OTHER DISORDERS

Schizophrenia

Credit: TED-Ed

From A Beautiful Mind (2001) to Benny and Joon (1993), Schizophrenia is one of the most commonly depicted mental illnesses in the media, albeit with varying levels of accuracy. It has an estimated 0.8% prevalence rate in the Singapore population and is among the top 5 most common mental health conditions that people seek help for.

So, what is Schizophrenia? 

Schizophrenia is a chronic condition that affects how a person thinks, feels, and behaves. It is one of the most severe and debilitating mental disorders. At times, persons suffering from Schizophrenia may think and communicate clearly, hold an accurate view of reality, and function well during their daily life. However, during an active phase of illness, these individuals may lose touch with reality, experience disorganized thinking and speech, and experience difficulty caring for themselves.  

Symptoms are grouped into 3 categories – positive symptoms, negative symptoms, and cognitive deficits. 

Positive symptoms are mental features/symptoms that are found in excess in a person with schizophrenia that we would otherwise not experience (and not that they are good symptoms to have!). Symptoms include: 

  • Delusions – Ideas that an individual believes are true but that are highly unlikely and often simply impossible 

  • Hallucinations – Unreal perceptual experiences 

  • Disorganized thought and speech

  • Disorganized or catatonic behavior 

 

Negative symptoms. Well yes, all symptoms of schizophrenia seem negative, but in this case, it refers to qualities that are lacking in a person. Symptoms include: 

  • Restricted affect – A severe reduction in or absence of emotional expression in people with schizophrenia (e.g., avoiding eye contact, a flat tone with voice very little intonation and emphasis to convey emotions)

    • *Note: A lack of expression does not mean that these individuals experience less affect than we typically do! Studies show that they may be experiencing intense emotions that they simply cannot express. 

  • Difficulty expressing emotions 

  • Reduced feelings of pleasure 

  • Difficulty planning and maintaining goal-directed activities at work, school, or home 

  • Limited speech

  • Social withdrawal 

 

Cognitive deficits tend to be subtle, but some may experience more severe changes in memory and thinking. They include: 

  • Memory problems 

  • Difficulty focusing and maintaining attention 

  • Deficits in working memory 

Course of Schizophrenia

 
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What causes Schizophrenia? 

While we still do not know the exact cause of Schizophrenia, it has a strong biological basis. Research indicates that structural and functional abnormalities in certain area of the brain may contribute to the disorder. Birth complications, prenatal exposure to viruses, excessive neurotransmitters, and genetics play a role as well.  

Although schizophrenia is strongly linked to biological factors, psychosocial factors play a role too. Studies have found that with schizophrenia are more likely to experience chronically stressful circumstances. While stressful circumstances may not cause the development of schizophrenia, they may trigger new episodes of psychosis.  

Addressing it  

A comprehensive management plan for people with Schizophrenia include pharmacological interventions and psychotherapy: 

Cognitive Behavioural Therapy 

  • Cognitive restructuring involves helping people with schizophrenia recognize and change demoralizing attitudes they may have toward their illness. The aim of this is to encourage them to seek help when needed and to participate in society to their best extent. 

  • Behavioral management involves the use of conditioning and modeling to teach persons with schizophrenia skills such as initiating and maintaining conversations with others, asking for help or information from physicians, and persisting in an activity. 

Family Therapy 

  • Family therapy aims to educate the family members of persons with Schizophrenia. With education comes a better understanding of the disorder, lowered levels of self-blame in family members, and greater tolerance of uncontrollable symptoms displayed by their loved ones. It also equips family members with effective communication and problem-solving skills to improve family interactions, as well as specific behaviour techniques for encourage appropriate behaviour and discouraging inappropriate behaviour. 

Although Schizophrenia tends to be a chronic condition, comprehensive management and support has been shown to significantly reduce the risk of relapse. In fact, many people with Schizophrenia can go on lead rewarding and meaningful lives!