Schizophrenia
The term ‘schizophrenia’, coined by Eugene Bleuler in 1911, was derived from the Greek words ‘schiza’ meaning split and ‘phren’ meaning mind. It refers to the lack of interaction between thought processes and perception. Schizophrenia is a type of psychotic disorder in which an individual loses touch with reality and cannot differentiate between what is real and imagined.
SYMPTOMS OF SCHIZOPHRENIA
The symptoms of schizophrenia can be divided into- Positive Symptoms and Negative Symptoms. In the context of schizophrenia, the terms “positive” and “negative” do not refer to good or bad. Instead, they describe the presence (positive symptoms) or absence (negative symptoms) of certain psychological functions.
Positive Symptoms:
Hallucinations: Auditory hallucinations are the most common, but visual hallucinations can also occur, often in combination with auditory hallucinations.
Example: In the movie “The Voices,” the main character Jerry suffers from schizophrenia and experiences vivid auditory and visual hallucinations. Jerry sees his cat (Mr. Whiskers) and dog (Bosco) talking to him. Mr. Whiskers often encourages Jerry to engage in violent and harmful behaviours, while Bosco tries to convince him not to do so. The lines between his distorted perception of reality and actual events are so blurred that he cannot differentiate between them.
Delusions: A delusion is a strong false belief that is resistant to reasoning and contrary to the individual's actual experiences and the surrounding evidence. Individuals commonly experience delusions of persecution (belief of being targeted), grandiose delusions (an exaggerated sense of importance), and paranoid delusions (distrustful and overly suspicious of other people).
Thought Disorders: Disturbances in thought processes may lead to issues such as thought blocking (sudden interruption of speech before the thought is completed), loosening of associations (lack of logical connection between thoughts), and neologisms (inventing new words or phrases that cannot be understood, like ‘headshoe’ for a hat, ‘glowzilla’ for a lamp, ‘fluffinator’ for a pillow, etc.).
Disorganized Speech: Individuals exhibit incoherent (jumbled) or fragmented speech, making it difficult for others to understand. Additional symptoms include mutism (inability or unwillingness to speak), poverty of speech (use of fewer words, taking longer to respond or being less likely to initiate talks), echolalia (repetetion of words or phrases uttered by others), perseveration (persistent repetition of specific words, phrases or sounds), and verbigeration (obsessive repetition of random words).
Motor Disorders: Disturbances in motor behaviour involve catatonia (excessive movement or no movement at all), stereotypy (involuntary, repetitive, and purposeless movements or gestures), and posturing (assuming and holding unusual or awkward body positions for extended periods without clear reason).
Negative Symptoms:
Affective Flattening: Reduced emotional expression, where individuals may show limited facial expressions, gestures, or vocals.
Alogia: Impaired ability to speak, resulting in brief or one-word responses.
Anhedonia: Loss of interest or pleasure in activities that were once enjoyable.
Avolition: Lack of motivation to initiate and sustain purposeful activities. This can manifest as neglect of personal hygiene or an inability to complete tasks.
Attention Impairment: Difficulty focusing and sustaining attention on tasks.
Apathy: Lack of interest, enthusiasm, or concern about what is going around.
TYPES OF SCHIZOPHRENIA
Schizophrenia was previously categorized into various subtypes. However, with the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association in 2013, these subtypes were eliminated. Instead, a spectrum-based approach to diagnosis was introduced, focusing on the severity of symptoms rather than fixed subtypes.
However, there are instances when these subtypes are still used to describe the presentation of schizophrenia. The various subtypes of schizophrenia are-
Simple Schizophrenia: Simple schizophrenia is characterized by the gradual and progressive decline in emotional responsiveness and cognitive functions over time. Characteristic ‘negative symptoms’ are present, while positive symptoms, such as hallucinations and delusions, are absent.
Disorganized Schizophrenia: Disorganized schizophrenia, also known as hebephrenic schizophrenia, is characterized by disorganization in speech, thoughts, or behaviours. Symptoms include hallucinations, delusions, abnormal behaviour, negative symptoms, and disorganized thinking. An individual may exhibit unusual speech patterns (constant repetition of a gesture or speech), incongruent facial expressions (facial expressions that do not match internal emotional experiences), and mirror gazing (staring at themselves in the mirror).
Catatonic Schizophrenia: The term catatonia refers to cases when individuals react little or not at all to their environment or surroundings. It is characterized by disturbances in motor behaviour, ranging from extreme immobility (catatonic stupor) to excessive and purposeless movement (catatonic excitement).
Paranoid Schizophrenia: The term ‘paranoia’ describes a behavioural pattern in which an individual exhibits distrust and excessive suspicion towards others. This is the most common type of schizophrenia. Symptoms include delusions (grandeur, reference, persecution, or infidelity) and auditory hallucinations, but no prominent disturbance of affect, speech, or motor behaviour.
Undifferentiated Schizophrenia: This term was used for cases that did not fit into one of the specific subtypes.
Residual Schizophrenia: This subtype refers to individuals who have a history of at least one episode of schizophrenia but are currently not displaying prominent positive symptoms such as hallucinations or delusions. Instead, residual symptoms such as social withdrawal or odd beliefs may be present.