Through adult development there will be many challenges some will be easy to master and others not so simple to maneuver such as, being diagnosed with Schizophrenia. Schizophrenia most commonly strikes between the ages of 16 and 30. Generally, men tend to expose signs and symptoms at a slightly younger age than girls. In many instances, the disease develops very slowly, the person doesn’t know or recall that they have had schizophrenia for many years. In different cases, it may suddenly strike and develop fast. Schizophrenia impacts about 1% of all adults, globally. People that are diagnosed with this disease require a lifelong treatment. (Up to Date, 2019)
Schizophrenia is a serious mental disorder where patients interpret reality abnormally. Suffering with the effects of the schizophrenia disease makes everyday choices becomes a challenge in its own. Patients experience a decline on daily abilities they once had, to perform typical daily activities example: brushing own hair and teeth. Performing tasks like keeping relationships with friends and family or going to work, becomes impossible. Even doing something as simple like paying monthly bills or having a conservation becomes tedious and difficult. That is what patient say living with schizophrenia is like, even if patient is high functioning. (American P)
According to DSM V, the definition of Schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. In order to make a proper diagnosis, symptoms must have been present for six months and requiring that an individual exhibit at least two of the specified symptoms of Schizophrenia. (American Psychiatric Association DSM 5, 2013). During the assessment of the primary symptom evaluation a series of evaluations are conducted. These assessments are meant to assess patient signs, symptoms and establish medical necessity. This data can be compared to results from any ancillary and/or laboratory results available. This documentation helps to track behavioral patterns that further define a patient’s progress and define a prognosis. Diagnosis’ are often modified from one subtype to another because of overlapping symptoms. (American Psychiatric Association DSM 5, 2013) According to WHO, schizophrenia is among one of the top ten illnesses that are most disabling and economically catastrophic. (Murray CJL, 1996) Before the DSM 5 was updated in 2013, the diagnosis of Schizophrenia included different subtypes of the disease, they are:
- Paranoid Schizophrenia: Thinking that the person is being followed or watched. This is a considered a separate ailment.
- Hebephrenic Schizophrenia: Disorganized thinking, behavior, incoherent and illogical thoughts and speech.
- Childhood Schizophrenia: Schizophrenic symptoms have an incidence of less than a 0.04% has occurred to children.
- Schizoaffective disorder: A person that has experienced mood disorders or had the psychotic symptoms of schizophrenia, from when they first started having symptoms up to the present.
- Catatonic Schizophrenia: Can include excessive, repetitive and peculiar motor behaviors or a decreased motor activity. (Black, 2019)
There are 3 forms of Catatonia aka Catatonic schizophrenia, they are: akinetic, excited catatonia and malignant catatonia. As explained by Dr. Stephen Rush, MD, assistant professor of clinical psychiatry in the University Cincinnati Department of Psychiatry and Behavioral Neuroscience in akinetic type, the patient can be mute, a decrease in or absence of eating/drinking, urinary incontinence, have slow movements, resist movement of a body part by another body part, or respond the opposite to a request to move—all without motive. “Moving their limbs can feel like moving a candle that bends slowly when it’s almost at the melting point,” says Stephen Rush, MD. “Other symptoms may include a refusal to following instructions, blank staring, and mirroring others. With excited catatonia, the person is restless and often combative.” “This looks almost more like a manic situation in which a person is generally in a frenzy and highly impulsive, the person may be swirling his arms around for no reason” says Dr. Rush. Hyperkinesis can be characterized by excessive and purposeless motor activity in extremities, restlessness; repetitive and purposeless movements.” In malignant catatonia, the person might have an increased heart rate and/or breath heavily, during initial vitals assessment with the medical assistant at the medical provider’s office. “Fever, delirium and severe rigidity of the muscles might also be seen,” Dr. Rush says. “This type of catatonia can have a sudden onset and progress to a severe state rapidly. In such a state, the body’s organs can begin to fail. Malignant catatonia can even be fatal.” (Black, 2019)
The clinical manifestations affiliated with the schizophrenia characteristics overlap with other clinical features of other mental disorders such as: depression, anxiety, bipolar, psychotic mood disorder and substance induced psychotic disorders. The difference between the mood disorders with psychosis and schizoaffective disorder is down to the timing of symptoms.
Schizophrenia symptoms may include, but not limited to:
- Positive symptoms: this group includes impairment of social cognition and occupational functioning including:
- Hallucinations*: These can be auditory such as: hearing voices or sounds. Or might experience visual hallucinations example: flashes of color, glowing dots, or other unexplained objects. The prevalence of this symptom is between 40 to 80% of diagnosed patients.
- Delusions an example of this behavior is the person thinking that patient is being watched, followed or controlled. Or the person experiencing bizarre false beliefs and/or paranoid delusions.
- Disorganized symptom can be characterized by person’s expression include making up words that don’t exist. Thoughts are often expressed as a “word salad” and seem to have sudden topic switches. Statements are structured with no organization or make any sense to convey anything to the listener.
- Cognitive impairments- this symptom affects the person’s attention span, memory, verbal/visual reasoning learning and memory.
- Recurrent psychosis mood disorder including manic episodes: person may have outbursts, extreme confusion and can potentially become combative.
- Negative symptoms: This can be described as the person’s flatness, lack of empathy and substance of personality.
- Symptoms are independent, vary in type and severity from person to person. (Up to Date, 2019)
The exact causes of Schizophrenia are not known. Researchers believe the cause to be a mixture of a combination of brain’s chemistry, genetics and environmental contributions. A person’s neurotransmitters called dopamine and glutamate are believed to be contributors to being diagnosed with schizophrenia. This after a study was conducted of the neuroimaging in schizophrenic patients studying the brain’s structure, central nervous system and tracking any changes. Although exact cause of this disease is not known as of yet, these are the risk factors have been identified family medical history, inflammation or autoimmune diseases, birth complications such as malnutrition, any exposure to toxins or viruses that can impact brain development or using and abusing psychoactive or psychotropic drugs during teenage and young adulthood. There is no prevention for the schizophrenic disease, however, a comprehensive treatment plan with consistent follow up can help prevent worsening of symptoms. If condition is left untreated, patient can experience:
- Suicidal ideations
- Cutting or other self-injury
- OCD and other anxiety disorders
- Social isolation
- Alcohol, tobacco and/or other recreation drug use or abuse
- Legal/Financial problems
- Other serious medical or health problems (Up to Date, 2019)
Early detection of this condition and treatment may help patient to get symptoms under control before any serious complications develop. Complications of schizophrenia vary based on patient ability to accept help, seek professional care and consistent follow up care, as instructed by medical provider.
- American Psychiatric Association DSM 5. (2013). Schizophrenia. 1.
- Black, R. (2019, July 17). Catatonic Schizophrenia: How to Recognize the Symptoms of a Catatonic State. (L. Remedy Health Media, Ed.) Psycom. Retrieved from https://www.psycom.net/schizophrenia/catatonic-schizophrenia/
- Murray CJL, L. A. (1996). The Global Burden of Disease. Harvard University Press, Cambridge, MA.
- Up to Date. (2019). Schizophrenia in adults: Clinical Manifestations course, assessment and diagnosis . Up to Date. Retrieved 10 31, 2019, from https://www.uptodate.com/contents/schizophrenia-in-adults-clinical-manifestations-course- assessment-and -diagnosis