in an involuntary and meaningless way] or echopraxia [imitation of movement]

Disorganized Type

A type of Schizophrenia in which the following criteria are met:

  1. All of the following are prominent:

    1. disorganized speech
    2. disorganized behaviour
    3. flat or inappropriate affect
  2. The criteria are not met for Catatonic Type.

Undifferentiated Type

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

Residual Type

A type of Schizophrenia in which the following criteria are met:

  1. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behaviour.
  2. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Differential

Diagnosis

Psychotic Disorder Due to a General Medical Condition, delirium, or dementia; Substance-Induced Psychotic Disorder; Substance-Induced Delirium; Substance-Induced Persisting Dementia; Substance-Related Disorders; Mood Disorder With Psychotic Features; Schizoaffective Disorder; Depressive Disorder Not Otherwise Specified; Bipolar Disorder Not Otherwise Specified; Mood Disorder With Catatonic Features; Schizophreniform Disorder; Brief Psychotic Disorder; Delusional Disorder; Psychotic Disorder Not Otherwise Specified; Pervasive Developmental Disorders (e.g., Autistic Disorder); childhood presentations combining disorganized speech (from a Communication Disorder) and disorganized behaviour (from Attention-Deficit/ Hyperactivity Disorder); Schizotypal Personality Disorder; Schizoid Personality Disorder; Paranoid Personality Disorder

Bibliography

[DSM-IV] http://www.mentalhealth.com/dis1/p21-ps01.html which is in turn, from the -Diagnostic and Statistical Manual IV-

[PE] Personal Experience of this author (Daniel F. Dickinson).

[SSC99] Schizophrenia Society of Canada -Learning About Schizophrenia: Rays of Hope- Schizophrenia Society of Canada (Toronto, 2002)

[Temes02] Roberta Temes, Ph.D -Getting Your Life Back Together When You Have Schizophrenia- New Harbinger Publications, Inc. (California, 2002)

[Torrey95] E. Fuller Torrey, M.D. -Surviving Schizophrenia, Third Edition: A Manual for Families, Consumers and Providers- Harper Collins Publishers Inc. (New York, 1995)


  1. [Torrey95] p.238 ↩︎

  2. [SSC99] p.24 ↩︎

  3. [PE] ↩︎

  4. [SSC99] p.24 ↩︎

  5. [SSC99] p.24 ↩︎

  6. [Torrey95] p.55 ↩︎

  7. [Torrey95] p.51 ↩︎

  8. [Torrey95] p.31 ↩︎

  9. [Torrey95] p.52 ↩︎

  10. [Torrey95] p.58 ↩︎

  11. [Torrey95] pp.52,53 ↩︎

  12. [PE] ↩︎

  13. [PE] ↩︎

  14. [Torrey95] p.57 ↩︎

  15. [Torrey95] p.57 ↩︎

  16. [PE] ↩︎

  17. [Torrey95] p.85 ↩︎

  18. [Torrey95] p.58 ↩︎

  19. [PE] ↩︎

  20. [Torrey95] pp.60,62 ↩︎

  21. [SSC99] p.24 ↩︎

  22. [SSC99] p.24 ↩︎

  23. [Torrey95] p.61 ↩︎

  24. [Torrey95] p.65 ↩︎

  25. [Temes02] p.16 ↩︎

  26. [PE] ↩︎

  27. [Torrey95] p.55 ↩︎

  28. [Torrey95] p.55 ↩︎

  29. [PE] ↩︎

  30. [Temes02] p.15 ↩︎

  31. [SSC99] p. 27 ↩︎

  32. [Torrey95] p.40 ↩︎

  33. [PE] ↩︎

  34. [Torrey95] p.63 ↩︎

  35. [SSC99] p.49 ↩︎

  36. [SSC99] p.27 ↩︎

  37. [Torrey95] p.67 ↩︎

  38. [SSC99] p.25 ↩︎

  39. [SSC99] p.27 ↩︎

  40. [PE] ↩︎

  41. [Torrey95] p.96 ↩︎

  42. [Torrey95] p.38 ↩︎

  43. [SSC99] p.17 ↩︎

  44. [Temes02] p.27 ↩︎

  45. [Torrey95] p.156 ↩︎

  46. [Torrey95] p.156 ↩︎

  47. [Temes02] p.27 ↩︎

  48. [Temes02] p.27 ↩︎

  49. [Torrey95] pp.158-160 ↩︎

  50. [Temes02] p.26 ↩︎

  51. [Temes02] p.25 ↩︎

  52. [Temes02] p.26 ↩︎

  53. [Temes02] pp.27,28 ↩︎

  54. [Torrey95] p.157 ↩︎

  55. [SSC99] pp.72,73 ↩︎

  56. [Torrey95] p.161 ↩︎

  57. [Temes02] p.24 ↩︎

  58. [Torrey95] pp.164,165 ↩︎

  59. [Torrey95] p.165 ↩︎

  60. [Torrey95] p.111 ↩︎

  61. [SSC99] p.18 ↩︎

  62. [Torrey95] pp.167,168,223 ↩︎

  63. [Torrey95] p.225 ↩︎

  64. [Temes02] p.51 ↩︎

  65. [Temes02] p.52 ↩︎

  66. [Torrey95] p.192 ↩︎

  67. [Torrey95] p.198-203 ↩︎

  68. [Torrey95] p.192 ↩︎

  69. [Torrey95] p.193 ↩︎

  70. [Torrey95] p.198-203 ↩︎

  71. [Torrey95] p.205-208 ↩︎

  72. [SSC99] p.72-73 ↩︎