Schizoprenia- Clinical Characteristics

Schizophrenia is a major psychotic disorder that causes a variety of possible psychological symptoms, it affects thought processes but it is typified by a lack of contact with reality.Degrees of severity varies between sufferers: some encounter only one episode, some have persistent episodes but live relatively normal life. 

Although it can emerge later in life, the onset of schizophrenia for men is usually in the late teens or early twenties and for women the onset is usually in the late twenties.  The Royal College of Psychiatrists (2012) noted that approximately 220,000 people in England and Wales have a diagnosis of schizophrenia in any one year. Kurt Schneider (1959) suggested categorising the symptoms of schizophrenia as either positive or negative symptoms.

There are two major symptom categories, Type I which relates to acute schizophrenia (severe but not necessarily life-long), characterised by what are known as positive symptoms, such as hallucinations and delusions and better prospects of recovery.The other Type II relates to chronic schizophrenia (permanent), characterised by what are known as negative symptoms, such as apathy and withdrawal and poorer prospects of recover

- Delusions of grandeur:  Beliefs that they are someone grand or famous or beliefs that they have special magical powers.

- Delusions of persecution:  Beliefs that people are plotting against them, that they are being spied upon, talked about by strangers or deliberately victimised. 

- Auditory hallucinations:  Voices heard in the absence of external stimuli, which are often critical, warning of danger or giving commands.  

- Disordered thinking:  The person’s thoughts and discourse seem to jump from one topic to another, for no apparent reason and show no logical flow of discussion. 

- Individuals with schizophrenia also sometimes report that the thoughts in their heads are not their own, this is called thought insertion.  The person believes the thoughts have been placed there by a third party.

• Flattened affect: Reduction in range and intensity of emotions
• Reduced motor activity: Lack of spontaneous movement
• Reduced fluency of speech: Rapid shifts from one topic to another
• Alogia: Reduced fluency of speech or poverty of speech
• Avolition: Difficulty initiating things. Personal activities that they may once have enjoyed.  
• Disorganised speech:  Speech patterns are very monotonous, and do not rise and fall as normal speech patterns do.
• Disorganised behaviour:  Severe disruption in the ability to perform daily living activities, such a showering, dressing, preparing meals.
• Anhedonia is where an individual does not react appropriately to pleasurable experiences. 
• Inappropriate affect:  Silliness and laughter which are out of context, 
• Flat emotions:  No emotional response can be elicited to any stimulus. 
• Apathy:  Loss of interest in normal goals.
• Loss of drive:  Feeling drained of energy 
• Cataleptic stupor:  Standing motionless like a statue in bizarre postures. 
• Echopraxia: mimic the movements of others around them.
• Echolalia:  Repetitive echoing of words spoken by others.

In the UK, to be diagnosed with schizophrenia, a person’s behaviours are assessed in relation to criteria set out in the ICD-10 – version 10 of The International Statistical Classification of Diseases, a manual used in clinical practice in Europe.  In the USA, the DSM-5 is used instead.  This is the Diagnostic and Statistical Manual of Mental Disorders and is published by the American Psychiatric Association (APA).  These diagnostic criteria also change over time.  

While the DSM focuses exclusively on mental illness, the ICD has a wider scope and includes physical illnesses too. When it comes to the diagnosis of schizophrenia, there is generally a high level of agreement between the ICD-10 and the DSM-5.

A big issue with both of these systems of classification is that they could be argued to be culturally biased. They are created in the West, and are based on Western ideals of mental health. The research that the systems are based on are also predominantly conduced in Western countries.

Lack of insight:  Unlike many other psychological conditions, most people with schizophrenia have difficulty accepting their diagnosis. 

Stigma:  Schizophrenia is misunderstood.  Although the stigma of having a mental illness is thankfully declining, there is still a great deal of misunderstanding with regard to how schizophrenia is portrayed in the media.  ‘Timetochange’  is an organisation set up to challenge the stigma of mental illness.  

Depression: Many symptoms of schizophrenia, especially the negative symptoms, may be seen in people who will be diagnosed as having a mood disorder, like depression. Sometimes it can be difficult to state which behavioural characteristics are the result of the schizophrenia and which are the result of the depression.

Does ‘Schizophrenia’ even exist? - Some researchers believe that because there is such disparity between the symptoms of different people diagnosed with schizophrenia, we shouldn’t diagnose them as having the same disorder, instead we should just focus on and treat each symptom individually

The normal requirement for a diagnosis of schizophrenia is that a minimum of one very clear symptom belonging to any one of the groups listed as (a) to (d) below, or symptoms from at least two of the groups referred to as (e) to (h), should have been clearly present for most of the time during a period of 1 month or more. 

The ICD also has classifications for a number of subtypes of schizophrenia. For example:

•Paranoid Schizophrenia: . Common symptoms include delusions of persecution, the belief that they are on a “special mission”, and voices that threaten the patient or give commands. In this type of schizophrenia, negative symptoms may be present but are not dominant.

•Catatonic Schizophrenia: in this type of schizophrenia, negative symptoms are dominant. The patient may be in a catatonic state; an extreme loss of motor skill or even constant hyperactive motor activity. Catatonic patients will sometimes hold rigid poses for hours and will ignore any external stimuli. Patients with catatonic excitement can suffer from exhaustion if not treated. Patients may also show stereotyped, repetitive movements.

a) thought echo, thought insertion or withdrawal, and thought broadcasting;

b) delusions of control, influence, or passivity, 

c) hallucinatory voices 

d) persistent delusions

e) persistent hallucinations in any form, accompanied by half-formed delusions 

f) breaks in the train of thought, resulting in incoherence or irrelevant speech

g) catatonic behaviour, such as excitement, posturing, or waxy flexibility and stupor;

h) “negative" symptoms such as apathy, reduced speech, and blunting of emotional responses, usually resulting in social withdrawal and lowering of social performance

i) a significant and consistent change in the overall quality of some aspects of personal behaviour, such as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.