SCHIZOPHRENIA

Schizophrenia is a psychotic disorder that causes changes in the person’s thinking, perception, mood and behaviour. It is a biochemical disorder of the brain and affects about 1% of the population. The onset occurs between age 17 and 29 in about three quarters of the people who have schizophrenia. There are acute and chronic phases of schizophrenia. During acute phases, the person experiences a number of severe symptoms that seriously impair their functioning in most life areas. During the chronic phase the person may experience fewer symptoms with less intensity, thus their level of functioning is usually higher. The course of schizophrenia can vary considerably from person to person.

Predisposing Factors:

Genetic factors appear to be important in the development of schizophrenia, but research points to the need for an environmental “trigger” to bring the illness to the surface in someone who is predisposed. Other predisposing factors include a viral infection during the second trimester of pregnancy; developmental problems during fetal development; birth trauma; chemical imbalances in the brain; and nutritional deficiencies. Drug and alcohol abuse may also trigger schizophrenia in those predisposed. Use of hallucinogens in particular are associated with it.

Characteristics: People with schizophrenia experience delusions and distorted view of reality that they believe to be true. Their thoughts are disorganized and illogical. Hallucinations are common (affecting hearing, vision, touch, smell or taste). Due to the fact that they hear voices in their own head, people with schizophrenia may not be hearing what others are saying to them. Sometimes their behavior may seem bizarre and ritualistic.The mood of a person which schizophrenia may be flat, or inappropriate to the situation. They may have an altered sense of self, and often isolate and withdraw from others, and into themselves, possibly because they have enough internal stimuli.

What do We see?

People with schizophrenia seem “odd” to outsiders. They may wander from topic to topic. They may hear things and respond outloud appearing like they’re talking to themselves. They may tell people that their thoughts are being monitored, controlled or broadcasted

Their speech may wander from topic to topic in random patterns. They may be hearing voices, like tapes playing in their heads; they may appear to be talking to themselves, or they may laugh at inappropriate times. Some may appear suspicious; They believe that they are being poisoned, or someone is out to get them. They may be making accusations. They may express interest in things, but fail to follow through due to lack of volition.

In a room full of noise, a person with schizophrenia may sit quietly, alone, and withdrawn. They may even flinch when touched. They can appear to be in a stupor with slow movements. Some may appear agitated, pacing restlessly.

Recommended Treatment:

• There is no cure of schizophrenia.
• Medication is used to manage or minimize the symptoms.
• Counselling/psychotherapy may be helpful to address the internal and external conflict that come from the internal experiences (delusions, hallucinations).
• Rehabilitation and skill development can help as well as Self-help groups offer peer support and problem-solving.

 

SCHIZO-AFFECTIVE DISORDER

Characteristics: Schizo-affective disorder is difficult to diagnose; and Many people are initially misdiagnosed with either schizophrenia or bipolar disorder. Schizo-affective disorder is similar to schizophrenia but involves an additional mood component. It is defined as the presence of psychotic symptoms in the absence of mood changes for at least two weeks in a person who has a mood disorder. People with schizo-affective disorder may have symptoms of both schizophrenia and a depressive disorder at the same time; or they may have symptoms of both schizophrenia and bipolar disorder at the same time. The diagnosis of schizo-affective disorder is used when the symptoms experienced by an individual do not fit the diagnostic standards for either schizophrenia or affective (mood) disorders. The Mayo clinic defines Schizo-affective disorder as: “…symptoms vary from person to person. Generally, people who have the condition experience psychotic symptoms — such as hallucinations, disorganized thinking and paranoid thoughts — as well as a mood disturbance, such as depressed or manic mood.

What do we see?

• Strange or unusual thoughts or perceptions
• Paranoid thoughts and ideas
• Delusions — having false, fixed beliefs
• Hallucinations, such as hearing voices
• Unclear or confused thoughts (disorganized thinking)
• Bouts of depression
• Manic mood or a sudden increase in energy and behavioral displays that are out of character
• Irritability and poor temper control
• Thoughts of suicide or homicide
• A speaking style that others sometimes can’t follow or understand
• Behavior at extreme ends of the normal spectrum (catatonic behavior) — either appearing to be in a coma-like daze, or talking and behaving in a bizarre, hyperactive way
• Problems with attention and memory
• Lack of concern about hygiene and physical appearance
• Changes in energy and appetite
• Sleep disturbances, such as difficulty falling asleep or staying asleep

Recommended Treatment:

• Anti-psychotic mediation plus a mood stabilizer
• Cognitive-behavioural therapy
• skill training

 

MOOD OR AFFECTIVE DISORDERS

Anxiety, elation, melancholy, anger and joy are a few of the moods that people experience. Moods are not problematic for most people. When moods continue long after the circumstances that triggered them have past, when they outlive their context, the mood can become a serious liability to emotional functioning, and begins to affects all aspects of a person’s life. The two main types of mood disorders recognized are depressive disorders and bipolar disorders. Depressive disorders consist of one or more periods of major depression. Bipolar disorders involve a series of moods that include at least one manic period and one or more periods of major depression.

Mood disorders, also called affective disorders, are a group of illnesses that have as their distinguishing characteristic an experience of mood that is unusual for the circumstances. Common mood disorders include: bipolar disorder, depression, postpartum depression,cyclothymia, schizoaffective disorder, and seasonal affective disorder. Most mood disorders are at least somewhat treatable with drugs and psychotherapy.

Affect: A feeling, mood, or emotion, or the visible, outward appearance of feeling.

Atypical: A form of depression or bipolar disorder that does not follow usual or expected patterns.

Bipolar: A disorder characterized by switching between the two extremes or “poles” of mania, a highly active or agitated state, and depression, a sad, withdrawn state.

Bipolar I disorder: Bipolar disorder characterized by alternating states of mania and depression.

Bipolar II disorder: Bipolar disorder characterized by alternating states of depression and hypomania, a milder form of mania.

Bipolar disorder NOS: Bipolar disorder that does not follow a pattern, or follows a pattern different from bipolar I or bipolar II disorder.

Cyclothymia (cyclothymic disorder): A form of bipolar disorder characterized by alternating hypomania and mild depression.

Delusion: A belief, such as “I have figured out the meaning of life,” “I have been chosen to save everyone on earth,” or “Everyone is talking about me,” that is exaggerated or untrue. Delusions may be part of mania or depression.

Dysthymia (dysthymic disorder): An illness characterized by a chronically depressed mood for most of the day, more days than not, for at least two years, with symptom-free periods lasting less than two months. Dysthymia may be difficult to identify or diagnose because the person may believe that sadness is part of his or her personality. While dysthymia is not as severe as major depression, it can be just as disabling.

Euthymia: A stable, even mood.

Hypomania: A milder form of mania characterized by a period of at least four days during which a person has a noticeable personality change along with milder manic symptoms which may include enthusiasm, irritability, racing thoughts, less need for sleep, increased productivity, distractibility and pleasure-seeking. Hypomania is not easily diagnosed, in part because many people mistake their symptoms for a really good day or don’t report them because they are enjoyable.

Predisposing Factors:

Both biological and environmental factors predispose people to develop anxiety disorders. The following factors increase the likelihood that a person will experience a mood disorder at some time in their life:

• a parent with a mood disorder
• a hormonal imbalance
• the experience of ongoing, serious, and chronic stress (poverty, living in abusive relationship)
• the loss of a loved one during your childhood
• the experience of a traumatic stress event.

Precipitating Factors:

Stressful life events, and/or chronic illness, sudden loss, child-birth, menopause, seasonal changes, and many medications can can contribute or lead to mood disorders.

DEPRESSION

Characteristics: People feel sad or worried and hopeless. They may have a loss of interest or pleasure in their usual activities. Sleep disturbances are common—sleeping at odd times or being unable to sleep. Appetite disturbances are common as well. People may suffer low self-esteem and a lack of self-confidence and some may feel totally worthless. Impaired memory and concentration, feelings of guilt and doubt and thoughts of suicide.

What do we see?

A depressed person may withdraw socially and avoid activities they always enjoyed’ they may refuse social invitations, neglect to return phone messages. They may present as lethargic. Also, there may be a sudden weight loss or gain. They may say things such as “don’t waste your time on me” or “it’s not important” “I won’t be bothering you much longer”. They may have trouble concentrating and focusing. They may forget things. They may tell you that they can’t go on this way, or they can’t handle things anymore.

Recommended Treatment:

• Treatment usually involves a combination of medication and therapy.
• Supportive and Cognitive-Behavioural Therapy
• Focus is placed on learning to problem-solve/ deal with stress and life problems
• Patterns of negative thinking are identified and replaced with healthier thoughts.
• Antidepressants are somewhat effective to stabilize some symptoms for the short-term. However, they are not recommended for stand-alone use.

BIPOLAR DISORDER

Characteristics: During the manic phases of this disorder, people present in an opposite manner from depression. They may experience an excessively good, euphoric mood. They are likely to have an inflated self-esteem and self-confidence, feeling incredibly optimistic about everything. They may experience grandiose delusions. They may also have racing thoughts and appear hyperactive—“bouncing off the walls”, and have very little need for sleep.

What do we see?

People will express upbeat responses that are incongruent with the situation, such as, “these things happen, life is great!” after an unfortunate event; They may believe they have been chosen for some special task. They may react with anger or paranoia if challenged on these beliefs. They may bombard others with words, ideas and thoughts that are not all related to the topic of conversation. They may pace and be unable to sit still, or they may stay up all night. Their behaviour may become reckless—spending money, driving dangerously, engaging in unprotected sex.

Recommended Treatment:

• Treatment almost always begins with medications. Mood stabilizers such as Lithium, may be a first choice
• Other medications may also be used to treat acute
• Benzodiazepines may be used in the short-term to sedate the acutely agitated person
• Cognitive-Behavioural Therapy (CBT) plays an important role in reducing the stresses that can trigger manic and depressive episodes