Schizofrenia - Informacje Ogólne

Schizophrenia - General Information

• Schizophrenia is a severe mental illness with a unique mechanism, linked to an individual's personal meaning system.
• Individuals with schizophrenia may exhibit withdrawal from social interaction beginning at a young age.
• Often, they experience strong ties to family but struggle to make independent decisions. Symptoms like anxiety, autism, delusions, or hallucinations may appear.

Bleuler's Symptoms of Schizophrenia

• Bleuler categorized schizophrenia symptoms into fundamental and additional categories.
• Fundamental symptoms include disruptions in simple mental processes (associative thinking and affect) and complex cognitive functions (autism, will, actions, and personality).
• Additional symptoms include delusions, hallucinations, catatonic behaviors, and depressive symptoms. Fundamental symptoms are persistent throughout the illness, while additional symptoms are secondary responses of the personality to the condition.

Schizophrenia Symptoms (ICD-10)

• Key symptoms in ICD-10 include disturbances in thought and perception, and flattened affect.
• Consciousness and intellectual ability are typically preserved but cognitive deficits can arise.
• Symptoms can include thought echo, thought insertion/withdrawal, thought broadcasting, delusional perceptions, and auditory hallucinations (commentating or discussing the patient).
• Negative symptoms (e.g., decreased motivation) are also possible. The course can be continuous, episodic, or feature either steady or progressive deficits. Partial or total remission might occur.

Diagnostic Criteria for Schizophrenia (DSM-V)

• Presence of at least two symptoms lasting at least a month:
  • Delusions
  • Hallucinations
  • Disorganized speech (e.g., associative looseness, incoherence)
  • Severely disorganized or catatonic behavior
• Significant impairment in social or occupational functioning.
• Continuous signs of illness including prodromal, active, and residual phases spanning at least six months.
• Absence of mood disorders or manic episodes.
• Exclusion of organic causes and/or substance abuse.
• In cases of autism spectrum disorder, severe delusions or hallucinations are necessary.

Types of Schizophrenia by Symptoms

• Simple: Lack of symptom differentiation
• Paranoid: Delusions and hallucinations, without disorganized thought or behavior
• Hebephrenic: Disorganized thought, behavior, emotions, and flat or inappropriate affect
• Catatonic: Motor immobility or excessive, purposeless movement (with rigidity, postures, or echolalia)
• Somatopsychic: Delusions or concerns about physical health, body sensations
• Child-onset: Early onset of symptoms
• Pseudo-neurotic: Symptom presentation that resembles nervous conditions.

Types of Schizophrenia by Course

• Acute (or brief): Rapid onset and short duration of symptoms, often following a particular life event
• Chronic (or long-term): Slow, insidious progression towards social withdrawal and autism. Hospitalization periods tend to be prolonged.

Schizophrenia with Paranoid Symptoms

• This type is characterized by delusions and hallucinations without significant disorganized thought or behavior; prognosis tends to be better than for other types.

Schizophrenia with Disorganized Symptoms

• It is characterized by disorganized thought, behaviour, emotional expression, and flat or inappropriate affect.

Additional Concepts

• Negativism: Patient resists instructions
• Waxy flexibility: Abnormal, unnatural flexibility in postures
• Formal thought disorder: Speech and thought disturbances
• Prodromal symptoms: Preceding signs or warnings before the diagnosis of a disorder
• Residual symptoms: Persistent symptoms of a mental disorder even when the original symptoms have lessened or subsided.

Antipsychiatry Concepts

• Laing: Focuses on the family's role in misconstruing reality, labeling patients as "sick" and neglecting their needs
• Bowen: Emphasizes the emotional system dynamics within families, implying three-generational influence and the transmission of dysfunctional patterns across generations.
• Lidz: Proposes that family dysfunction and emotional patterns are crucial factors in establishing or perpetuating schizophrenic symptoms.
• Bateson: Explains the concept of "double bind," where families communicate conflicting messages creating a frustrating environment for the individual, potentially escalating into severe mental health conditions.
• Stierling: Focuses on families imposing "delegated tasks, on children, as means of fulfilling parental needs and desires leading to mental health ailments
• Selvini-Palazzoli: Introduces a model that analyses development of schizophrenia within familial dynamics.
• White: Uses a narrative perspective to interpret families responses and interpretations to psychological imbalances within the family dynamic.