What is schizophrenia?
Schizophrenia is a type of chronic psychotic disorder that is characterized mainly by the presence of delusions, hallucinations, as well as altered language and/or behavior for at least 6 months and whose alterations significantly influence the work or social life of person. The person may hear noises, sounds or voices that speak to him or that converse with each other and that are generally perceived as unpleasant and/or distressing. Some patients consider that their own thinking has undergone a change and perceive it as foreign to themselves, or as if someone had stolen it from them. Sometimes they even consider that their thought comes from the outside or that other people can hear or read it.
In the patient's attempt to understand those abnormal phenomena that he feels are happening to him, the patient commonly elaborates a delirium or explanation that gives "coherence" to those sensations. There are different types of delusions, although the most frequent are those of prejudice or persecution, in which the person thinks that others are following or spying on them, or that their environment conspires to cause them some type of harm. It is also very common for the patient to believe that certain events or situations that occur around him refer to or have some kind of special meaning for him, for example that the day is cloudy is because of him, that when he enters a room and someone sneezes it is because he has arrived, or they talk about him on television.
On the other hand, in schizophrenia symptoms that we call negative also predominate, such as affective flattening, anhedonia (inability to enjoy), social withdrawal, apathy and sometimes thought blocks. Unfortunately, in many cases, the patient lacks awareness of the disease and does not believe that he needs any treatment. Naturally, as with any medical and psychiatric illness as well, the sooner the disorder is detected and treated, the better the prognosis.
Types of schizophrenia
Paranoid schizophrenia
It is mainly characterized by the presence of delusional ideas and auditory hallucinations, with areas such as affectivity, language or behavior being less affected. Fundamentally, delusional ideas are persecutory, detrimental or referential, but delusional ideas can also occur with other themes, although they are usually organized around a coherent theme. It is also common for hallucinations to be related to the content of the delusional theme. Associated symptoms include anxiety, anger, withdrawal, and a tendency to argue. Onset tends to be later than in other types of schizophrenia, and they also tend to have a better prognosis than other types, generally presenting less cognitive and social impairment.
Undifferentiated schizophrenia
When a schizophrenia does not meet the criteria of the previous subtypes or presents several of them, it is called undifferentiated.
Disorganized Schizophrenia
El trastorno bipolar tipo II suele ser más difícil de diagnosticar que el de tipo I, puesto que las personas que lo padecen no suelen identificar las fases de hipomanía como algo patológico y, por lo tanto, no suelen relatar estos periodos en consulta. Por esta razón, en ocasiones se realizan diagnósticos erróneos de depresión recurrente en personas que en realidad padecen trastorno bipolar tipo II.
Catatonic schizophrenia
The main feature of the catatonic type of schizophrenia is a marked psychomotor disturbance that may include immobility, excessive motor activity, extreme negativism, mutism, or voluntary movement peculiarities. Excessive motor activity appears to be purposeless and uninfluenced by external stimuli. There may be anything from maintaining a rigid posture against any attempt to be moved to adopting strange or inappropriate postures. To diagnose this subtype, the picture must first meet all the criteria for schizophrenia and not be further explainable by other causes or diseases..
Residual schizophrenia
The residual type of schizophrenia should be used when there has been at least one psychotic episode, but in the current clinical picture the existence of delusions, hallucinations, disorganized behavior or language is not marked, mainly negative symptoms (emotional, social isolation, poor language, lack of interest...).
Schizophrenia - Questions and Answers
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There are no pathognomonic symptoms in schizophrenia, that is, symptoms whose appearance is sufficient to issue the diagnosis, but its diagnosis is clinical (that is, it must be made by a specialist psychiatrist or psychologist) and implies the existence of a set of manifestations, among which the psychotic ones stand out (the person is out of touch with reality), along with the presence of occupational or social deterioration that lasts for a while.
The characteristic symptoms of schizophrenia involve a series of cognitive and emotional dysfunctions that include: perception, fluency and productivity of thought and speech, language and communication, affectivity and behavior, will, motivation , attention, etc.
However, and given the wide range of possible symptoms, we could classify these into two main types:
Positive symptoms
- Hallucinations: are perceptions that occur without an external stimulus. There are many types (olfactory, bodily, visual...) but the most common are auditory: hearing voices, noises or sounds. Voices that talk to each other and those that comment on the person's activity are especially characteristic.
- Delusions: they are beliefs that the patient elaborates in his attempt to explain to himself those sensations and perceptions that he is experiencing, and they are characterized by his absolute conviction.
There are different types of delusions, depending on their content: harm or harm (belief that someone wants to harm or harm them), reference, control (belief that others control their behavior and / or thoughts) , of greatness (believing to be special or famous), somatic (believing that your body or internal organs have changed or are sick), guilt, jealousy, etc. - Extravagant or violent behavior: many times the patient's behavior is motivated by his hallucinations and delusions.
When the person is attending to the voices or thinking about her delusion, she is usually absorbed or worried and remains indifferent or isolated from her environment. Other times you may react with laughter or intense fear, being able to carry out behaviors that are outside of social norms: talking to yourself on the street, dressing in a scruffy or outlandish way, or careless in terms of hygiene, shouting, arguing, insulting, etc. ). - Language and disorganized thought: in the psychotic patient there are many types of language disorders, ranging from derailment or flight of ideas, in which the patient goes from one sentence or one topic to another without the ability to follow a thread, until total incoherence or illogicality, which makes their speech incomprehensible or meaningless.
Negative symptoms
- Affective poverty: there is usually an impoverishment in the expression of emotions and feelings, with facial expressionlessness, diminished spontaneous movements and a lack of expressive gestures. The patient may remain seated in the same place for a long time, or keep their eyes lowered, avoiding eye contact.
- Alogia: Impoverishment of thought and cognition, which is manifested through poor language, blockage... with the patient's responses being excessively brief or empty of content.
- Avolition-Apathy: manifested as a lack of energy, motivation and interest, which can translate into physical inactivity and a lack of persistence at work, school or any task, neglect in daily cleaning, feeling tired, slow and tendency to physical or mental exhaustion.
- Anhedonia-Unsociability: it has to do with the difficulty to experience pleasure for the things that used to be enjoyed, and with the social isolation to which this type of patients tend, who stop participating in interpersonal activities.
- Cognitive attention and concentration problems: the patient may become distracted in the middle of an activity or conversation, for this reason it may be difficult for him to understand a reading or the development of a social interaction.
The causes of this type of mental disorder can be understood from the vulnerability-stress model, which has as its basic assumption that schizophrenia, and psychotic disorders in general, are the result of a set of factors that predispose to a greater or to a lesser extent the patient to the development of the disease, and that generally have to do with the presence of environmental factors in a genetically vulnerable person.
We could say, for example, that a person with a family history of schizophrenia (that is, genetically vulnerable) who is subjected to a significant level of sustained stress (environmental factor) is more likely to develop the disease as several predisposing factors come together Of the same. None of the two factors (vulnerability and stress) are sufficient separately to cause the disorder, so only a part of predisposed people end up developing the disease throughout their lives.
The main factors involved in the appearance and development of this disease are: