Schizophrenia—literally means “split mind,” but it’s not ...



Schizophrenia

Schizophrenia—literally means “split mind,” but it’s not the same thing as a split personality. It refers to the fragmenting of thought processes and emotions.

1 out of 100 people will get schizophrenia, and half of all inpatient mental patients have it. It usually strikes between the late teens and mid 30s. It tends to strike men earlier and more severely than women, but both sexes are affected in roughly equal numbers.

There are five areas of disturbance in schizophrenia, but people may not have disturbances in all 5 areas:

1. Perceptual—senses may be blunted or they may be enhanced. People can’t concentrate on what they choose, and sensory stimulation is distorted or jumbled. There may be hallucinations, most commonly auditory.

2. Language—words lose their usual meanings and associations. May jump from topic to topic or jumble words together incoherently (word salad) or create artificial words. May echo what they hear—echolalia.

3. Thought—thoughts are disorganized and bizarre; logic is impaired. The most common thought disturbance is psychosis—lack of contact with reality. Delusions are common—persecution, grandeur, control, reference (delusion of reference is when the person things two unrelated events are given special significance.).

4. Affect—Emotions may be exaggerated and fluctuate rapidly. At other times, emotion may be blunted. Some people have flattened affect—almost no emotional response of any kind.

5. Behavior—A person with schizophrenia may hurt others, but they are more commonly destructive toward themselves and suicidal. They may also become cataplectic and maintain an immobile stance for a long period of time.

Positive vs. Negative Schizophrenia: Positive symptoms (additions to or exaggerations of normal thought and behaviors, including delusions and hallucinations) are more common when schizophrenia develops rapidly. Negative symptoms (absence of normal thought processes and behaviors, including impaired attention, limited or toneless speech, flat affect, and social withdrawal) are more common when schizophrenia onset is gradual.

Causes of schizophrenia:

Probably has multiple biological and psychosocial bases. Biological causes may include prenatal viral infections, birth complications, immune responses, maternal malnutrition, and advanced paternal age. Most biological theories focus on genetics, neurotransmitters, and brain abnormalities.

People with schizophrenia have been observed to have increased dopamine production, larger cerebral ventricles, and a lower level of activity in the frontal and temporal lobes (involved in language, attention, and memory). The lower level of brain activity and the schizophrenia itself may result from an overall loss of gray matter.

In identical twins, if one twin has schizophrenia, the other twin has a 48% chance of having it. Obviously, environmental factors must contribute the other 52%.

There are at least two psychosocial factors that may contribute to schizophrenia:

1) Stress—may trigger a schizophrenic episode in people with a predisposition to schizophrenia.

2) Disordered communication in families—unintelligible speech, fragmented communication, and parents’ frequently sending severely contradictory messages to children. Critical, hostile families also contribute to relapses.

PERSONALITY DISORDERS

Personality disorders are considered to be stable and incurable. They represent a personality that is so inflexible and maladaptive that a person cannot function properly.

Antisocial personality disorder: sociopath/psychopath. Considered by some to be the most serious of all mental disorders because they are so far outside the ethical and legal standards of society. These people feel no personal distress and are unmotivated to change. Serial killers, ruthless politicians, and crooked business people are examples.

Four hallmarks:

1) Egocentrism (preoccupation with oneself and insensitivity to needs of others)

2) Lack of conscience

3) Impulsive behavior

4) Superficial charm

Antisocials act impulsively and have little to no thought of the consequences. They’re usually poised when confronted with their destructive behavior and feel contempt for anyone they’re able to manipulate. They change jobs and relationships suddenly, and they often have a history of truancy from school and of being expelled for destructive behavior. They can be charming and persuasive and have a very good insight into the needs and weaknesses of other people.

Twin studies show a genetic predisposition. Also, studies suggest that people with antisocial personality have abnormally low autonomic activity during stress, right hemisphere abnormalities, and reduced gray matter in the frontal lobes.

Social factors are also implicated. The disorder is highly correlated with abusive parenting and inappropriate modeling. Antisocials often come from homes characterized by harsh and inconsistent discipline and antisocial parental behavior.

Borderline personality disorder: among the most commonly diagnosed personality disorders. Core features are impulsivity and instability in mood, relationships, and self-image. Term originally implied that the person was on the borderline between neurosis and schizophrenia, but modern understanding no longer supports this assumption. Still, BPD is a very complex and debilitating disorder.

Hallmarks of BPD:

--Extreme difficulties in relationships

--Chronic feelings of depression, emptiness, and intense fear of abandonment

--Engage in destructive, impulsive behaviors (sexual promiscuity, drinking, gambling,

eating sprees

--May attempt suicide or self-mutilate

--See themselves and others in absolute terms—perfect or worthless.

--Constantly seek reassurance from others and may quickly erupt in anger at the slightest

sign of disapproval.

--Long history of broken friendships, divorces, and lost jobs.

--Frequently have a childhood history of neglect, emotional deprivation, and physical,

sexual, or emotional abuse.

--Runs in families

--Biological evidence suggests it may be the result of impaired function in the frontal

lobes and limbic system, which controls impulsive behaviors.

--General prognosis is not favorable, although some therapists have had success treating

BPD with drug and behavior therapy.

--Seven years after treatment, 50% still have the disorder. (1998 study)

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