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1. Schizophrenia - First rank symptoms:<br />SymptomVariationsDescriptionThought disturbance or control of thoughtInsertionThoughts are being placed in the mind by…
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  • 1. Schizophrenia - First rank symptoms:<br />SymptomVariationsDescriptionThought disturbance or control of thoughtInsertionThoughts are being placed in the mind by external forcesWithdrawalThoughts are being removed from the mind by external forcesBroadcastingThoughts are being broadcast to others for example over the radio or through the TVHallucinationsAuditoryThe most common symptom of schizophrenia.  Voices telling the person what to doOther sensesFor example touch or visual.  The schizophrenic might see Elvis or feel people touching them.DelusionsGrandeurThinking you’re Napolean really is quite common amongst schizophrenics.PersecutionA worrying one in which they think people are out to get them.  (Also common in sleep deprivation studies).ReferenceThe person believes that characters in a book, songs or in films are actually referring to them.<br />Major symptoms of Schizophrenia (according to Slater and Roth 1969)<br />Thought disorder in which there are breaks in the train of thought and the person appears to make illogical jumps from one topic to another (loose association).  Words may become confused and sentences incoherent (so called ‘word salad).<br />Psychomotor disturbances (or catatonic behaviour) were the patient may adopt strange postures or engage in repetitive movements such as pacing or rocking.  Catatonic refers to the tendency of some patients to hold a particular position for an extended length of time (in extreme cases several years!!!).<br />Lack of volition: in which a person becomes totally apathetic and sits around waiting for things to happen.  They engage in no self motivated behaviour.  Their get up and go has got up and gone!<br />Disturbances of affect, where the patient may show little in the way of emotional response or in some situations may exhibit inappropriate emotional responses:<br />Blunting: Show few signs of emotional sensitivity (e.g. on the death of a friend)<br />Flattened affect: More general loss of emotional expression.<br />Inappropriate affect: Laugh at bad news or at a funeral (think of the ‘giggle-loop’ in Coupling)<br />First rank symptoms appear to be describing the ‘core’ characteristics of schizophrenia and the ones that most people find most concerning.  Slater & Roth on the other hand see these so called ‘first rank’ symptoms as being secondary manifestations of other underlying processes.<br />It is essential to remember that there is no one characteristic that must be present for a person to be diagnosed with schizophrenia!   <br />Positive and Negative symptoms<br />One other particularly useful, way in which the symptoms can be broken down: <br />Positive symptoms:  <br />These refer to the characteristics that appear in addition to existing behaviours, for example hallucinations, delusions and thought disturbances such as thought insertion.<br />Negative symptoms:<br />Refers to those symptoms that an impairment of usual behaviours such as psychomotor disturbances, lack of volition, disturbances of mood and thought disorders.<br />This is a useful distinction to make since it appears that the dopamine hypothesis (medical model) accounts for positive symptoms whereas other explanations (serotonin or brain structure) are needed to explain the negative symptoms.  Note however, that Schneider’s first rank symptoms all appear to be positive and most of Slater & Roth’s are negative.<br />Types of schizophrenia<br />The validity of schizophrenia has a single disorder is questioned by many.  This is a useful point to emphasise in any essay on the disorder.  The symptoms are so diverse and the possible causes so varied that it seems likely that we are in fact dealing with many different psychological disorders.  One way round this problem is to consider different types of schizophrenia. Below are the main five subdivisions which just a brief description of each:<br />Paranoid schizophrenia<br />Characterised by type I or positive symptoms.  Typically the paranoid schizophrenic experiences delusions of persecution or grandeur that are very detailed and complex.   On average about 100 paranoid schizophrenics are arrested outside the White House, and in Britain sufferers are drawn to Downing Street or Buck House.  Sometimes they are seeking money but often want to give advice on how to run the country or on impending disaster.  This category is odd in that patients do not have any of the negative symptoms and other than their strange beliefs show no outward signs of their condition.<br />Disorganised schizophrenia (formerly hebephrenic)<br />Hebephrenic means ‘silly mind.’  The characteristics of this disorder are silly and incoherent behaviour such as giggling and inane laughter and a tendency to talk about meaningless topics for hours!  Negative symptoms such as disorganised behaviour and incoherent language are common.  (Tune into the Radio 1 breakfast show any morning for a fuller understanding).  <br />Catatonic schizophrenia<br />Characterised by impairment of body movement.  This may involve wild and uncontrolled movements that put themselves or others in danger or may be simply holding one particular posture for long periods of time.  ‘Waxy flexibility’ may also result, when someone attempts to move them they simply freeze in the new position instead.  The movements may coincide with hallucinations, often about death and catastrophe.  <br />Simple schizophrenia<br />Characterised by a withdrawal from reality resulting in declining academic performance, loss of friends and extreme apathy or loss of volition.  Note: simple schizophrenia is not recognised by all categorisations of the disorder.<br /> <br />Evaluation of these types of schizophrenia<br />With the exception of paranoid schizophrenia the others types are difficult to distinguish in practice (even for psychiatrists specialising in the condition).  On top of this the symptoms may change over time so that a patient displaying one set of symptoms may display a different set a few years later.<br />Catatonic schizophrenia (the rocking and strange movements seen in films about the Victorian-style asylums) are very rare today.  This could be due to much improved drug therapy or it could be that this was a mis-diagnosis in the first place.  The film ‘Awakenings’ starring Robin Williams and Robert de Niro looks at a case of sleeping sickness* that could have been misinterpreted as catatonic schizophrenia. <br />The different types are of little use in helping treatment or suggesting prognosis (unlike the Positive and Negative symptoms distinction).<br />* The precise cause of sleeping sickness (an epidemic of which occurred in the 1920s) is not known.  It could be due to a viral infection or perhaps even an auto-immune response triggered by a bacterium.  The symptoms include very high fever and in some cases coma (hence the name).  They can also include disturbances of movement and slowing of mental responses, hence the confusion with schizophrenia. <br /> The course of schizophrenia    <br />Prodromal phase (start of the abnormality)<br />Onset is usually late teens. Patient becomes withdrawn, takes less interest in education and shows flattened affect.<br />Residual phase<br />Symptoms are reduced and person returns to symptoms similar to prodromal phase. 25% return to ‘normal.’<br />Active phase<br />Main symptoms appear e.g. hallucinations, delusions.  10% remain in this phase and show no further improvement.<br /> Summary of characteristics (adapted from Gross & Rolls)<br /> FIRST RANK SYMPTOMS MAJOR SYMPTOMS  HallucinationsDelusionsThought disturbances Disturbance of moodDisorders of movementLack of volition Not observableSubjective experiences of the patientPositive symptoms since they are in addition to expected behaviours Negative symptoms since they are expected behaviours that have become impairedObservablecan be measured and assessed objectively<br />Exercise: Describe and evaluate issues in diagnosing Schizophrenia<br />
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