Schizophrenia is a mental disorder marked by negative serious disturbances of thought. Though there is no universally agreed upon definition of schizophrenia but the term can be used to refer to a group of disorders characterized by gross distortion of reality, withdrawal from social interaction and disorganization of thoughts and emotions.
Clinical Picture –
When the disorder develops gradually over a period of time and not in response to obvious discrete stressors and tends to be long lasting it is referred to as “Process Schizophrenia”. The Process Schizophrenia is generally considered as unfavorable because the need for treatment is usually not recognized until the behavior pattern has become firmly entrenched. It also called as “Chronic Schizophrenia”.
In Reactive Schizophrenia the onset of the symptoms is sudden and dramatic and is marked by intense emotional turmoil and nightmarish sense of confusion. This pattern is often associated with identifiable precipitating stressors. The symptoms may clear in matter of weeks though in some cases they may serve as a signal for development of chronic pattern.
Mental Health Workers typically distinguish between positive and negative symptoms of schizophrenia. Recently the third category of symptoms has been added which is called as disorganized category. Though there is no universal agreement about which symptoms should be included in these categories, positive symptoms usually include more active manifestation of abnormal behavior Hallucination and Delusions are included here.
Negative Symptoms involve deficits in normal behavior in such areas as speech or motivation.
The disorganized symptoms include disorganized speech, erratic behavior, and inappropriate affect.
The diagnosis of schizophrenia requires that two or more positive, negative.
Positive Symptoms –
- Disturbances of thought content – delusions are irrational beliefs that the individual defends vigorously despite their logical absurdity and despite the objective evidence showing them to be untrue. It is the basic characteristic of madness. A common delusion in the people with schizophrenia is that others are ‘out to get them’. In other words delusions of persecution are the main common delusions. Other common delusions in schizophrenia are :-
- Delusion of grandeur.
- Delusion of reference (feeling that others are talking about them).
- Disruption of Perception (Hallucination) –
The patient is not able to sort out a process the great mass of sensory information to which he is exposed. There is a massive breakdown of perceptual filtering throwing the person into turmoil. Hallucinations particularly auditory hallucinations are experienced.
Negative Symptoms –
- Avolition – without will
Inability to persist and initiate activities. The goal directed behavior is almost universally disrupted in schizophrenia individuals. They show little interest in performing the most basic day to day activities, including those associated with personal hygiene.
- Alogia – without speech
It refers to relative absence of speech. The person is uninterested in communication and gives only brief replies.
The patient is indifferent to the activities that provide pleasure.
- Affective Flattering
By flat affect we mean that the person does not show emotion that is shown by most normal people. Schizophrenia stares at others vacantly and speak in a flat and toneless manner.
- Retreat to Inner World
Ties with the external world are loosened in schizophrenia and there is a withdrawal from reality which is often accompanied by collaboration of the inner world in which the person develops illogical fantastic ideas.
- Confused Sense of Self
The patient may feel confused about their identity to the point of loss of subjective sense of self.
Disorganised Symptoms –
- Disorganised Speech
Communication disturbances are usually considered as the prime indicator of schizophrenia. The communication is fragmented and there is loosening of associations.
- Disorganized Behavior
Various peculiarities of movement are sometimes observed in the patients. The motor disturbances may range from hyperactivity to marked decrease in movement.