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Schizophrenia Spectrum and Other Psychotic Disorders

It was the Swiss psychiatrist, Eugen Bleuler that introduced the term schizophrenia to the world of psychiatry in 1908. Schizophrenia means a “splitting of the mind”, and was used by Bleuler to describe a group of patients who showed a “breaking up or splitting of psychic functioning”, including thoughts, feelings, and perceptions. Today individuals who show psychotic symptoms are diagnosed along a gradient, or spectrum, reflective of the duration and intensity of their disorder.




Characteristic Symptoms

The symptoms of the schizophrenia spectrum disorders fall into two broad categories: positive and negative. Positive symptoms are abnormal thoughts, perceptions and behaviors that most individuals do not normally experience. These include delusions, hallucinations, disorganized thinking, and grossly disorganized behavior.

Delusions are strongly held false beliefs despite evidence to the contrary. There are several delusional themes that are commonly seen in schizophrenia, including persecution (the belief that one is going to be harmed or harassed by another), reference (the belief that certain gestures, comments, or environmental cues are directed at you), grandiosity (the individual believes they have exceptional abilities, wealth, or fame), erotomania (the individual falsely believes that another person is in love with him or her), jealousy (the belief that the individual’s spouse or lover is unfaithful), nihilism (the belief that a major catastrophe will soon occur), and somatic issues (preoccupation with one’s health and organ function).

Hallucinations are experiences involving the apparent perception of something not present. These experiences can occur in relation to any of the senses, but auditory hallucinations are the most common in the schizophrenia spectrum disorders. Auditory hallucinations are usually experienced as voices that are perceived as distinct from an individual’s own thoughts.

Disorganized Thinking is typically recognized in the speech of the individual with schizophrenia. They may show loose associations by switching from one topic to another. Answers to questions may be tangentially related or completely unrelated. In rare instances, speech may be so severely disorganized that it is incomprehensible.

Grossly Disorganized Behavior (including catatonia) may manifest itself in a variety of ways, ranging from childlike silliness to unpredictable agitation. Individuals with schizophrenia often have difficulty formulating and producing goal-directed behavior. Catatonic behavior is a marked decrease in reactivity to the environment. Individuals exhibiting catatonia appear to be completely unaware of their environment, maintain a rigid posture, and resist efforts to be moved.

Negative Symptoms are the loss or decrease of an ability that is normally present. Common negative symptoms seen in schizophrenia include diminished emotional expression, decreased motivation (avolition), lack of speech (alogia), lack of interest in social interactions (asociality), and a decreased ability to experience pleasure from enjoyable activities and experiences (anhedonia).

 

Types of Psychotic Disorders

Schizotypal Personality Disorder 

Schizotypal Personality disorder is a pervasive pattern of social and interpersonal deficits, including reduced capacity for close relationships, cognitive or perceptual distortions, and eccentric behavior. Abnormalities of beliefs, thinking, and perception are below the threshold for the diagnosis of a psychotic disorder. This is the lowest end of the schizophrenia spectrum.

Delusional Disorder

Delusional Disorder is characterized by at least one month of delusions but no other psychotic symptoms. If hallucinations are present, they are not prominent and are related to the delusion. Apart from the impact of the delusion or its ramifications, functioning is not markedly impaired, and the individual’s behavior is not obviously bizarre or odd.

Brief Psychotic Disorder 

Brief Psychotic Disorder is characterized by the presence of one or more of the primary symptoms of psychosis (delusions, hallucinations, disorganized thinking, and grossly disorganized behavior). The duration of the disturbance is at least one day but less than one month, with an eventual return to a normal level of functioning.

Schizophreniform Disorder

Schizophreniform Disorder is characterized by the presence of two or more psychotic symptoms. The duration of the disturbance is at least one month but less than six months.

Schizophrenia

Schizophrenia is characterized by the presence of two or more psychotic symptoms, each present for a significant portion of time during a one month period. For a significant portion of the time since the onset of the disturbance the individual’s level of functioning in one or more major areas, such as work, interpersonal relations, or self-care is noticeably below normal. Continuous signs of the disturbance must persist for at least six months.

Schizoaffective Disorder

Schizoaffective Disorder is characterized by the symptoms of schizophrenia as well as a major mood episode. There are two subtypes of schizoaffective disorder, bipolar and depressive. The essential feature of the bipolar subtype is the presence of a manic episode during the illness, while the depressive subtype is characterized the presence of a major depressive episode. Schizoaffective disorder is the highest and most severe end of the schizophrenia spectrum.


Prevalence and Age of Onset

It is estimated that schizophrenia affects 0.3%-0.7% of the population. The onset of schizophrenia occurs between the late teens and early thirties. The disorder affects men and women equally, although symptoms generally appear earlier in men (in their late teens or early twenties) than in women (in their late twenties or early thirties). Schizoaffective disorder appears to be less common than schizophrenia with a lifetime prevalence estimated at 0.3% of the population. The age of onset for schizoaffective disorder is the late teens to early twenties. Schizoaffective disorder is more common in women than men.

 


Treatment & Support

Given that schizophrenia is predominantly a biologically driven disorder, medication will always be a major component of any treatment plan. Like diabetes, schizophrenia is a chronic condition that requires constant, lifelong management.

Antipsychotics

Antipsychotic medication is the first line of treatment for the positive symptoms of schizophrenia. These drugs can be placed into two broad categories: typical antipsychotics and atypical antipsychotics. The typical antipsychotics (e.g., Haldol, Navane, Thorazine) are older medications that work by blocking the function of the neurotransmitter dopamine in the brain, meaning they are dopamine antagonists. Typical antipsychotics can have serious side effects that mimic the symptoms of Parkinson’s disease, such as rigidity, persistent muscle spasms, tremors, and restlessness. After long-term use, a condition known as tardive dyskinesia may appear in the patient, resulting in uncontrollable jerky movements of the arms, legs, and facial muscles. The newer atypical antipsychotics (e.g., Abilify, Geodon, Risperdal, Zyprexa) do not seem to produce the same serious movement related side effects seen with the older drugs. Atypical antipsychotics modify the functioning of both dopamine and serotonin in the brain. While these medications can greatly improve the patient’s quality of life by managing the psychotic symptoms of schizophrenia, they are not a cure.

Psychosocial Therapy

A positive relationship with a therapist gives the patient a reliable source of information, encouragement, and hope. For those who are stabilized on antipsychotic medication, psychosocial therapy helps deal with issues like communication, motivation, self-care, work, and establishment and maintenance of relationships with others. For example, most people who are recovering from schizophrenia want to become more independent in their daily living. To do so, they may need assistance learning how to better manage everyday activities, such as shopping, budgeting, cooking, clothes laundering, personal hygiene, and social/leisure activities. Psychosocial therapy can provide this type of life skills training. In addition, including cognitive behavior therapy in the patient’s treatment plan has been shown to be effective in the direct reduction of symptoms.

 

A Spiritual Perspective

Schizophrenia is a destructive disorder. Not only does it destroy the mind of the one who is afflicted, but it also destroys his or her relationships and family. Watching a loved one suffer with schizophrenia makes it difficult to believe in God, let alone trust Him. How could a loving God allow such misery, such pain?

As finite beings, we are limited in our ability to grasp the broader meanings and purposes of trials and suffering in our lives. What we can rest in, however, is that God does understand them and that He is fully in control. God is both sovereign and good. We know that God is sovereign because He created and sustains all things (Deuteronomy 4:39; Daniel 4:34–35; Colossians 1:16–17). Without Him there is nothing, and nothing occurs apart from His divine will. We know He is good because He sent His beloved Son to die for us so that we might have new life (1 John 4:9). Recognizing God’s sovereignty and goodness helps us navigate through the difficult times, as we cry out with the psalmist: “But as for me, I trust in You, O Lord, I say, ‘You are my God.’ My times are in Your hand” (Psalm 31:14–15). We may never understand why our loved one is suffering, but we can be assured that God is in control and ready to provide sustaining grace to all those who seek Him (2 Corinthians 12:9).

  

Finding Care

The links and information below will provide you with a starting point in terms of finding mental health care providers, treatment facilities and support groups for those struggling with schizophrenia.

Mental Health Care Providers

When assisting an individual it is important to help them find the right type of mental health care provider. These links will assist you in beginning your provider search. Knowing and building relationships with providers in your area can prove invaluable. Both in aiding the individual in getting an appointment, as well as, being able to better support them once they begin receiving professional treatment.

An individual struggling with schizophrenia will most likely need to see both a clinical psychologist / therapist for psychotherapy (talk therapy) and a psychiatrist for medication.

By providing your zip code the following search engines will give you information about local mental health care providers.

Clinical Psychologists / Therapists Psychiatrists


Treatment Facilities

In some people, the symptoms of schizophrenia can become so severe that a hospital stay is needed. This may be necessary if the individuals seeking your care can’t take care of themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric treatment at a hospital can help keep them calm and safe until their mood improves.

Partial hospitalization or day treatment programs also may help some people. These programs provide the outpatient support and counseling needed to get symptoms under control.

By providing your zip code the following search engine will give you information about mental health treatment facilities in your area.

Substance Abuse and Mental Health Services Administration American Residential Treatment Association


Support Groups

Recognizing that community is one of the factors necessary for successful recovery, attending support groups can be a powerful and meaningful way to connect with others facing similar challenges. Support group experiences allow people affected by mental health difficulties and disorders to connect in a safe and supportive environment. Support groups are led by trained facilitators and teach coping skills, help reduce anxiety, build resiliency and provide a place for people to share common concerns and receive emotional support.

These links will give you information on support groups in your area.

Schizophrenia and Related Disorders Alliance of America National Alliance on Mental Illness Grace Alliance


Supporting the Family

Many times the family caring for an individual with a mental illness is overlooked. They are often the front line support for the individual. The responsibility of care can take a physical and psychological toll on caregivers. Many times the caregiver needs as much support as the individual that has the illness. Caregiver support groups are available for the families of those struggling with Schizophrenia or other psychotic disorders.

These links will give you information on caregiver (family) support groups in your area.

National Alliance on Mental Illness – Family Support Group National Alliance on Mental Illness – Family to Family Support GroupGrace Alliance




Educational Resources

Here are some links to aid you in learning more about schizophrenia. The more information you have, the better you will be able to help those seeking your guidance.

National Institute of Mental Health Mental Health America


Downloadable Resources 

First Step – What to do once a diagnosis has been made.

Daily Steps – Developing a holistic mental health care plan.

Difficult Steps – Navigating destructive behavior and legal issues.

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