classification of schizophrenia

• Schizophrenia is a mental illness characterised by a profound disruption of cognition and emotion where the individual has lost touch with reality and because of this an individual does not have insight into their own disorder meaning they cannot recognise the symptoms. The illness affects the patient’s language, thoughts emotions and perceptions as well as their sense of self.
• schizophrenia is a type of psychosis in which thoughts and emotions are impaired and contact is lost with external reality)
• -          Schizophrenia affects about 1% of the population and many of these people with just have one episode and lead normal lives after if they receive treatment.
• -          schizophrenia ranks amongst the top ten cases of disability worldwide and effects about 4in 1000 people at some time in a person like said Saha et al 2005.
• Diagnosing it

  -          According to the DSM 5 schizophrenia is characterised by delusions, hallucinations and disorganised speech or behaviour and there are also other symptoms that cause social or occupational dysfunction.
• Diagnosing it

  -          DSM 5 states the following criteria for diagnosing schizophrenia – the symptoms of schizophrenia must have been present for 6 months and include at least one month of active symptoms.

  And they state that the individual must exhibit at least 2 of the specific symptoms.
• Positive symptoms

  Positive symptoms are those which are an add on / addition to the individual’s behaviour and are those that appear to reflect an excess or distortion of normal functions - some include.
• Positive symptoms

  -          Delusions – which are distorted believes that feel real to the individual but aren’t in reality the individual also doesn’t feel in control of their own thoughts and feelings.

   
• Positive symptoms

  -          Delusions – there are different types of delusions sometimes they can be paranoid in nature (persecutory), so they often believe that a person is being followed or spied on by someone or that their phone has been tapped or there are hidden cameras in their home. however, they may also have delusions of grandeur where they have inflated believes about their power and importance –

   
• Positive symptoms

  -          Delusions - they may believe they are famous or have special powers and abilities. they can also experience delusions of reference where events in the environment they feel are directly related to them like a secret special message being communicated to just them via a tv broadcast or radio.

   
• Positive symptoms

     Disorganized speech – is the result of disorganised thought processes which then shows up in the patient’s speech resulting in confused and muddle sentences – the patient will slip between topics mid-sentence leading to their speech sounding like gibberish and this is often referred to as word salad.
• Positive symptoms

        Disorganized speech –

  -          Grossly disorganised or catatonic behaviour – this includes the inability or motivation to initiate a task or to complete it once they have started which then leads to difficulties in daily living and can result in decrease interest in individuals personal hygiene and so the individual may act or dress in ways that seem bizarre to others – wearing heavy clothes on hot summer dayscatatonic behaviours are characterised by a reduced reaction to the immediate environment rigid postures or aimless motor activity
• Positive symptoms

  -          Hallucinations – are bizarre unreal perceptions of the environment that are usually auditory – voices that exist only to the individual and are not real however feel very much real to the person hearing them the content of the voices varies from person to person but it often takes the form of a running commentary on the persons behaviour or is a voice telling them to do something like harm themselves or others.

   

   
• Positive symptoms

   

  -          Hallucinations – they can also experience visual hallucinations seeing lights , objects and faces that others cannotolfactory hallucinations is when they can smell things others cannotalso tactile hallucinations where they feel like bugs are crawling on or underneath their skin or just like something is touching their skin

   
• Negative symptoms

  ·       Negative symptoms are those that appear to reflect a reduction or loss of normal functions which often persist even during periods of low or even absent positive symptomsnegative symptoms weaken a person’s ability to cope with everyday activities which affects their quality of life and their ability to manage without significant outside help and the individual is often unaware of the extent of their negative symptoms and are typically less concerned by them then their relatives may be
• Negative symptoms

  ·       enduring negative symptoms is sometimes referred to as the deficit syndrome which is characterised by the presence of at least 2 negative symptoms for 12 months or longer – individuals with this syndrome have been found to have more pronounced cognitive deficits and poor outcomes then patients wo don’t with several studies including Milev et al in 2005 reporting worse functional outcomes in individuals with more prominent negative symptoms which involve losses of emotions interests , pleasures and more
• Negative symptoms

  ·       negative symptoms also respond poorly to antipsychotic treatment although  newer atypical antipsychotics are claimed to be superior at treating negative symptoms than older typical antipsychotics
• Negative symptoms

  -          Speech poverty (alogia)  - is a symptom characterised by the Lessing of speech fluency and productivity  (a reduction in the amount of quality of speech in schizophrenia ) which is thought to reflect the slowing or blocked thoughts
• Negative symptoms

  -          Speech poverty (alogia)  - patients who display speech poverty display a number of characteristics / signs – they produce fewer words in a given time on a task of verbal fluency so if they were asked to name as many animals as they could in a minute they old struggle and this is not because they don’t have the knowledge to answer the question they are struggling with the ability to spontaneously produce them

  so the person will speak infrequently and when they do speak the speech lacks fluency.
• Negative symptoms

  -          Speech poverty (alogia)  -in response to questions they are asked they are also likely to give brief , empty answers and they are unlikely to engage in spontaneous speech
• Negative symptoms

  -          Speech poverty (alogia)  - speech poverty can be displayed in a less complex syntax so they may use fewer clauses or shorter sentences and this type of speech poverty is more associated with long illness and earlier onset of the illness
• Negative symptoms

  -          Avolition – is when a patient shows a reduction of interest and desires as well as an inability to persist in goal directed behaviours (spending hours a day doing nothing)
• Negative symptoms

  -          Avolition – andeason 1982 identified three identifying signs of avolition including poor hygiene and grooming, lack of persistence in work or education and lack of energy.
• Negative symptoms

  -          Avolition –

  -          Affective flattering – is the reduction in the range and intensity of emotional expression including facial expression, tone of voice, eye contact and body language.
• Negative symptoms

  -          Avolition –

  -          Anhedonia – the loss of pleasure in almost all activities or a lack of reactivity to normal pleasurable stimuli it may be pervasive so all embracing or may be confined to a certain aspect or experiencephysical anhedonia is the inability to experience physical pleasures like from food , bodily contact
• Negative symptoms

  -          Avolition –social anhedonia is the inability to experience pleasure from interpersonal situations such as interacting with other people – social anhedonia can overlap with other disorders like depression by physical anhedonia doesn’t so is considered a more reliable symptom of schizophrenia says Sarkar et al 2010