| Schizophrenia
and Other Psychoses Schizophrenia is a very serious mental illness.
It is characterized by a breakdown in normal thought processes and a loss of reality
contact.
This loss of reality contact is called psychosis, and is marked by the
presence of hallucinations and/or delusions (false beliefs).
Thankfully, schizophrenia is fairly uncommon, affecting roughly one
percent of the population. However, because of the severity of schizophrenia, it can have
devastating effects on the person's life. It also can be a source of considerable
heartache and stress for family members.
In the sections below, we discuss symptoms of schizophrenia and other
psychotic disorders, some general issues regarding treatment, and the role of
psychologists in diagnosis and treatment.
Symptoms of Schizophrenia
Schizophrenia is a
thought disorder. This means that you usually see some form of mental disorganization,
such as thought processes and speech that seem disconnected or illogical.
In its milder forms, this mental disorganization can lead the listener
to feel puzzled because what the person says just doesn't quite fit together or make
sense. At its worst, their speech is completely incoherent.
Schizophrenia also is characterized by the presence of hallucinations
and/or delusions. Usually, these are present in conjunction with the mental
disorganization described above, but someone can have hallucinations and delusions without
grossly disorganized thought processes.
Other symptoms that are characteristic of schizophrenia include a lack
of emotional response or depth, called "flat affect." Sometimes, however, there
can be strong emotional reactions and volatility, particularly in response to delusional
beliefs. Also, you sometimes see inappropriate affect, such as laughing when hearing that
someone has died.
People with schizophrenia often seem unmotivated, and may just sit and
stare at the television for hours without moving. You might also see deterioration in
self-care, like refusal to bathe or change clothes. Withdrawal from social interactions is
common.
Behavior problems can occur in response to the hallucinations,
delusions, and mental confusion. Sometimes these behaviors are relatively benign, like
mumbling to themselves or putting multiple layers of clothes on. Other times, the behavior
can be hazardous for the person, who might, for example, wander in the road or go into
dangerous environments. Finally, people with schizophrenia sometimes act out in
threatening or aggressive ways, usually in response to their psychotic symptoms.
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Other Psychotic Disorders
Other psychotic
disorders also exist. Some of these are mentioned briefly here.
Delusional
Disorder is present when the person
is generally intact except for a distinct area of his life that is marked by a delusional
belief. For example, the person might believe that he has a special romantic relationship
with a celebrity, or he might be certain that there is a conspiracy against him among his
coworkers. Apart from the delusional belief, the person usually appears fairly normal.
A person can experience a brief, transient psychotic reaction, during which there could be mental
disorganization, hallucinations, or delusions. Often, when this occurs, it is in response
to extreme stress. It also can occur in the weeks after childbirth. When it resolves, the
person returns to their normal state.
Severe
mood disorders (depression or
mania) can include psychotic symptoms.
Alcohol
and other drugs can provoke
psychotic symptoms. In some cases, the symptoms are directly caused by the drug and
resolve fairly quickly after a period of sobriety. In other cases, the symptoms can
persist for weeks or even months. In a subset of people, drugs seem to provoke a dormant
mental illness that becomes a chronic problem requiring ongoing treatment.
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General Treatment Issues
The primary treatment
for schizophrenia and other psychoses is medication. Once a diagnosis is established, the
psychologist can refer the person to a physician for medication management.
In some cases, the disorder is severe enough that hospitalization is
necessary. In such circumstances, the psychologist will refer the person to the treating
physician, who can admit the person, or to the Emergency Department of the hospital.
Schizophrenia often responds well to medications, particularly with the
newer, more effective drugs that have come out in recent years.
However, medications also can have some unpleasant side effects, such
as extreme drowsiness. Compliance can suffer if the person does not develop tolerance for
these side effects.
Another major difficulty in treating schizophrenia is the tendency of
the person to deny they have the disorder. This denial is a common human response to
something that is very frightening or that threatens the person's self-image.
Unfortunately, along with this denial comes a tendency to discontinue medications, since
taking the medications implies that one needs them.
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The Role of the Psychologist
Diagnosis:
The psychologist can
establish the diagnosis of schizophrenia. This involves evaluating the presence of
schizophrenic symptoms, while also assessing whether other disorders could account for the
symptoms.
The psychologist establishes the diagnosis through the clinical
interview, during which thought processes can be observed directly, and through reports of
symptoms by the person or loved ones. Sometimes, psychological testing can be useful to
clarify whether there is a thought disorder present, particularly when that mental
disorganization is subtle and relatively mild.
Treatment:
The psychologist can
provide therapeutic
services for the person with schizophrenia, including support and help in communicating any problems with their
medications.
A significant role for the psychologist is dealing with denial of the
disorder. Because denial is based on the instinct for self-protection, it can be a very
strong obstacle to successful treatment.
The psychologist tries to overcome the need for denial by working with
the person to identify and reduce the anxiety associated with having schizophrenia. This
involves coming to understand the meaning of the disorder for the person who has it,
dealing with the real losses they experience because of the disorder, and addressing their
expectations for the future.
In addition, the psychologist works to strengthen the person's sense of
self-appreciation and empowerment in order to counter the negative impact of the disorder
on his self-image. Part of this work also involves developing the person's ability to
respond to the stigma of schizophrenia -- to respond in constructive ways to negative
biases they might encounter with other people.
In addition to directly helping the person with schizophrenia, the
psychologist can provide support for family members. The role of the family member can be very stressful, emotionally painful, and
often thankless. In particular, family members can be central figures in delusional
beliefs and can suffer antagonism, harassment, or abuse as a result.
Also, the family may be
forced to take responsibility for the person's well-being during periods when they are too
ill to care for themselves appropriately. This might include taking them to treatment
against their will, and facing considerable anger and resentment for doing so. It also can
mean pursuing civil commitment through the probate court in order to mandate treatment or
hospitalization.
The psychologist can
help by providing a place where family members can express their feelings, their
frustrations, and their questions. In addition, communities often have support groups that
can be very worthwhile.
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