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DSM IV Schizophrenia Diagnosis

May 7, 2009

Schizophrenia is a serious mental disorder characterised by hallucinations and delusions that affects roughly one percent of individuals around the world. If you have a close family member with Schizophrenia then the risk rises to around ten percent but if that family member is an identical twin then the other twin has a fifty percent chance of developing Schizophrenia.

No one knows what causes Schizophrenia but we now know that genetics certainly do play a part as it does tend to run in families. Other causes that have been implicated include maternal stress in the very early stages of pregnancy, biological, environmental and social factors. Scientists now believe that Schizophrenia may be a whole range of different disorders as opposed to just one which would explain why there are so many variations and potential triggers.

There are no diagnostic tests that will identify Schizophrenia so a diagnosis is made according to the symptoms that are present.

The DSM-1V criteria for Schizophrenia

Two or more of the following symptoms have to have been present for more than one month coinciding with reduced social or personal or occupational functioning that has been present for six months. These symptoms must not be a result of drug abuse or any other medical condition or medication and Schizoaffective and Mood Disorder have been ruled out.

•    Hallucinations (the most common type of hallucinations in Schizophrenia are auditory hallucinations where the individual may hear voices but hallucinations can affect any of the senses for example sight, hearing, taste, touch and smell)
•    Delusions (holding bizarre ideas and beliefs which are evidently false)
•    Disorganised Speech (speech may be rambling and incoherent)
•    Disorganised or Catatonic Behaviour
•    Negative Symptoms (a flattening of the emotions, apathy, social withdrawal etc.)

If another disorder is present, an additional diagnosis of Schizophrenia may be made if delusions or hallucinations are also present and have been for at least one month.

Symptoms and Sub Categories of Schizophrenia

The symptoms of Schizophrenia are classified into positive and negative symptoms. The positive symptoms can be described as behaviour that is in addition to what you would normally expect such as hallucinations and delusions. Negative symptoms can be described as behaviour that is missing from what you would normally expect such as lack of emotion, lack of facial expressions, and an inability to function effectively.

There are five different sub categories of Schizophrenia and the type of Schizophrenia diagnosed will depend on which type most suits the symptoms. For example:

•    Paranoid Schizophrenia – feelings of persecution or that someone or something is out to get you
•    Disorganized Schizophrenia – speech and behaviour that is disorganized and chaotic, there may be inappropriate social responses
•    Catatonic Schizophrenia – disturbances affecting movement, echolalia and echopraxia may be present
•    Undifferentiated Schizophrenia – where the symptoms don’t clearly fit in with any other category
•    Residual Schizophrenia – currently no positive symptoms but a past history of Schizophrenia. This is the long term state of Schizophrenia.

What is the prognosis?

Although Schizophrenia is a distressing disorder, most people can and do lead very fulfilling lives. Around a quarter of people with Schizophrenia will go on to make a full recovery, about half will have periods of remission but will still need support and the remaining quarter will require long term treatment and support.

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Is Schizophrenia like Bipolar Disorder?

May 7, 2009

Both Schizophrenia and Bipolar are mental disorders and although there can be similarities between them they are two separate conditions.

It is disturbing that despite awareness campaigns about mental health issues, surveys have shown that many members of the general public are still unaware of the differences between Schizophrenia and Bipolar and often mistakenly believe they are the same thing. They are not.

What is Bipolar Disorder?

Bipolar disorder or manic depression as it is often called is a mental disorder characterised by extreme highs (episodes of mania) and extreme lows (episodes of depression). These mood swings are the defining feature of Bipolar.

When an individual is experiencing a manic episode they usually have bundles of energy, will often need very little sleep, they may speak faster and appear to think faster than other people and they could have unrealistic ideas about what they can achieve.

Once the manic episode is over the person with bipolar will tend to sink into a depressed state where they experience low moods, apathy and disinterest, they may sleep a lot, talk little and withdraw socially.

However, no two individuals will experience Bipolar in the same way and the symptoms and severity of the symptoms will vary significantly from person to person.
Fortunately, most people with Bipolar can function normally with appropriate medication and support.

What is Schizophrenia?

Schizophrenia is characterised by positive symptoms which include hallucinations and delusions as well as negative symptoms such as flattening of the emotions and speech. The type of symptoms and the way they are manifested will be different for each person. Consequently there are 5 sub categories of Schizophrenia.

Paranoid Schizophrenia – feelings of persecution
Disorganised Schizophrenia – disorders of speech and behaviour
Catatonic Schizophrenia – disorders of movement
Undifferentiated Schizophrenia – doesn’t clearly fit with any other sub type
Residual Schizophrenia – no more positive symptoms. This is the long term state of schizophrenia

So what can you expect with regard to symptoms? Hallucinations can be defined as seeing, hearing, tasting, feeling, and smelling something that isn’t really there. As far as Schizophrenia is concerned, the most common type of hallucinations are auditory hallucinations. The individual might hear voices which can take the form of a single voice talking to them, often in a critical manner, or they may hear a running commentary or even conversations between two or more voices.

Delusions can be described as having a belief in something that isn’t real and sticking to that belief despite being shown evidence to the contrary. For example, the individual may have delusions of grandeur such as believing believe they are famous, are a secret spy, that they can fly, that they have special magical powers and so on. Or, they may have delusions of persecution where they think that family members, neighbours, aliens or the government are plotting against them, spying on them or following them.

Treatment for schizophrenia consists of anti-psychotic medication and some form of psychotherapy. Anti-psychotic medication is generally very successful at treating psychosis but treating the so called negative symptoms can prove more challenging.

Fortunately around fifty percent of people diagnosed with schizophrenia will be able to function most of the time and will experience periods of remission. A quarter of people diagnosed will actually go on to make a full recovery; however, the remaining quarter will require long term help and treatment.

Interestingly, there is a growing amount of evidence that supplementing with Fish Oil that has a very high content of the Omega 3 fatty acid EPA helps to alleviate the symptoms of both Bipolar disorder and Schizophrenia.

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Schizophrenia Suicide Risk

May 7, 2009

Studies have shown that people suffering from Schizophrenia have a higher risk of suicide or attempted suicide than other members of the general public. Depression is a common feature in Schizophrenia and yet it often goes undetected and undiagnosed, mainly because the so called negative symptoms of Schizophrenia can mask an underlying depression. Depression also increases the risk of suicide.

Although figures vary slightly from study to study the overall results indicate that between five and thirteen percent of individuals diagnosed with Schizophrenia will commit suicide. There is no doubt that suicide is a major cause of death in individuals with Schizophrenia.

Most researchers agree that the profile of the Schizophrenic patient most likely to commit suicide is a young, white, single, male who functioned well prior to the onset of the illness and who suffered depression after a psychotic episode and who has a history of substance abuse. However, this doesn’t mean that a person fitting this description is going to commit suicide. Although anyone can commit suicide there are other risk factors to be aware of.

Risk factors for suicide in Schizophrenia

•    Depression
•    Feelings of hopelessness
•    Previous suicide attempts
•    Social isolation
•    Living alone
•    Stress in the family
•    Relationship problems
•    Recent loss or rejection
•    Substance abuse
•    Homelessness
•    Lack of support
•    Hospitalisation
•    Not sticking to treatment plan
•    Fear of mental disintegration

Some researchers have found that individuals who functioned well prior to the onset of Schizophrenia symptoms and who are fully aware of the implications of their disorder and the impact that it is likely to have on their future lives are more at risk.

However, other researchers claim that a full understanding of the nature of Schizophrenia can actually help the individual to cope and does not increase the risk of suicide.

According to the Royal College of Psychiatrists a literature review revealed that the suicide risk in individuals with Schizophrenia was related more to the affective symptoms of Schizophrenia such as depression and feelings of hopelessness and a previous history of suicide attempts or threats of suicide rather than the positive symptoms of hallucinations and delusions.

To reduce the risk of suicide in people with Schizophrenia it’s important to be aware of the risk factors and to seek help as soon as possible if there are any indications or signs that the individual might be having suicidal thoughts.

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How Adolescent Schizophrenia Develops

May 7, 2009

Schizophrenia affects males and females equally; however, it tends to develop earlier in males, usually between the ages of 15 and 25. Schizophrenia can be devastating, especially when it develops at such a young age and it can put a tremendous amount of pressure on family members. It is important to know what to look for and to seek help as soon as possible if your child is showing signs of Schizophrenia.

Changes in your child’s behaviour may happen slowly over a long period of time so that there is a growing awareness of something wrong, or, symptoms can develop suddenly over a few days or weeks.

The first signs could be a gradual withdrawal from social activities and friends, becoming more shy and talking less, spending a great deal of time alone, appearing fearful or anxious or moody. On the other hand the first signs may involve the youngster expressing bizarre ideas and behaviours.

There is such a wide variation in symptoms and no clear pattern however there are some early warning signs that you can look out for and these include the following:

Social withdrawal and a reluctance to take part in social activities, difficulty making friends or unwilling to make friends, social isolation, spending a lot of time alone
Bizarre behaviour and thoughts
Strange ideas or beliefs that are not based on reality (delusions)
Hearing voices or seeing things that are not really there (hallucinations)
Lack of emotion and emotional expression
Inappropriate social responses such as laughing when hearing bad news
Becoming increasingly agitated and anxious
Staring into space or sitting in the same position for long periods of time
Cannot function effectively at school and difficulty carrying out homework or other tasks
Paranoia and feelings of persecution or that someone or something is out to do them harm, suspicious of other people and their intentions
Distorted perception of reality
Difficulty organising thoughts, confused thinking
Aggressive outbursts

The problem with diagnosis is that these symptoms are also present in other conditions and can also occur as a result of substance abuse. It’s absolutely vital to seek help as early as possible for two main reasons.

The first is to obtain an accurate diagnosis so that the right treatment and help can be given, particularly as there is a high suicide risk in people with Schizophrenia. The second is that research has shown that the longer treatment is delayed when the symptoms of Schizophrenia first develop, the poorer the outlook. If you are worried, speak to your doctor.

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Surviving Schizophrenia Hallucinations and Delusions

May 7, 2009

Hallucinations and delusions can be a terrifying experience for the individual with Schizophrenia. Fortunately, anti-psychotic medication, particularly the newer so called atypical antipsychotics, are generally very effective at helping to control episodes of psychosis. These include:

•    Amisulpride
•    Olanzapine
•    Risperidone
•    Clozapine
•    Quetiapine
•    Aripiprazole
•    Zotepine

These atypical antipsychotics are less likely to cause some of more unpleasant side effects associated with the older types of antipsychotics so are more likely to be tolerated by individuals.

The importance of continuing to take medication

One of the problems with treating Schizophrenia is that people suffering from Schizophrenia will often stop their medication for a number of different reasons. They may find that the side effects are so unpleasant they decide not to bother, or they might believe they don’t need them anymore, or during an auditory hallucination a could have voice told them to stop taking them, or because their thoughts are so disorganised they forget to take them.

People respond to medication in different ways so if one drug doesn’t suit, another can be tried until one is found that suits the individual. It might also be possible to receive long term injections which could possibly help in cases where the individual simply forgets to take their medication. It is important not to stop taking medication unless your doctor advises you to because if you do, the psychotic episodes will most likely return soon after.

The importance of avoiding stress

Research has shown that people with Schizophrenia are far more susceptible to the negative effects of stress than other people and that stress can make the symptoms of Schizophrenia much worse. Losing a job, suffering bereavement or going through a divorce is stressful for anyone but for someone suffering from Schizophrenia even minor stresses can trigger an episode of psychosis. It is therefore important to avoid stressful situations as much as possible.

The importance of Family Support

A number of studies have revealed that if family members are openly critical, hostile, or aggressive, an individual with Schizophrenia is more likely to suffer a relapse. It is therefore important that family members are educated as to the nature of Schizophrenia and are aware of the kind of support they need to offer. There are a number of organisations that can help so find out what is available in your area or speak to your doctor for more information.

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Types Of Schizophrenia Medications

April 14, 2009

If someone is suffering with the so called positive symptoms associated with Schizophrenia such as hallucinations and delusions, they are likely to be prescribed anti-psychotic medication in order to control the symptoms.

As with all medications, antipsychotics can carry some unpleasant side effects although the newer types of antipsychotics are believed to be less likely to result in severe side effects, particularly involuntary movements of the face and body.

In the past, the so called typical or traditional antipsychotics included drugs such as chlorpromazine, flupenthixol, fluphenazine and haloperidol. The side effects associated with these older types of antipsychotics include muscle stiffness, tremors, restlessness, sexual dysfunction and in some people, Tardive Dyskinesia or TD for short.

TD can be described as involuntary, repetitive and purposeless movements often affecting the face, tongue and lips but sometimes other parts of the body too. For example, constant lip smacking, tongue protrusion, grimacing, blinking etc.

These older medicines first appeared in the mid 1950’s and they worked by altering the activity of a chemical in the brain called Dopamine. More recently, in the last decade or so, they have recently been more or less replaced by newer ‘atypical’ antipsychotics which include:

•    Amisulpride
•    Olanzapine
•    Risperidone
•    Clozapine
•    Quetiapine
•    Aripiprazole
•    Zotepine

The side effects most often reported with the newer type of medicines include drowsiness, sexual dysfunction and weight gain. There is also some evidence of a higher risk of developing diabetes. In high doses involuntary movements are still possible. Each drug will also produce its own side effects so you should check the leaflets for a full description of all known side effects and speak to your doctor if you are worried.

These newer types of antipsychotics work on many different chemical messengers in the brain and have proved quite effective in controlling Schizophrenia. One type in particular, Clozapine, appears to work quite well for people who do not respond to other types of medication and is also believed to reduce the risk of suicide, which is already high in people suffering from Schizophrenia.

However, we all respond to medication in different ways and what might suit one individual may not suit another. Therefore if you are already taking an older type antipsychotic and it is causing no problems, there is no need to change and it may be that you have to try several different drugs before finding one that works for you.

Sometimes an individual who is taking medication for Schizophrenia will stop taking it, maybe because they find the side effects too unpleasant, or they believe they are well again and no longer need them, or perhaps because their thinking is so disorganised they forget to take them. Unfortunately if this happens the hallucinations and delusions are likely to return. If this is the case, it may be possible for a doctor to give the medication by long term injection.

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Side Effects Of Schizophrenia Drugs

April 14, 2009

Any medication can cause unwanted side effects in some people, even over the counter remedies and herbal preparations and the antipsychotic medicine prescribed for patients with Schizophrenia is no different.

Sometimes it is worth putting up with some mild side effects in order to get the benefits provided by the medication but one of the drawbacks of antipsychotic medication for Schizophrenia is when an individual finds the side effects so unpleasant they decide to stop taking them, or, due to the nature of Schizophrenia an individual’s thinking might be so disorganised they forget to take their medication, or they may feel better from taking the medication and decide they no longer need it.

However, taking the medicine reduces the chance of experiencing relapses and future psychotic episodes. It may not necessarily prevent relapses altogether but the medication is likely to reduce the frequency and the severity of the symptoms and there is a much higher risk of experiencing a relapse by stopping the medication.

It is therefore important not to stop taking any medication and if you are experiencing side effects you should inform your doctor or health care provider so that you can discuss treatment options and possibly be prescribed an alternative. What may suit one person may not suit another so it really is more a case of finding out what type of medication suits each individual.

A lot of progress has been made in recent years and risk of experiencing unpleasant side effects with the newer atypical antipsychotic drugs available is believed to be lower than with the older typical antipsychotic medicine.

Atypical antipsychotic drugs include Amisulpride, Clozapine, Risperidone and Olanzapine to name only a few. Examples of the older typical antipsychotic medicine include Haloperidol, Chlorpromazine and Thioridazine.

What are the most common side effects reported when taking antipsychotic drugs?

•    Dry mouth
•    Drowsiness
•    Blurred vision
•    Changes in bowel movements
•    Flushes
•    Weight gain
•    Sexual dysfunction

In some cases movement disorders can also occur which can include tremors, restlessness in the legs, involuntary movements affecting the face, body, arms and legs, tongue clicking or lip smacking etc. Movement disorders are thought to happen less with the so called atypical antipsychotic drugs but this isn’t always the case. If someone is taking an older typical antipsychotic drug and is tolerating it well there is no need to change.

Occasionally anti-depressants are also prescribed to people with Schizophrenia in order to treat some of the so called ‘negative’ symptoms. There have also been studies that have shown that Fish Oil can be effective for some people with Schizophrenia. Speak to your doctor for more information.

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Slow Schizophrenia Onset

April 14, 2009

Schizophrenia is a serious mental disorder affecting around one percent of the population around the world. No one knows exactly what causes it although there is a genetic element as it can run in families. However, even people without a family history of the condition can develop it. There is currently no cure although around a quarter of people developing symptoms of Schizophrenia will go on to make a full recovery.

Both males and females suffer from Schizophrenia in roughly equal numbers but males are more likely to develop the symptoms earlier such as in their late teens or early twenties, than females, who are most likely to experience their first symptoms in their early thirties.

Schizophrenia can develop slowly or suddenly. Slow onset Schizophrenia, also known as gradual onset or insidious Schizophrenia is when the symptoms of Schizophrenia develop slowly over a period of time so that it can be quite some time before the individual, their family and friends realise there is a problem. The so called negative symptoms of Schizophrenia are likely to be more common than the positive symptoms.

Negative symptoms of Schizophrenia include the following:

•    A ‘flattening’ of the emotions and speech where the individual may appear to lack emotional expression, their faces seem unresponsive and their speech can seem monotonous and devoid of any warmth
•    An apparent inability or unwillingness to partake in social activities and conversations, they will often say little or nothing at all
•    The individual may not be able to make or stick to any goals
•    Social isolation and seeming to prefer their own company
•    Neglect of personal hygiene
•    A lack of ability to enjoy oneself or experience pleasure

Schizophrenia can also develop abruptly with an acute psychotic episode and can sometimes happen after experiencing an extremely stressful or traumatic event in life. The symptoms of acute Schizophrenia are a lot more obvious as they will usually include the so called positive symptoms of Schizophrenia.

Positive symptoms of Schizophrenia include the following:

•    Hallucinations – hearing, seeing, tasting, feeling, smelling something that isn’t really there. Auditory hallucinations are the most common in Schizophrenia
•    Delusions – believing in something that isn’t true and sticking to that belief despite rational explanations or evidence to the contrary
•    Disorganised thinking – unable to connect thoughts together

Slow onset Schizophrenia or Schizophrenia that develops early in life is associated with a worse prognosis than Schizophrenia that develops suddenly. It is essential that treatment begins early as there is also evidence that if treatment is delayed when the symptoms first appear, the outlook is worse than when treatment is started early.

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The History of Schizophrenia

April 14, 2009

Evidence of what we describe as Schizophrenia today can actually be traced right back to ancient Egyptian times and a description of symptoms in the Book of Hearts resembles what we would recognise as Schizophrenia today.

It wasn’t until 1887 that the German physician, Emile Kraepelin identified the symptoms of different mental disorders, including Schizophrenia and classified them accordingly.
Kraepelin didn’t call it Schizophrenia though; he referred to it as ‘dementia praecox’, which literally means early dementia.

The term Schizophrenia didn’t actually appear until 1911 when the Swiss psychiatrist Eugen Bleuler changed the name. Bleuler recognised that the various symptoms of Schizophrenia fell into two distinct groups and was the first person to describe the symptoms of Schizophrenia as being either positive or negative.

Schizophrenia comes from the Greek words Schizo and Phrene which translated means split and mind. This led the general public to mistakenly believe that Schizophrenia is split personality, which is incorrect.

Both Kraepelin and Bleuler managed to classify Schizophrenia into different types and today we recognise the five different sub-types of Schizophrenia as Disorganised, Catatonic, Paranoid, Residual and Undifferentiated.

The first antipsychotic medicines

It’s hard to believe in these modern times in the West that Schizophrenia and indeed all mental illnesses were once thought and in some parts of the world still are believed to be caused by evil spirits or some other divine or ridiculous idea. Who knows what suffering some poor individuals have had to endure at the mercy of a superstitious public?

Before the discovery of antipsychotic medicine, treatment of individuals with Schizophrenia included bizarre practices such as exorcism, boring holes into the skull, incarceration, even burning as witches. However, in 1952 French surgeon Henri Laborit discovered that Chlorpromazine effectively reduced the symptoms of Schizophrenia and a new era was born.

In the last ten years or so, even newer types of antipsychotics have become available which are even more effective than the older typical antipsychotics and which produce fewer side effects. Research also continues to highlight potential triggers and causes and there is hope that a cure may be found in the future.

In the meantime, we have come a long way regarding our attitude to and our treatment of Schizophrenia, particularly in the West, and although stigma still exists, nowadays the main objective is to control the symptoms and help the individual integrate into society.

Many people with Schizophrenia can and do go on to lead very full and productive lives, can maintain relationships, have children, learn, work, partake in social activities, just like everyone else, and as research continues to advance our understanding of Schizophrenia, the future looks even more promising.

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Schizophrenia Effects The Family

April 14, 2009

Schizophrenia is a severe mental disorder characterised by hallucinations, delusions and disorganised thought processes that affects around one in a hundred people around the world. However, in reality it impacts on a great many more because the family and close friends of an individual with Schizophrenia also suffer too.

Although no one knows the exact cause of Schizophrenia as there would appear to be several different triggers, it is now well established that genetics play a significant role. Schizophrenia does tend to run in families and if you have a family member with Schizophrenia you are at greater risk of developing it yourself.

Unfortunately there is still a great deal of stigma surrounding all mental illness and a lot of misunderstanding, particularly with Schizophrenia. The symptoms of Schizophrenia can appear quite dramatic so many people mistakenly believe that people with Schizophrenia are violent and dangerous and incapable of mixing well in society, which is not only untrue, it serves to increase the social isolation often experienced by schizophrenia sufferers.

Research shows that around a quarter of people diagnosed with Schizophrenia will go on to make a full recovery. Fifty percent are likely to have periods of remission where they appear quite well. A final quarter will need constant treatment and support.

If you have a member of your family with Schizophrenia it can be frightening and difficult. You have to witness and cope with the terrifying symptoms of the illness as well as the stigma still associated with the disease which can put a tremendous amount of stress and strain on the whole family.

Studies have also shown that people with Schizophrenia are more likely to suffer a relapse if family members openly display emotions such as anger and hostility, if they are critical, or if the required level of support isn’t there. Fortunately, family intervention therapies can help family members educate themselves as to the nature of Schizophrenia and the best ways to help the family and the person suffering from Schizophrenia to cope.

There is no doubt that Schizophrenia is distressing and there may be times when family members or anyone else caring for the person with Schizophrenia will find it all too much and will require some level of support themselves. If you have a family member who has Schizophrenia or if you are caring for an individual with Schizophrenia, it might be a good idea to find out what sort of support systems are available in your local area.

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