Schizophrenia: Introduction and Overview

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Running head: THE IMPACT OF SCHIZOPHRENIA

Schizophrenia: Introduction and Overview

Student ID: 2540 (AP205)

Southern Cross International College

(Path Education Singapore)

Schizophrenia: Introduction and Overview

Diseases of the brain and mind have occupied humanity from ancient times. Syndromes recognizable as forms of psychosis appear in the writings of Plato and Hippocrates. Psychosis is a syndrome such as a constellation of symptoms that reflects the distortion of the person's thoughts and perceptions such that there is a loss of boundaries between what is real and what is unreal, between himself or herself and the external world. And Schizophrenia, itself is a form of psychosis, characterized by a multiplicity of symptoms affecting the most fundamental human attributes: cognition, emotion and perception - a mind that is torn asunder. The early age of onset, varying degree of intellectual and psychosocial impairment, possibility of long-term disability and above all associated stigma, often brings to its victims and their family's emotional and financial distress, which makes schizophrenia one of the most severe and devastating mental illness (Thaker and Carpenter, 2001).

Symptoms of schizophrenia are generally divided into three categories: positive, negative and disorganized symptoms (Andreasen, 1995 pg. 477 - 81). Positive symptoms refer to the presence of mental features that should not be normally present. These include delusions which are false beliefs without any basis in reality and which are not in keeping with the person's educational, cultural and religious background. Other symptoms are hallucinations which are perceptions of stimuli that have no external reality, like auditory, visual, tactile, olfactory and gustatory hallucinations. And Andreasen, 1995 further identified the following symptoms of Negative and disorganized symptoms that normally present:

Negative symptoms refer to a lack or reduction of emotional responses and psychological functioning that should normally be present. These are manifested as affective flattening (difficulty in expressing emotions), alogia (limited or poverty of speech with consequent inability to initiate or maintain a conversation), avolition (extreme apathy with lack of initiation, drive or energy which result in academic, vocational and social deterioration), anhedonia (lack of interest or pleasure in life), asociality (social withdrawal and few social contacts) and attentional impairment.

Disorganized symptoms refer to disturbances in thinking and speech, and bizarre behavior. The disturbance in thinking (thought disorder) is inferred from the person's speech, which usually reflects the loosening of the link between one thought to another. The person may shift from one topic to another completely unrelated topic without realizing it makes no logical sense. New words may be made up that have no meaning to others. Behavior may also be abnormal and manifested as strange mannerisms, doing seemingly senseless things or assuming bizarre postures.

However, Andreasen, (1995) stressed that although positive, negative and disorganized features suggestive of schizophrenia may be present, none of these clinical features are pathognomic. Physical disorders and psychosis often overlap and it is essential for patients to have a comprehensive physical assessment to exclude psychosis arising from medical and/or organic causes.

The course of illness can be divided into four major epochs: premorbid adjustment, onset of illness, middle course, and late course (Sadock B.J. and Sadock, V.A., 2001 p. 1106). Premorbid adjustment refers to symptoms that appear prior to the onset of positive symptoms, which may be manifested as poor social and scholastic adjustment or diminished social drive; decreased emotional responsivity; withdrawn, introverted, suspicious, or impulsive behavior; idiosyncratic responses to ordinary events or circumstances; short attention span; and delayed developmental milestones or poor motor and sensorimotor coordination. Childhood asociality - a trait that has been referred to in the past as a poor prognostic indicator, is probably more appropriately conceptualized as the early morbid manifestation of deficit symptomatology. Disturbances in social behavior have been picked up as early as infancy by workers who have noticed a lack of responsiveness and emotional expression in infants who later developed schizophrenia. It is also evident, however, that deficit symptoms may have their onset following psychosis and become part of the progression of the illness during the initial years of psychosis. Subtle forms of positive formal thought disorder may also be manifest before overt hallucinations and delusions occur. Studies have evaluated the development of the offspring of mothers with schizophrenia have observed cognitive difficulties during the pre-teen and teenage years in these high-risk children (p. 1106). And in terms of family relations, there is some evidence that parents of schizophrenics are emotionally disturbed more often than the patterns of normal children and that more of the mothers have schizoid personality traits. Moreover, it is claimed that the parents of schizophrenics seem to be in conflict with one another more often than the parents of other psychiatric patients, and that the mothers are more concerned about and protective towards their children (Johnstone and Lawrie, 1998 p. 404).
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The etiology process or processes by which a causal agent creates the pathophysiology of schizophrenia is not yet known. However, while the reliability of the schizophrenia diagnosis introduces difficulties in measuring the relative effect of genes and environment (for example, symptoms overlap to some extent with severe bipolar disorder or major depression), there is evidence to suggest that genetic vulnerability and environmental stressors can act in combination to cause schizophrenia (Harrison & Owen, 2003). The extent to which these factors influence the likelihood of being diagnosed with schizophrenia is debated widely, and currently, controversial. Schizophrenia is likely to ...

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