Disorders of thought and verbal behavior, perception, affect, motor behavior, and relationship to the outside world are all symptoms of schizophrenia, a severe and crippling brain and behavior disorder that affects how one thinks and behaves.
Types of Schizophrenia
Paranoid schizophrenia:In addition to the general characteristics of schizophrenia, paranoid schizophrenia is distinguished by the following clinical traits.
The delusions are typically well-systematized, that is, thematically well connected with one another. Persecution, reference, grandeur (or grandiosity), control, or infidelity (or “jealousy”).
Usually, the hallucinations are grandiose or persecutorial in nature.
There are no obvious changes in speech, movement, affect, or volition.
The patient may be quite fearful and anxious due to delusions and hallucinations, and appear evasive and guarded on a mental status examination. Personality deterioration in the paranoid subtype is much less than that seen in other types of schizophrenia.
In contrast to the other subtypes of schizophrenia, paranoid schizophrenia typically develops slowly over time, in the late third and early fourth decade of life, and has a progressive course with frequent remissions and relapses.
Disorganized (or Hebephrenic ) schizophrenia:Along with the general characteristics of schizophrenia, disorganized schizophrenia has the following characteristics.
Severe loosening of associations, incoherence, and marked thought disorder; fragmentary and variable hallucinations.
Extreme social withdrawal, mannerisms, “mirror gazing,” disinhibited behavior, markedly impaired social and occupational functioning, emotional disturbances (inappropriate affect, blunted affect, or senseless giggling), and other odd behaviors.
Disorganized schizophrenia has one of the worst prognoses among the different subtypes of schizophrenia due to its insidious onset, which typically occurs in the early second decade, downhill course, severe deterioration without any notable remissions over time, and prognosis.
Schizophrenia with catatonia: In addition to the typical symptoms of schizophrenia, catatonia is distinguished by a noticeable motor behavior disorder.
Three clinical manifestations are possible: catatonia that alternates between excitement and stupor, catatonia that is excited and stuporous, and catatonia that is stuporous.
The following characteristics describe excited catatonia:
An increase in psychomotor activity that can take the form of agitation, agitation, excitement, aggression, and, occasionally, violent behavior.
An increase in speech production, along with more spontaneity, pressure, looser associations, and blatant incoherence.
The excitement is not goal-directed because there is no obvious connection between it and the environment; instead, it is influenced by internal factors such as thoughts and impulses. On occasion, the excitement can become extremely severe and be accompanied by rigidity, hyperthermia, and dehydration, leading to death. This is when the excitement is referred to as a “severe excitement.”catatonia that is fatal or harmful.
Stuporous or Retarded Catatonia:The characteristic signs of this condition include extreme psychomotor function retardation and include:
·Mutism:Complete absence of speech.
·Rigidity:keeping a stiff posture in opposition to motion-inducing attempts.
·Negativism:resistance to orders and attempts to move that is manifestly without cause, or action to the contrary.
·Posturing:long-term, voluntarily adopting an odd and frequently inappropriate posture.
·Stupor:a kinesis (lack of movement), mutism, and signs of a largely intact state of consciousness.
·Echolalia:mimicking, echoing, or repetition of verbal cues.
·Echopraxia:Observed actions being repeated, echoed, or imitated.
Waxy flexibility is the ability of certain body parts to remain in uncomfortable positions for extended periods of time.
·Ambitendency:Ambivalence causes conflicting impulses and tentative actions to be taken, but no goal-directed action is taken. For example, when the tongue is asked to be removed, it protrudes slightly before retracting again.
· Other signs such asmannerisms, stereotypies( verbal and behavioral ),automatic obedience(commands are executed without hesitation, no matter what they are) andverbigeration( incomprehensible speech).
Not all the symptoms occur at the same time, and hallucinations and delusions may be present but are typically not prominent.
Residual and Latent Schizophrenia:The only distinction between residual schizophrenia and latent schizophrenia is that the latter is diagnosed after at least one episode has taken place, whereas the latter is diagnosed after prodromal symptoms have appeared.
Along with the previously mentioned general characteristics of schizophrenia, the following characteristics are listed as its ICD-10 distinguishing characteristics.
Prominent “negative” symptoms of schizophrenia, such as psychomotor slowing, underactivity, blunting of affect, passivity and lack of initiative, poor nonverbal communication through facial expression, eye contact, voice modulation, and posture, poor self-care, and poor social performance.
Evidence of at least one recent, clearly defined psychotic episode that met the criteria for schizophrenia in the past
At least a year-long period in which the ‘negative’ symptoms of schizophrenia have been present while the intensity and frequency of florid symptoms like delusions and hallucinations have been minimal or significantly reduced.
Lack of chronic depression or institutionalization, dementia, or another organic brain disease or disorder that would adequately explain the negative impairments.
Undifferentiated Schizophrenia:There are two ways to diagnose this type of schizophrenia, which is very common:
When all of a subtype’s characteristics are absent, or
When the general requirements for schizophrenia diagnosis are satisfied and symptoms of multiple subtypes are displayed.
Simple Schizophrenia:Despite being referred to as simple, it is one of the subtypes of schizophrenia that is hardest to diagnose. It is characterized by an early onset, early second decade, very insidious and progressive course, presence of characteristic “negative symptoms” of residual schizophrenia (such as marked social withdrawal, shallow emotional response, with loss of initiative), vague hypochondriacal features, a decline in social standing, living shabbily and wandering aimlessly, and delusions and hallucinations.
Post- Schizophrenic Depression:Within a year of an acute episode, some patients with schizophrenia develop depressive features; these features appear in the presence of active or residual symptoms of the disease and are linked to an increased risk of suicide.
Pseudoneurotic Schizophrenia:Hoch and Polatin were the first to identify pseudoneurotic schizophrenia, which has three distinctive characteristics.
Panic disorder (a generalized, irrational fear that hardly ever passes).
Pan-neurosis, which can manifest as the presence of nearly all neurotic symptoms.
Pansexuality, or an ongoing fixation on sexual issues.
At present, borderline personality disorder encompasses this subtype.
Schizophreniform Disorder:The term was first used by Langfeldt in 1916 to designate good prognosis cases, distinct from ‘true’ schizophrenia. This condition is a diagnostic category in DSM-1V-TR with features of schizophrenia as diagnostic criteria. The only difference is that the duration is less than 6 months and prognosis is typically better than that of schizophrenia. A similar condition in ICD-10 is known as acute schizophrenia-like psychotic disorder.
Oneiroid Schizophrenia:This subtype of schizophrenia—oneiroid, which means “dream”—has an acute onset, clouding of consciousness, disorientation, dream-like states, and perceptual disturbances with rapid shifting. Mayer-Gross was the first to describe it.
Van Gogh Syndrome:Dramatic self-mutilation associated with schizophrenia is also known as Van Gogh syndrome, after the famous painter Vincent Van Gogh, who famously cut off his ear while suffering from the illness.
Late Paraphrenia:This disorder, which is more prevalent in women, especially single or widowed women, was first described by Sir Martin Roth. It is a late-life condition that typically manifests in the sixth decade.
Intelligence and social judgment outside of the realm of persecutory delusions are typically normal. About 25–40% of the patients have some sort of visual or auditory impairment. Hallucinations of every kind (visual, auditory, tactile, gustatory, and olfactory) can be present.
This syndrome is currently classified as the late-onset type of paranoid schizophrenia.
Pfropf Schizophrenia:Behavioral disturbances are much more noticeable than delusions and hallucinations in this form of schizophrenia, which develops when mental retardation is present. It differs from schizophrenia only in that ideation is frequently poor and delusions are typically not very well-systematized.
Type 1 and Type 11 Schizophrenia:The Type 1 syndrome is distinguished by positive symptoms, whereas the Type 11 syndrome is predominately distinguished by the presence of negative symptoms, according to TJ Crow, who divided schizophrenia into two subtypes, namely Type 1 and 11 schizophrenias.
Crow also described dilated ventricles on a brain CT scan in Type 11 syndrome, which is thought to have a chronic course, a poor response to medication, and a poor outcome in contrast to Type 1 syndrome, which is supposed to present acutely and respond well to treatment.
Causes
Several hypotheses have been put forth, some of which are listed below, but the cause of schizophrenia is currently unknown.
Biochemical Theories
Though other neurotransmitters like serotonin, especially 5-HT2 receptors, GABA and acetylcholine are also likely to be involved, schizophrenia is currently thought to be likely caused by a functional increase of dopamine at the postsynaptic receptor.
Brain imaging
A few schizophrenia patients have mild cortical atrophy (with a general decrease in brain volume and cortical grey matter by 5–10%), enlarged ventricles (not amounting to hydrocephalus), and postmortem studies have shown this.
In an effort to localize schizophrenia symptoms, such as auditory hallucinations, negative symptoms, to the various brain regions by PET studies, hypofrontality and decreased glucose utilization in the dominant temporal lobe are shown in a PET (positron emission tomography) scan.
However, when clinically indicated, brain imaging can be used to rule out an organic cause of psychotic symptoms. Currently, brain imaging does not play a role in confirming a diagnosis of schizophrenia.
Psychological Theories
Stress
According to the Stress-Vulnerability Hypothesis, the more genetically vulnerable a person is, the less environmental stress is required to cause a relapse. Therefore, an increase in stressful life events before the onset or relapse likely has a triggering effect on the onset of schizophrenia in those individuals.
Family Theories
Schizophrenogenic mothers, lack of “real” parents, mother dependence, parental marital schism or skew, double-bind theory, communication deviance, and pseudomutuality are a few theories that have been proposed in the past but are currently of dubious value.
Unfortunately, a few of these theories led to parents feeling unwarranted guilt for their role in their children’s schizophrenia.
Information Processing Hypothesis
Schizophrenia patients may initially be overly attentive to stimuli but later may reduce or exclude attention to stimuli, suggesting that there is likely a breakdown in the internal representation of mental events. Other common findings in schizophrenia include disturbances in attention, inability to maintain a set, and inability to assimilate and integrate percepts.
Psychoanalytical Theories
When defense mechanisms are employed, Freud claimed that psychosexual development regresses to the preoral and oral stage.denial, projection,andreaction formationAccording to Paul Federn, there is a loss of ego-boundaries and a disconnect from reality.
Sociocultural Theories
Low social class is a breeding ground for schizophrenia brought on by social circumstances (Farris and Durham, 1939).
In contrast to social class, Hare (1959) claimed that social isolation is more closely related to schizophrenia.
Schizophrenics migrate to lower social classes as a result of social drift (Goldberg and Morrisom, 1963).
A ‘downward social drift’, which is a consequence of having developed schizophrenia rather than causing it, has now been explained as the reason why some studies found that the prevalence of schizophrenia was higher in people with lower socioeconomic status, despite the fact that the prevalence of schizophrenia is quite uniform across cultures.
Some migrants, including those of the second generation as well as those of the first, have higher rates of schizophrenia.
Symptoms
The signs and symptoms of schizophrenia can include delusions, hallucinations, or disorganized speech, and they reflect a reduced ability to function. Schizophrenia involves a range of issues with thinking (cognition), behavior, and emotions.
Abuse, violence, pessimism, and unwillingness to cooperate are examples of abnormal behavior.
Inappropriate, irrelevant, and illogical conversations; inappropriately worded responses.
Muttering to oneself and gesticulating.
Voices that are hot to the touch, unprompted face recognition.
Grimacing, mannerisms, and mirror grazing are examples of long-term abnormal postures while sitting or standing.
Fearful, litigious, accusatory, suspicious, and suspicious.
· Sleeplessness.
A propensity for straying from home or work for hours or days at a time; suicide attempts; and a propensity for accidents.
Uncalled-for laughter or sobs.
Self-neglect, which includes disregarding nutrition, personal hygiene, and general appearance (including clothing).
Lacks insight and refuses to acknowledge his illness.
Gradual onset, ongoing illness that lasts for at least 6 months, typically without remission, without medication, and with a course that worsens without any impairment of consciousness
Management
The following topics can be covered when talking about schizophrenia treatment:
a. Somatic treatment
· Pharmacological treatment
· Electro-convulsive therapy (ECT)
· Miscellaneous treatments
b. Psychosocial treatment and rehabilitation
HOMOEOPATHIC REMEDIES
When it comes to treating schizophrenia, homoeopathy has a number of effective medications available, but the choice depends on the patient’s individuality, taking into account their mental and physical health. Homoeopathy is currently a rapidly expanding system that is used throughout the world. Its strength lies in its evident effectiveness as it takes a holistic approach to the sick individual by promoting inner balance at mental, emotional, spiritual, and physical levels.
ANACARDIUM ORIENTALE:Dual personality. Seems to have two wills, one good and one bad. Clairaudient. Auditory hallucinations. Hearing voices of people far away or dead. Hears voices behind her. There is a great propensity to swear, curse, and blaspheme in persons not usually known to curse. Suspicious and jealous. Anxious when walking, as if being pursued. Profound depression with tendency to use foul, violent language.
ARSENIC ALBUM:Hallucinations of smell and sight. Fixed ideas. Suicidal impulses. Hallucinations of sight and smell. Imagines house full of thieves, jumps and hides. Sees ghosts day and night. Self-tortures, pulls her hair, bites her nails, tears his own body. Changes places frequently.
AURUM METALLICUM:Great depression, disdain for life, suicidal thoughts, plans to end one’s life, extreme sensitivity to sound, asking questions quickly without waiting for an answer, being peevish and vehement at least in contradiction, and being hostile and argumentative are all symptoms.
CANNABIS INDICA:Disorganized speech, a sudden loss of speech, the inability to finish a sentence, forgetting the last word said and being unable to remember it, persistent thoughts crowding the patient’s mind, causing them to forget while speaking and preventing rational speech, a sudden loss of memory, exaltation of spirits, a constant fear of going insane, uncontrollable laughter, and distorted perceptions of time and space, where seconds seem to last for an eternity.
HYOSCYAMUS NIGER:Very suspicious. Fears being alone, being chased by water, being poisoned, and being bit. Patient feels like others are plotting against him. Restless, jumps out of bed, wants to flee. Rage with desire to talk, bite, fight insult, scold, and kill. Talks with imaginary persons to dead ones. Imagines things are animals. Inclined to laugh at everything. Laughs, sings, talks, babbles, quarrels. Talkative,
IGNATIA AMARA:Oversensitive, anxious, and easily frustrated. Melancholic, depressed, and tearful. Extremely emotional and moody. Sighing and sobbing. Changeable mood. Silent brooding. Angry with himself. Internal conflicts with herself. Ailments from disappointments, emotional shocks, grief, and fright.
LACHESIS:Delusions, thinks she is under superhuman control, believes she is dead and funeral preparations are underway, believes she is being pursued, hated, and despised. Great loquacity, rambling, frequently switching topics, sadness or repeating the same thing. One word often leads into another story.
MELILOTUS OFFICINALIS :irritable, impatient, disgruntled, and finding fault; furious; had to lock him in a room; delusions; fears speaking aloud; fears of danger; fears of being arrested; fears of speaking aloud; wants to flee or commit suicide; vicious; threatens to kill those who approach him; religious melancholy.
NUX VOMICA:Overactive mind; nervous and excitable; very irritable people; sensitive to all sensations; unable to bear sounds, odors, or light; angry and impatient; unable to stand pain; so furious as to cry; suicidal and homicidal impulses; fear of knives; hypochondria; fault-finding; argumentative; scolds and insults others.
PLATINUM METALLICUM:Superiority complex; delusions that everything about her is small; contempt for others; haughty, looks with disdain upon everyone and everything; proud and arrogant; alternately weeps and laughs; believes her husband won’t return; believes something bad will happen to him; impulse to kill her own child, her husband (on seeing a knife), whom she secretly dislikes, or her father;
PHOSPHORUS:Exaggerated sense of one’s own importance. Oversensitivity to outside impressions. Fearfulness, as if something were lurking around every corner. Amorous, willing to uncover his body and expose his genitalia. Clairvoyant. Wants sympathy. Anxious, restless, patient cannot sit or stand still for a moment, especially in the dark or at dusk. Dread of dying when alone. Symptoms are exacerbated by thunderstorms.
STRAMONIUM:Fearful hallucinations that terrorize the patient include seeing ghosts, vividly brilliant or hideous phantoms, animals, jumping out of the ground or running to him, and delusions about his identity such as thinking he is tall, double, or missing a part. Fear of darkness, must have light and company. Disorganized talking, continues talking. Devout, earnest, beseech.
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