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Schizophrenia

Child & Adolescent Schizophrenia

Though schizophrenia is more commonly seen among adults, it can also be present in children and young adults. It must be noted, though, that the only difference between childhood schizophrenia and adult schizophrenia is that the former shows up earlier in a person’s life than the latter does. Early onset schizophrenia comes on before a person is eighteen years old, and is rarely seen in someone before they are thirteen years old. Most schizophrenia symptoms fall under three kinds: Behavior, Emotions, and Thinking.

Behavioral symptoms may include a person having difficulty sleeping, isolating oneself from those closest to them, being violent, and not having the incentive to do daily tasks such as showering or doing school work. Emotional symptoms can include being depressed, being suspicious of other people, and not showing any emotions. Thinking symptoms may include believing fiction to actually be reality and not being able to think logically. These are some symptoms, but as one gets older and the disorder progressives, the symptoms can get relatively worse. 

Worsening symptoms of schizophrenia can be the onset of hallucinations, the start of misinterpretations of social behaviors, and being scatterbrained. Hallucinations involve a person seeing things or hearing voices that are actually not real. These tricks of the mind can seem very real to the person experiencing them. A person with schizophrenia may experience hallucinations which cause them to misjudge how others feel about them. This perception a person with schizophrenia can have about those around them is one of the most common symptoms. Another symptom is a person becoming absentminded which can include not being able to concentrate or fidgeting around a lot. While all these symptoms can be very overwhelming to go through, and schizophrenia is chronic, it is very treatable (Mayo Clinic Staff, 2021).

The first step in childhood schizophrenia being treated is going to a psychiatrist. From there they can help with an official diagnosis and then begin to make a treatment plan. One option is for a patient to go on a low dose of an antipsychotic drug. This can help with any hallucinations one may be experiencing. Another alternative is going to therapy to help talk out what one is feeling. This therapy can be great for a child because they can get a better understanding of schizophrenia and how it affects them. Children with schizophrenia can also go to different classes or training to help them feel more comfortable. The classes can be on subjects like learning how to build healthy relationships in connection to their schizophrenia. And if symptoms get extremely severe, a child can be hospitalized to get the special care they need to feel better (Schizophrenia, 2021). 

While schizophrenia, especially among children, can be very difficult, it is very treatable, especially when families make some of the accommodations mentioned. People can acknowledge and work through their schizophrenia symptoms.

 

Resources

Mayo Clinic Staff. “Childhood Schizophrenia.” Mayo Clinic, 19 May 2021, https://www.mayoclinic.org/diseases-conditions/childhood-schizophrenia/symptoms-causes/syc-20354483.

“Schizophrenia .” Boston’s Children Hospital, 2021, https://www.childrenshospital.org/conditions-and-treatments/conditions/s/schizophrenia/diagnosis-and-treatments.

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Schizophrenia

Schizophrenia and Religion

The relationship between religion and schizophrenia is often studied by psychologists because of the similar nature between religious experiences and psychotic episodes. Positive symptoms of schizophrenia (symptoms that appear after the onset), such as auditory and visual hallucinations and delusions, are often the experience of many who practice religion. Thus a stigma exists that schizophrenia patients and highly religious people are crazy and out of line with society. However, results from studies go in two completely different directions, suggesting that religion can be both a risk and a protective factor for schizophrenia. 

Some studies focus on the intersection between religious practice and inpatients of schizophrenia. According to a paper written by Grover et al., the prevalence of religious delusions and hallucinations varies across countries, with rates ranging from 6 to 63.3 percent. Cultural differences also exist across religions, with Christian patients having more religious delusions when compared to Buddhist and Muslim patients. Common themes amongst religious delusions include: persecution, influence (being controlled by the spirits), and self-significance (delusions of sin/guilt or grandiose). Interestingly, the same paper states, “Data also suggest that patients with religious/spiritual delusions value religion as much as those without these types of delusions, but patients presenting delusions with religious content report receiving less support from religious communities” (Grover et al., 2014). This highlights that stigma exists for those who experience religious delusions. 

With the high amount of overlapping qualities between religious delusions and schizophrenia symptoms, it is important to study the effects of religious practice on the outcomes of schizophrenia. Some studies have suggested that religious practice in schizophrenia patients is associated with positive outcomes, such as “Increased social integration, reduced risk of suicide attempts, reduced risk of substance use, decreased rate of smoking, better quality of life, lower level of functioning, and better prognoses.” Nevertheless, some studies contest otherwise and stress that religiosity, or strong religious beliefs, has negative impacts on schizophrenia patients, such as higher risk of suicide and poorer treatment adherence (Grover et al., 2014). 

Studies have also been conducted on how religious beliefs influence the treatment adherence of schizophrenia patients. According to the paper written by Borras et al., “Thirty-one percent of nonadherent patients and 27% of partially adherent patients underlined an incompatibility or contradiction between their religion and taking medication, versus 8% of adherent patients.” This demonstrates that schizophrenia patients who are religious are less likely to follow instructions on medications due to contradiction with their religious beliefs. The same paper also points out, “Fifty-seven percent of patients had a representation of their illness directly influenced by their spiritual beliefs (positively in 31% and negatively in 26%).” This suggests that research holds contradictory results to whether religions positively or negatively affect individuals with schizophrenia. 

Although there is a lot of overlap between schizophrenia symptoms and religious experiences, there is not a lot of medical literature that covers religiosity, and religious delusions are seldom diagnosed. According to Living With Schizophrenia, “A review of four major psychiatric journals carried out in the US in 1982 found that only 2.5% of the articles even mentioned religiosity and that in most cases the mention was just cursory.” In order to destigmatize the experience of schizophrenia and religious delusions and improve treatment adherence, there should be more studies in the future so that schizophrenia patients can obtain a balance between practicing their faith and falling in line with their treatment. 

 

Resources

Borras, L., Mohr, S., Brandt, P. Y., Gilliéron, C., Eytan, A., & Huguelet, P. (2007). Religious beliefs in schizophrenia: their relevance for adherence to treatment. Schizophrenia bulletin, 33(5), 1238–1246. https://doi.org/10.1093/schbul/sbl070

Grover, S., Davuluri, T., & Chakrabarti, S. (2014). Religion, spirituality, and schizophrenia: a review. Indian journal of psychological medicine, 36(2), 119–124. https://doi.org/10.4103/0253-7176.130962

Religious and Spiritual Delusions in Schizophrenia. (2019). Living With Schizophrenia. livingwithschizophreniauk.org/religious-spiritual-delusions-schizophrenia/.

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Addiction Schizophrenia

Schizophrenia and Crime

Many countries have a law that defends individuals from being responsible for the crimes they committed while under the influence of mental illnesses. This is known as the insanity defense, which the media often blame for an increase in violent crime rates. One infamous incident that comes to mind is the “2016 Taipei Neihu Murder,” where a man who previously sought treatment from a psychiatric hospital committed a brutal random murder of a four-year-old girl in front of her mother in broad daylight. The man eventually received a life sentence instead of the death penalty, leaving Taipei City fearful and resentful of the fact that many murderers would face abolished responsibility. The purpose of this article is not to discuss the moral or legal implications of the insanity defense. Rather, it is to explore the stigma that surfaces from these cases: violent crimes are often committed by people with mental illnesses. Even though there is an association between crimes and schizophrenia, it can be explained by a mediator: substance abuse.

An earlier study conducted by Lindqvist et al. investigated the connection between crimes and schizophrenia patients, as well as the types of crime committed by those patients compared to the general population. It found that female schizophrenia patients alone are twice as likely as the general population to commit crimes; but for male schizophrenia patients, there was no difference in crime rate compared to the general male population. Additionally, the rate of violent crimes is four times higher among schizophrenia patients. The results specifically showed that 13% of the violent offenders in the study were women, which is higher than the five to ten percent female contribution in national figures of corresponding crimes. In terms of criminal activity after conviction, only “one of the women in the cohort committed two or more violent offences during the follow-up period, whereas seventeen received two verdicts of violence, and three men were guilty of three violent offences each” (Lindqvist et al., 1990).  The study not only pointed to higher crime rates in the population with schizophrenia, but also a gender disparity in crimes committed by schizophrenia patients. 

While earlier studies aimed to find the association between crime and schizophrenia, recent studies focus on mediating the relationship between the two variables. Substance abuse is thought to be one of the strongest mediators. A study conducted by Fazel et al. investigated the severity of the crimes committed by persons with schizophrenia. They found it to be 4 to 6 times the level of those committed by persons without schizophrenia, and this can be explained by a comorbidity of substance abuse. According to the paper, “The rate of violent crime in individuals diagnosed as having schizophrenia and substance abuse comorbidity (27.6%) was significantly higher than in those without comorbidity (8.5%)” (Fazel et al., 2009). This shows that comorbid substance abuse is associated with higher violent crime rates in individuals with schizophrenia. 

One explanation for comorbid substance abuse as a mediator of the relationship between crime and schizophrenia is that, similar to schizophrenia, substance intake can also have a toll on a person’s cognitive ability. Common symptoms experienced by schizophrenia patients, such as hallucinations and delusions, may be present after alcohol and drug consumption, making substance abuse a risk factor for violent or criminal behavior. An article written by Tsimploulis et al. contests with the previous studies that substance use disorder can increase the risk of offending in persons with schizophrenia, especially among women. Moreover, the study found, “The percentages of substance abuse among NGRI [not guilty by reason of insanity] subjects with schizophrenia ranged from 35.7% to 74%” (Tsimploulis et al., 2018), demonstrating that there is an inverse relationship between criminal responsibility and schizophrenia patients with substance abuse problems. 

Altogether, many studies have established a link between schizophrenia and rates of criminal offences higher than the general public. More recent studies point to substance abuse as a mediating factor that contributes to this increased rate. The effect of schizophrenia itself on criminal offences is more obvious in women, and so is the effect of substance abuse on offending patients diagnosed with schizophrenia. Nevertheless, this association does not justify the stigma that all individuals with schizophrenia are dangerous. Similar to the effects of drugs and alcohol abuse, hallucinations and delusions can cause a person to behave abnormally. We should have compassion for the individuals struggling with these pathologies to achieve destigmatization. 

 

Sources

Fazel, S., Långström, N., Hjern, A., Grann, M., & Lichtenstein, P. (2009). Schizophrenia, substance abuse, and violent crime. JAMA, 301(19), 2016–2023. https://doi.org/10.1001/jama.2009.675

Lindqvist, P., & Allebeck, P. (1990). Schizophrenia and Crime: A Longitudinal Follow-up of 644 Schizophrenics in Stockholm. British Journal of Psychiatry, 157(3), 345-350. doi:10.1192/bjp.157.3.345

Tsimploulis, Georgios MD*; Niveau, Gérard MD, PhD†; Eytan, Ariel MD, PhD*; Giannakopoulos, Panteleimon MD, PhD*; Sentissi, Othman MD, PhD* Schizophrenia and Criminal Responsibility, The Journal of Nervous and Mental Disease: May 2018 – Volume 206 – Issue 5 – p 370-377 doi: 10.1097/NMD.0000000000000805

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Schizophrenia

Childhood Schizophrenia

Schizophrenia in school-aged children is rare but not unheard of. Childhood schizophrenia essentially appears the same as schizophrenia in adults, except that the onset starts early in life and can have a profound impact on the child’s development and behaviors. The affected child may experience a combination of hallucinations, delusions, and disordered thoughts, making it difficult for them to interpret reality. It is a severe and chronic disease that requires lifelong treatment and early discovery to have positive outcomes.

Schizophrenic symptoms typically appear in an adult’s mid-to-late 20s. Early-onset in children can occur from as early as 13 years old to age 18. It is hard to diagnose children with schizophrenia because the symptoms in early phases may pass as other disorders such as ADHD. Some of the early signs of schizophrenia may include delay in language and walking as well as unusual motor behaviors such as rocking or arm flapping (Mental Health America). Symptoms in teenagers are difficult to recognize as well because some of these behaviors are common for the age group, including withdrawal from peers and family, a drop in performance at school, trouble sleeping, mood swings, lack of motivation, substance use, etc (MayoClinic.org). 

There have been studies conducted to compare the academic performance of children who were later diagnosed with schizophrenia and their peers. One case-control study done by Helling et al. found no significant correlation between underachievements in school and early onset of schizophrenia; the teenagers with schizophrenia performed almost as well as their peers. This is supported by the study’s results that at age 9, there was no difference in performance; at age 12, some patients with schizophrenia tended to excel in the arts and language; at age 15, some remained proficient in the arts but performance in PE dropped. Overall, this study concluded that it is hard to spot a young patient with schizophrenia completely based on their grades in school.

However, another study done by Jundong et al. (2011) suggested a contradiction. Using longitudinal data in Sweden, they found that offsprings of schizophrenia patients have overall poorer performance in school compared to offsprings of non-schizophrenia parents. This study also suggested that genetic factors (vs. environmental causes) causing cognitive deficits account for poorer academic performance in school-aged children whose parents have schizophrenia. With these findings came the conclusion that early detection of signs of schizophrenia and intervention is important for a better prognosis.

Aside from academic performances in school, there is also research demonstrating that some children with schizophrenia may experience severe emotional disturbances (SEDs). According to an article by Chen et al., “[Children] with histories of SED are among the lowest-performing special needs students, especially when they have additional comorbid learning and psychiatric conditions.” SEDs are also associated with poor impulse control and other disruptive behaviors in school, thus requiring special educational services. Nevertheless, according to the same article, these additional services are often underprovided and rarely incorporate instructional goals to help with social skills. Hopefully, in the future, the needs of children with schizophrenia will be better accommodated so that children growing up and living with a chronic disease like schizophrenia can experience more positive outcomes.

 

References

Chen Y-L, Rittner B, Manning A, Crofford R. Early Onset Schizophrenia and School Social Work. Journal of social work practice. 2015;29(3):271-286. 

Childhood schizophrenia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/childhood-schizophrenia/symptoms-causes/syc-20354483

Helling I, Öhman A, Hultman CM. School achievements and schizophrenia: a case-control study: School performance and schizophrenia. Acta psychiatrica Scandinavica. 2003;108(5):381-386.

Jundong J, Kuja-Halkola R, Hultman C, Långström N, D’Onofrio BM, Lichtenstein P. Poor school performance in offspring of patients with schizophrenia: what are the mechanisms? Psychological medicine. 2012;42(1):111-123. 

Psychosis (Schizophrenia) In Children And Youth. Mental Health America. https://www.mhanational.org/psychosis-schizophrenia-children-and-youth

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Schizophrenia

Hallucinations in Schizophrenia

We often see pop artists refer to themselves as “delusional” in songs about lost love or characters in mainstream shows saying to one another, “You’re just hallucinating, that never happened,” blurring the line between imagination and disordered psychosis. While a person imagining is aware that their occurring thoughts are “just thoughts,” it is difficult for people with schizophrenia to tell a psychotic episode apart from reality. Positive symptoms of psychosis are not usually present before the onset of the disorder, such as delusions and hallucinations. Delusions are false beliefs or thoughts, whereas hallucinations are usually in the form of seeing or hearing things when there is no such stimulus present. They are two of the most common symptoms of schizophrenia. Approximately 70% of individuals with schizophrenia experience them, especially hearing voices (Hugdahl et al, 2008), but not everyone is distressed by them or feels the need to seek help. The fact that these experiences feel so real to the patients and that they are covert and idiosyncratic, which may factor into the difficulty of diagnosing schizophrenia. 

Scientists have been trying to explain what is happening to people’s brains when they experience auditory hallucinations. One study used functional magnetic resonance imaging, or fMRI, to scan the patients’ brain activity, then later asked them to report whether they experienced hallucinations during each interval of scanning. They found that multiple areas of the brain, including the inferior frontal/insular, anterior cingulate, temporal cortex bilaterally, right thalamus and inferior colliculus, and the left hippocampus and parahippocampal cortex, were active when the patients reported hearing voices (Shergill et al, 2000). Another study used the dichotic listening test to present two consonant-vowel syllables simultaneously, one in each ear and had the participants report the syllable identified best on each trial. The results demonstrated that there is an inverse relationship between auditory hallucinations and right ear performance, which suggests that “auditory hallucinations interferes with the perception of an externally presented speech sound, localized to the left temporal lobe” (Hugdahl et al, 2008).

Many people with schizophrenia shared their unique experiences with hallucinations in interviews. According to healthtalk.org, one patient, Nikki, described the voices she heard as coming from multiple different people simultaneously, known or unknown. Other patients, Lucy and Emily, recalled that the voices were persecutory, persuading them into self-harm or even suicide. Although auditory hallucinations are common among people with schizophrenia, some people experience visual hallucinations more, such as Joe, who has experienced hallucinations about hurting his loved ones. For some patients, auditory and visual hallucinations can go hand in hand, as seen in Dominic’s case, where he visualized hurting others and heard voices commanding him to do so. Each of these accounts of experiencing hallucinations is covert and distinct in each person’s case. Unless the patients themselves or the people around them realize that what they are struggling with is a serious psychological disorder, it is difficult for the patients to receive professional intervention. 

Even though researchers cannot pinpoint the exact cause of hallucinating episodes for each person yet, they have identified a few possible factors. Environmental and genetic dispositions may trigger the onset, as well as life stressors. With these discoveries, scientists have then come up with rehabilitation methods for patients with schizophrenia. For example, psychosocial therapy is a widely used treatment method to help patients cope with stress and establish a support system within the patient’s family to reduce the chances of relapse. Overall, though hallucinations are very pervasive, they can be controlled with the right interventions. 

 

References

Felix Torres (2020). What Is Schizophrenia? American Psychiatric Association. 

Psychosis (young people). Healthtalk.org.

Hugdahl, K., Løberg, E. M., Specht, K., Steen, V. M., van Wageningen, H., & Jørgensen, H. A. (2008). Auditory hallucinations in schizophrenia: the role of cognitive, brain structural and genetic disturbances in the left temporal lobe. Frontiers in human neuroscience.

Shergill SS, Brammer MJ, Williams SCR, Murray RM, McGuire PK. (2000). Mapping Auditory Hallucinations in Schizophrenia Using Functional Magnetic Resonance Imaging. Arch Gen Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/481670

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Schizophrenia Uncategorized

Paranoid Schizophrenia: How Accurately Does the Film A Beautiful Mind Portray It?

In the film A Beautiful Mind based on the life of the American mathematician John Nash, the audience gets a glimpse into what life is like for a person living with schizophrenia. We follow Nash in his day-to-day life and discover that his closest friend and roommate, Charles, and his spy identity, are all products of his hallucinations. As the film progresses, we witness his symptoms become more severe to the point where he was always paranoid and almost hurt his wife because the voices in his head told him to do so. But how accurate is this media portrayal of schizophrenia? 

First, let’s start with the question: what is schizophrenia? According to the DSM-5, schizophrenia is a mental disability distinguished by continuing episodes of psychosis. The age of onset is usually in one’s mid- or late-twenties. Major symptoms include hallucinations, delusions, and disorganized thinking. Other symptoms include apathy (lack of feeling), decreased emotional expression, and social withdrawal (Patel et al, 2014). We can see examples of these in the movie, in Nash’s poor social skills and avoidance of social situations, his lack of emotions and interest in anything other than his studies, and most importantly, his constant hallucinations about interacting with imaginary friends and foes. These all dated back to Nash’s years in graduate school.

The specific subtype of schizophrenia that John Nash had is paranoid schizophrenia, which is characterized by the constant belief that others intend to harm the individual. Before Nash was diagnosed and when his condition had been the most severe, he believed he was working for the Department of Defence on a classified mission to locate a bomb placed by Russian spies on U.S. soil. The paranoid symptoms are most evident when he hallucinated a car chase and gunfight at night between him and the imagined Soviet spies. His heightened suspicion after the imagined incident, such as staring through the blinds from time to time, is evidence that these hallucinations had caused significant impairments in his life, his job, and his relationship with his wife. 

What causes paranoid schizophrenia? One case study found an association between paranoia and grandiosity, the unrealistic perception of one’s importance, and the high value of their possession that others would harm them for it (Lake, 2008). We see Nash deluding his own importance through his imaginary secret mission at the Pentagon. When these delusions were challenged, he believed that the psychiatrists were communist spies intended to kill him. These are in parallel with the study’s conclusion that grandiosity precedes paranoid schizophrenia. 

Besides its accurate depiction of one’s experience with schizophrenic symptoms, A Beautiful Mind also did an exceptional documentation of the prognosis and treatment of the disease. If untreated, the condition can gradually worsen. However, since Nash didn’t have many attachments and his imagination required him to keep his “mission” a secret, his condition went unnoticed by others for a long period. Although schizophrenia can be treated with antipsychotic drugs, complete recovery is very rare and relapses are common. We see that Nash’s positive symptoms (behaviors that are added) such as hallucinations and delusions were reduced through taking medication regularly, whereas when he stopped taking his medication, his symptoms worsened. Nash was also put through insulin shock therapy, which is a prime treatment method at the time until it was deemed ineffective and replaced by narcoleptic medicines (ABC News, 2006). Another potential outcome of schizophrenia is that the emotional support of family members and close friends will likely decrease the chances of relapses in the future (Caqueo-Urízar et al, 2015). This is demonstrated in the film when Nash’s wife, Alicia, chose to take care of him and believed in his ability to overcome his hallucinations, and Nash becoming more able to cofunction with his imagination while staying intact with reality. 

In conclusion, A Beautiful Mind portrays the experience of individuals with schizophrenia in a non-stigmatized way while pertaining to the general truths of the disease’s symptoms, course, and treatment. One important thing to recognize is the fact that, despite struggling with schizophrenia, John Nash led a functioning lifestyle and won the Nobel Prize. His story and the film adaptation are what we often do not see in media representation of mental illnesses. Hopefully, in the future, we will see more media portrayals like A Beautiful Mind that aim to educate the public about people with schizophrenia as well as their beautiful individuality.

 

References

ABC News (2006). How Realistic Is ‘A Beautiful Mind’?. ABC News. https://abcnews.go.com/GMA/DrJohnson/story?id=126426&page=1

Bell, David (2019). “John Nash.” Living With Schizophrenia. http://livingwithschizophreniauk.org/john-nash/#:~:text=Although%20Nash%20continued%20to%20work,and%20conversations%20became%20increasingly%20disturbed.&text=The%20psychiatrists%20treating%20Nash%20came,were%20both%20grandiose%20and%20persecutory

Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatric disease and treatment, 11, 145–151. https://doi.org/10.2147/NDT.S51331

Lake C. R. (2008). Hypothesis: grandiosity and guilt cause paranoia; paranoid schizophrenia is a psychotic mood disorder; a review. Schizophrenia bulletin, 34(6), 1151–1162. https://doi.org/10.1093/schbul/sbm132

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management, 39(9), 638–645.

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Schizophrenia

Understanding the Diagnosis Procedure for Schizophrenia

Medicine has evolved throughout the years with the purpose of improving the quality of life for people suffering from all kinds of ailments. While the development of new treatments and cures have certainly aided in this cause, one aspect that is often overlooked is its impact on the improvement of diagnostic procedures. After all, how can a doctor prescribe treatment if they are unsure what the patient’s problem is? Furthermore, there have been considerable improvements in diagnostic procedures for some areas of health that have progressed faster than others. This is most commonly seen in the mental health sector, as conditions such as schizophrenia are difficult for professionals to diagnose right away.

The only way for medical professionals to diagnose someone with schizophrenia is to see whether that person shows two or more core symptoms for at least a month (Schizophrenia Diagnosis and Tests | Cleveland Clinic, 2018). There are other parameters that medical professionals watch for, but these criteria work as a road map rather than a strict set of directions on how to diagnose schizophrenia. There is a noticeable absence of laboratory tests from the diagnosis process because there is no quantitative data that can be gathered to pinpoint and diagnose schizophrenia. This scenario also exists in other diagnosis procedures of most mental ailments, thus consolidating the fact these medical professionals are under a lot of stress to correctly diagnose patients purely off their behavior and patient testimony.

To ensure that professionals can accurately diagnose people, as mentioned previously, they must observe the person over a period of a month or, in some cases, even longer. The reason being is that they want to be certain that they don’t misdiagnose someone who has schizophrenia with autism, PTSD, bipolar disorder, etc. Conditions such as bipolar disorder and PTSD share a common symptom with schizophrenia, which is psychosis or the disconnection from reality. This point is further discussed by child psychiatrist, Dr. Abhijit Ramanujam, who described how the social impairment aspect of other disorders, such as autism, can sometimes be seen as the negative symptoms (psychosis and social withdrawal) that are associated with schizophrenia (The Realities of Childhood Schizophrenia, 2020). Therefore the large window of time in which medical professionals work to diagnose someone with schizophrenia is mainly used to see the true nature of the symptoms.

Despite the lack of diagnostically relevant laboratory tests, there is technology in the works in order to provide faster diagnoses. Most of the work being done is in the field of biomarkers, which are characteristics that can be measured as indicators of normal biological functioning. In other words, there are tests being made that can determine if schizophrenia will or has clinically manifested. It is not completely foolproof, but it is going to be an important addition to a physician’s diagnostic toolbox. These tests will work to reaffirm or refute an initial diagnosis, thus acting as another parameter to ensure that people are receiving the best possible healthcare (Psychiatry Advisor, 2020).

The future is looking bright for the next generation, as more quality tests are being developed for all kinds of mental illnesses. This will drastically change the landscape of mental healthcare, as people who struggle with mental illnesses will be able to get a simple blood test to be diagnosed. However, until the technology gets there, people should understand that just getting help isn’t as simple as it sounds. Patience goes a long way, as getting over that initial hurdle of getting diagnosed can be intimidating for some. 

 

References

Schizophrenia Diagnosis and Tests | Cleveland Clinic. (2018). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4568-schizophrenia/diagnosis-and-tests#:~:text=According%20to%20the%20DSM%2D5,disorganization%20and%20diminished%20emotional%20expression

The Realities of Childhood Schizophrenia. (2020). Psychiatric Times. https://www.psychiatrictimes.com/view/realities-childhood-schizophrenia 

Psychiatry Advisor. (2020, November 5). Advances in Psychiatry Biomarkers – Psychiatry Advisor. Psychiatry Advisor. https://www.psychiatryadvisor.com/home/topics/general-psychiatry/advances-in-psychiatry-biomarkers/

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Schizophrenia

Dealing with Schizophrenia During Lockdown

The unprecedented nature of a lockdown brought on due to COVID-19 is something most of the world has never experienced before. It has brought hardships and required people to reshape their lives in order to comply with all of the new mandates and regulations. These changes were needed to ensure that the most vulnerable portions of our society were safe and not exposed to the virus. However, one group that ended up getting overlooked were the people suffering from mental illness. People dealing with conditions such as schizophrenia have been impacted in multiple aspects of their illness. These aspects include their symptoms, treatments, and management plan.

Isolation from the outside world is something even people who don’t suffer from mental illnesses have had trouble coping with. In people with schizophrenia, this isolation is believed to have profound effects on their symptoms. In one article, it described how this detachment from social interaction could lead to an uptick in psychosis or “the exacerbation of symptoms” in people with schizophrenia (Hamada & Fan, 2020). This isn’t all that far-fetched of a claim since one common behavior observed in people with schizophrenia is the avoidance of social interaction. So, in a day and age where being social isn’t really as prevalent as it once was, these people can now completely remove themselves from all daily interactions and it might go unnoticed by their support system. 

For some people who have schizophrenia, finding high-quality effective treatment was already a difficult thing to do. However, due to new regulations, getting access to those treatments have been a little more complicated. While there are therapy options that can be done over the internet and in video calls, the one-to-one in-person experience is hard to replicate through a screen. This isn’t really a problem with inpatients with schizophrenia because they are monitored in a hospital and their doctors know who and what they have been exposed to. Conversely, for outpatients (people who receive medical treatment without being admitted to a hospital) with schizophrenia, gaining access to one-on-one in-person sessions is difficult. The reason is because these face-to-face interactions are discouraged due to the increased risk of transmission between the doctors and patients. As a result, doctors fear that there will be an increase in service disengagement and medication nonadherence in people with schizophrenia (Kozloff et al., 2020)

The most influential area for people with schizophrenia is the management of their symptoms, which refers to how they are handling their daily lives. Antonio, who is a blogger diagnosed with schizophrenia, discussed how he has managed his symptoms during lockdown. He said, “…living with schizophrenia, along with being on lock down can trigger memories of being in hospital, on section. So, in this case, it really does help alternating the environment as much as possible.” He further discussed how important it was to make a schedule and stick to it, while seeing his mental health as a work in progress (My experience of living with schizophrenia during lockdown, 2020). This advice is echoed by medical professionals, who added other bits of advice on how to manage schizophrenia during COVID-19. Some of the suggestions included avoiding alcohol and illicit drugs, exercising, and limiting exposure to information surrounding the pandemic (Leonard, 2020). The ability for people with schizophrenia to follow these pieces of advice will have a large impact on how lockdown affects them.

Lockdown has had an impact on people throughout the country who are battling mental illness. With seemingly no end in sight, it could be hard for them to honestly believe that there is a light at the end of the tunnel. However, Antonio is a symbol who shows that taking it one step at a time is necessary in maintaining one’s sanity. Believing in that sentiment can help people struggling during lockdown to see that the proper management of their symptoms and treatments is an attainable goal.

 

References

Hamada, K., & Fan, X. (2020). The impact of COVID-19 on individuals living with serious mental illness. Schizophrenia Research, 222, 3–5. https://doi.org/10.1016/j.schres.2020.05.054 

Kozloff, N., Mulsant, B. H., Stergiopoulos, V., & Voineskos, A. N. (2020). The COVID-19 Global Pandemic: Implications for People With Schizophrenia and Related Disorders. Schizophrenia Bulletin, 46(4), 752–757. https://doi.org/10.1093/schbul/sbaa051 

My experience of living with schizophrenia during lockdown. (2020, May 22). Time To Change. https://www.time-to-change.org.uk/blog/my-experience-living-schizophrenia-during-lockdown 

Leonard, J. (2020, May 13). Schizophrenia and COVID-19: Impact and management. Medicalnewstoday.Com; Medical News Today. https://www.medicalnewstoday.com/articles/schizophrenia-and-covid-19#management

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Schizophrenia

The Hardships of Treating Schizophrenia Spectrum Disorder

For most people, when they feel under the weather they can just run to their local pharmacy and grab some over-the-counter medication to relieve their symptoms. If it persists, an appointment with their primary healthcare provider usually ends with them getting a prescription for a more powerful medication. However, the end result is almost always the same: they gain satisfaction. The feeling of almost bliss and harmony that marks the end of a period of illness is something many people can attest to. However, this cycle of being healthy, falling ill, and then regaining your health is not as simple when the illness is one that affects the mind. The unpredictable nature of some mental illnesses can lead to a decrease in quality of treatment someone with said illnesses will receive. For instance, schizophrenia spectrum disorder’s affected population faces these hardships constantly.

The term schizophrenia spectrum disorder is really just a broad brush grouping of similar illnesses which include but is not limited to: schizophrenia, schizoaffective disorder, schizophreniform disorder, and schizotypal personality disorder (Barch, 2010). While these illnesses do share similarities in terms of the symptoms that are present, they are not identical. With that being said, people with a disorder on the schizophrenia spectrum do share similar obstacles when trying to get treatment. 

One of these obstacles is treatment adherence. A common issue reported by medical professionals is that people with schizophrenia spectrum disorder often have shown lack of insight. This lack of insight pertains to their inability to grasp the idea that they have a mental illness and in turn will cause them to not adhere to any medication that is prescribed by their healthcare provider. While that does play a role in treatment adherence, another factor is what kind of delusions or hallucinations people are experiencing. One article describes treatment adherence to be poor in people who experience grandiose delusions. This is attributed to the fact that the medication causes a reshaping of one’s self image to one that isn’t as spectacular as they once thought (Schizophrenia Treatment Challenges, 2020).  

Another obstacle is the psychosis relapse common in people undergoing assured antipsychotic treatment. Psychosis relapse is defined as “the recurrence of previously treated psychotic symptoms” (Sandy, 2013). The go-to explanation for this is poor medication adherence, as mentioned previously. The data of one massive systemic review showed that patients who were classified with prospective symptom remission (PSR) had a lower percent chance of undergoing a psychosis relapse in comparison to patients who did not show PSR. This could be interpreted as patients who “truly wanted help” seemed to take the medication as prescribed and had a lower chance of experiencing a psychosis relapse. However, the rest of the data from that same study doesn’t support the conclusion, as a risk for relapse was shown to be heavily linked to tardive dyskinesia (Psychiatry Advisor, 2020). This condition causes repetitive, involuntary movements and often results from long-term use of antipsychotic medication. Therefore, context is needed to truly understand why a certain population possibly stopped taking their medication as prescribed. Could it be that they suffered physical symptoms that were too much to bear and decided they felt better off of the medication? 

People’s largest obstacle in getting treatment for schizophrenia spectrum disorder is the chance of developing a co-occurring disorder, such as alcohol use disorder (AUD). The main reason that scientists believe this co-occurrence develops is the drive for some people to self-medicate with alcohol or other substances. However, whatever the reason may be for the co-occurrence, it’s detrimental effects on the person is seen in the sudden drop in available treatment options. Many of the treatments given to people with schizophrenia spectrum disorder are built around the administration of antipsychotic medication to help the person with their delusions and hallucinations. An obvious conflict arises when a patient is seen to have schizophrenia spectrum disorder and AUD because a medical professional cannot in good faith prescribe medication to someone who is seen to abuse alcohol due to the fact that the consumption of alcohol with prescription medication can cause life threatening issues. Therefore, the medical professional has to figure out a treatment plan that excludes the use of prescription medication or try and help the person overcome their battle with alcohol (Drake & Mueser, 2002).

Despite all of the medical advances that have come out throughout the years, mental illnesses are still extremely difficult to treat. Understanding that treatment plans for people with mental illness are unique to the individual is crucial for grasping the complex nature of such ailments. As was discussed through this piece, there are a number of obstacles that can arise for each person that alters what treatment works for them. It is essential to know that, for these people, it is an ongoing battle, which is better served when they have a support system around them that recognizes it is a lifelong marathon and not a race to be “cured.”

 

References

Barch, D. M. (2010). Schizophrenia Spectrum Disorders. Noba. https://nobaproject.com/modules/schizophrenia-spectrum-disorders#:~:text=The%20spectrum%20of%20psychotic%20disorders,substance%20use%20or%20medical%20conditions

Schizophrenia Treatment Challenges. (2020). Psychiatric Times. https://www.psychiatrictimes.com/view/schizophrenia-treatment-challenges 

Psychiatry Advisor. (2020, September 16). Psychosis Relapse Common During Assured Antipsychotic Treatment – Psychiatry Advisor. Psychiatry Advisor. https://www.psychiatryadvisor.com/home/topics/schizophrenia-and-psychoses/psychosis-relapse-common-during-assured-antipsychotic-treatment/ 

Sandy. (2013, May 14). Psychotic relapse. NeuRA Library. https://library.neura.edu.au/schizophrenia/illness-course-and-outcomes/psychotic-relapse-2/#:~:text=What%20is%20psychotic%20relapse%3F,social%20support%20and%20stress%20reduction

Drake, R. E., & Mueser, K. T. (2002). Co-Occurring Alcohol Use Disorder and Schizophrenia. Alcohol Research & Health, 26(2), 99–102. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683824/

Categories
Schizophrenia Somatic Symptom and Related Disorders Uncategorized

What is Anosognosia?

In a day and age where information is readily available to anyone with Internet access, a scenario that often pops up when you’re feeling ill is to look up your symptoms. This has led many people to self-diagnose themselves with various types of illnesses and falsely believe they have symptoms of a particular condition. While the Internet is helpful as a preliminary step before going to a doctor, what do you do when you show symptoms but don’t realize it? The people who struggle with recognizing and accepting their symptoms are said to have anosognosia. This impairment can affect the timing and quality of treatment they receive for an illness. Specifically, one illness that is quite readily affected by such an impairment is schizophrenia. 

Before one can understand how anosognosia affects people with schizophrenia, it is important to know what exactly it is. Anosognosia is described as “a lack of ability to perceive the realities of one’s own condition” (Jewell, 2018). This means that someone refutes the reality that they have a condition despite showing all of the symptoms or having been diagnosed. One large misconception surrounding this impairment is that someone with anosognosia’s inability to accept that they have a condition is a conscious choice that they are making. This is incorrect because people with this condition truly cannot perceive that they have a certain symptom or condition. Making this distinction is important to truly grasping what anosognosia is because it is not the same as being in denial. For example, one might experience delusions but have no true understanding that they are delusions. Rather those delusions are what define their reality, so they feel that their grasp on what’s “real” is no different than someone without anosognosia. A situation like this takes an emotional toll on someone with anosognosia and can cause them to disregard any other symptoms that they really did experience (Jewell, 2018). 

As alluded to previously, many people with schizophrenia are also diagnosed with some form of anosognosia. Around 57 to 98 percent of people with schizophrenia are reported to have “poor insight” where different aspects of their awareness can be affected. “Poor insight” in these cases relate to the lack of awareness and ability to recognize one’s own illness. Medical professionals believe that this “poor insight” is connected to any other mental health conditions that person may have. Specifically, in the case of people with schizophrenia, alterations to the prefrontal cortex and insular cortex are correlated with having “poor insight” (Lehrer & Lorenz, 2014). These parts of the brain are important players in the never-ending process of reshaping one’s self-image and any alterations can cause someone to lose the ability to ingest new information and update the perception of one’s health (Jewell, 2018). That is why doctors’ feel that a patient’s insight is a good predictor of a few things: will they react negatively to a certain treatment, will they relapse, and will their symptoms come back (Lehrer & Lorenz, 2014).

While people with schizophrenia often also have anosognosia, it should be noted that the aspects of their awareness that are affected, due to schizophrenia/anosognosia, are different and seemingly do not overlap. What this means is that just because someone lacks awareness in one domain does not mean they are completely unaware of how the other domains are affected. In one study, a group of people with schizophrenia were shown to have an understanding that their day-to-day functioning was impaired to a certain degree while underestimating their memory functioning. However, as a group, a majority of the participants were shown to be unaware that they were mentally ill (Gilleen et al., 2010). 

Someone refuting that they have a mental illness should not be characterized as stubborn or in denial. There are physiological and psychological reasons for their rebuttal and it cannot just be categorized as being hard-headed. Creating an environment where people with mental illnesses and anosognosia can have an open discussion about how they feel without the fear of being gaslighted or judged is crucial in ensuring that they can get the proper treatment in a timely manner. The main goal should be helping everyone who has a mental illness and not letting anyone slip through the cracks just because “they didn’t want to get helped.” 

 

References

Jewell, T. (2018, October). What Is Anosognosia? Healthline; Healthline Media. https://www.healthline.com/health/anosognosia 

Lehrer, D. S., & Lorenz, J. (2014). Anosognosia in schizophrenia: hidden in plain sight. Innovations in Clinical Neuroscience, 11(5–6), 10–17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140620/ 

Gilleen, J., Greenwood, K., & David, A. S. (2010). Domains of Awareness in Schizophrenia. Schizophrenia Bulletin, 37(1), 61–72. https://doi.org/10.1093/schbul/sbq100