10 Things You Should Know About Schizophrenia
This SharePost is the companion to the last one, 10 Schizophrenia Myths Busted. I consulted with a friend whose wisdom was on-target and I’ll refer to him here.
1.The following symptoms lead to a diagnosis of schizophrenia: Two or more “Criteria A” symptoms or bizarre delusions alone or auditory hallucinations alone, along with Criteria B: continuing social and occupational dysfunction as well as Criteria C: symptoms must persist for six months or more.
Here I’ll break down the prodromal stage, active stage and residual stage into their corresponding symptoms. Each symptom will fall under a descriptive category.
Onset Symptoms/Prodromal Stage [NS: Negative Symptoms]
Uncontrollable crying; anxious; irritable; flat “blunted” emotional responses [NS]
Physical [Body] Symptoms:
Sleeplessness; agitation; weight loss
Withdrawal; decline in function; no attention to hygiene; odd, peculiar behaviors; lack of motivation (avolition) [NS]; inability to relate to others (Autism) [NS]
Suspicious; superstitious; illogical, odd beliefs; poverty of speech (Alogia) [NS]
Acute; illusions; odd sensory experiences.
Negative Symptoms [NS] present in the prodromal stage: (Criteria A)
Acute Symptoms/Active Stage [A: Criteria A Symptoms]
Anxiety, panic; angry outbursts; inappropriate emotional responses; severe emotional blunting [NS]
Physical (Body) Symptoms:
Sleeplessness; A: Catatonic rigidity - bizarre body postures, mutism, negativism; A: Catatonic excitement - pacing, rocking, grimacing
A: Grossly disorganized behavior - Bizarre actions, follows rituals, swearing and shouting mimics others.
A: Delusions - false beliefs; A: Disorganized speech - incoherent, loose associations, “word salad”
A: Hallucinations - Voices, visual apparitions; Bizarre interpretations of taste, touch, smell.
Lingering Symptoms/Residual Stage [NS: Negative Symptoms]
Depression, moodiness; anxiety; ambivalence; flat, “blunted” emotional responses [NS]
Physical (Body) Symptoms:
Unusual eating and sleeping patterns; slowed movements; odd posturing
Decline in function; no attention to hygiene; lack of motivation (Avolition) [NS]; Inability to relate to others (Autism) [NS]
Suspicious; superstitious; odd “fixed” beliefs; concentration/memory problems; poverty of speech (Alogia) [NS]
Dulled; illusions; odd sensory experiences.
Negative Symptoms present in the residual stage: (Criteria A)
So as you can see there are five descriptive categories under which the symptoms fall: Mood “Affect”, physical (body) symptoms, behavior, thinking and senses, and each stage is comprised of symptoms that fall under those categories.
To wrap up: a diagnosis of schizophrenia is made when the following symptoms are present:
Two or more Criteria A symptoms or bizarre delusions alone or auditory hallucinations alone, plus Criteria B: continuing social and occupational dysfunction and Criteria C: symptoms must persist for six months or more. Negative Symptoms present in the prodromal stage are considered Criteria A and Negative Symptoms present in the residual stage also fit Criteria A.
This should hopefully clear up in your mind why a diagnosis was made [it is based on empirical evidence and observations]. Also: for people who don’t live with schizophrenia every day who are curious about whether someone they know could have schizophrenia: remember that only a qualified professional can make the diagnosis of schizophrenia. This is intended to clarify how the psychiatrist arrives at that diagnosis for those of us who would like to know.
2. A person is labeled in remission with the absence of symptoms or minimal symptoms on the PANSS scale for six months.
My second SharePost at the Connection-Optimism and Hope for Successful Treatment Outcomes-you can revisit now because in that blog entry I referred to an APA [American Psychiatry Association] working group on schizophrenia that outlined the criteria for remission: absence of certain symptoms or minimal symptoms for six months. So once you hit the six month mark and your symptoms are under control according to the criteria you can consider yourself to be in remission.
3. Repeated episodes could result in greater susceptibility to the illness.
The “kindling effect,” observed primarily in those with bipolar, could take place for someone who has schizophrenia too. One definition: “Kindling means that something happens in the brain which increases a person’s vulnerability to mood disorders over time. In the early stages of illness, episodes are generally related to a precipitating event. But with each episode, susceptibility increases so that further episodes are set off by less significant stressors. Eventually, episodes occur spontaneously. This same process is also thought to occur in the case of repeated psychotic episodes in schizophrenia.”
4. Partial medication compliance is often the culprit when a drug is perceived as not being effective.
People who only partially comply with their medication routine could suffer continuing loss of functionality. That’s the deal where you take your meds and you’re at a certain level, and then you go off them and your functionality sinks, and you go on them again and the functionality increases yet it doesn’t go back up to where it was before. My good friend Robin pointed this out and I tend to agree with him that it’s not worth risking a drug holiday. I feel that if you keep going on and off your meds and are still able to function well you are lucky indeed.
5. Schizophrenia is an all-in-one medical condition.
This is because you get the symptoms of all the mental illnesses: depression, mania, anxiety, confusion, and some form of hallucinations or thought insertions or other symptoms. Schizophrenia is a catch-all and is hard to diagnose because the person exhibits all these symptoms at one point or another. According to a study it takes 8.5 years typically to arrive at a diagnosis and that is long after the onset of the symptoms. This does a disservice to the person who is often left alone to deal with what’s going on without support in the community and effective treatment.
6. Schizophrenia needs to be treated with medication immediately to achieve the best possible recovery outcome.
This is the corollary to number five above. In no instance is delaying treatment for any disease a good thing. An aside: if I had not gone to the physical therapist within one week of developing my frozen shoulder, I would have lost the use of my arm. No kidding. So if you’d rush to the emergency room when you’re having chest pains, it is not unreasonable to think you should get things checked out right away if any of the symptoms listed in number one appear.
7. One of the most important aspects of schizophrenia is a person’s belief system.
If you understand their belief system you will see they’re thinking logically if you believe what they believe. For example: if they’re paranoid and believe someone’s trying to kill them that is their belief system. If you believed this, you’d be looking out your venetian blinds or in the rearview mirror of your car. So a lot of the behaviors in schizophrenia are logical responses to a disturbed or distorted belief system.
8. Medication determines your potential level of functionality.
A good medication will give you the potential for a good functionality. What enables you to realize that level of functionality is the therapy you get. So if a person finds the medication that works for him, he has the potential of having a perfectly normal life. When you first get sick you need counseling to get yourself back on track and to deal with the anxiety and other symptoms. There’s an important relationship between medication and therapy. With schizophrenia you can’t do it with therapy alone. Medication is the precursor. If you get an effective medication, the therapy can be effective.
9. Society doesn’t give a darn whether you have a mental illness or not.
My friend Robin-who had a 25-year career in business-offered this suggestion: other people don’t care what your illness is, they care about your functionality. According to him you can be what people consider “crazy as a jaybird” as long as you’re functional and can go to your job and do it well and show up on time. So they don’t care what your diagnosis is. He believed this is important for people in recovery to understand: you don’t have to have to a completely clear mind to be functional. Robin’s first psychiatrist helped him realize a higher level of functionality as all along they tried every new medication to see what would work. [He was originally on Thorazine and it worked minimally. Though it wasn’t totally effective he credits staying on the medication with preventing further brain deterioration.]
10. Keeping stress at a manageable level is vital for a person with this diagnosis.
In addition to talk therapy or cognitive therapy to cope with the symptoms of schizophrenia, other activities can be considered therapeutic, such as: art, music, writing, baking and other pleasant hobbies or vocations. Living in an emotionally charged environment or with family members who are critical or facing multiple chaotic changes all at once are deterrents to recovering and can set someone back when he has a diagnosis of schizophrenia.
Controlling the amount of stress we experience is possible and is necessary for us to achieve optimal mental health. That said a healthy amount of stress is though to challenge us emotionally and help us grow.
I bailed out of a lucrative career early on after I obtained my MLS because I did not want to have to jump through hoops, set ever higher by supervisors, to get the respect I deserved. I wanted to work at the kinds of jobs where my success was in direct proportion to my efforts. I wanted to be recognized based on my own merit, not on whether an employer decided I had done a good job or not. Ironically: I have a stronger constitution and I’m cool under pressure so something would have to be totally stressful before I would feel the effect.
However: I doubt it would be a stretch for me to say most people with schizophrenia need to keep their stress level at a minimum. It is not possible to live without any stress. We need to be honest about the kinds of stress we can tolerate and use our personal histories as the tool for measuring our own comfort level. Sometimes it is our response to the stress that can be more stressful than the trigger itself. So things like yoga and meditation could also be helpful.
These are the 10 Things You Should Know About Schizophrenia.
The next SharePost will talk about a promising new drug which research shows combats the cognitive deficits seen in people diagnosed with schizophrenia. Stay tuned.
Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.