Schizophrenia and Acute Psychosis

Psychosis & Health Psychology

Schizophrenia is a chronic debilitating brain disease that has affected people throughout history. At times, those afflicted appear to be emotionally healthy until they communicate their thoughts, feelings and perceptions. This illness impacts men and women equally, does not usually occur after the age of 45 and infrequently appears in children. Males are prone to develop manifestations earlier than women and symptoms occur at similar rates in all ethnic groups across the globe.  In the year 2014, NIH estimated that approximately 1.1% of the U.S. population  was living with the disorder.

Tragically, as this story explains, the condition usually begins in early adulthood and those diagnosed may hallucinate (hear voices, see images that other people do not hear or see), may insist that someone is in control of their thoughts, can read their minds, or are plotting to harm them. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. These terrifying beliefs can cause the sufferer to withdraw or at times they can become extremely agitated. When in crisis and while in their deepest moments of despair, the sufferer may communicate in a nonsensical manner, such as, sitting for hours without moving or attending to the environment. Families and society are affected by all forms because many have difficulty physically caring for themselves or maintaining employment, thereby, rely on others for assistance. Schizophrenia is a mental illness identified by illogical, incoherent thoughts, bizarre speech patterns, hallucinations, delusions and unusual behaviors. Some researchers view Schizophrenia from a developmental perspective which arouses optimism, stating that concentrated treatments may provide greater assistance to those afflicted, and believe full psychosis represents a late stage of the disorder. Schizophrenia is a complex disease that many scientists are beginning to identify symptoms being on a spectrum or a group of different disorders.

Schizophrenia, Acute Psychosis and how to help

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 Mental Health professionals, researchers and the literature commonly describe symptoms of schizophrenia into three broad categories that characterize into being positive, negative, and cognitive expressions. Positive symptoms are those found specifically among people with schizophrenia but are usually not present among the general population. These symptoms include thought disorders, delusions, and hallucinations. Oftentimes sufferers may hear voices other people do not hear, or believe that someone is examining their thoughts, controlling their mind, or conspiring to abuse. Negative symptoms are those found in other mental illnesses and in the general population, however, these symptoms are intensified with schizophrenia. The expressions consist of blunted affect and emotion, lack of ambition or wish to achieve any goal and an absence of or craving to form social bonds. These symptoms make day-to-day functions especially problematic, if not impossible and contribute to their inability to maintain employment, become independent and form relationships with other people.  The three broad categories:

Positive symptoms of Schizophrenia

Positive symptoms and behaviors are usually not seen in people who do not have a mental illness.  The manifestations can wax and wane depending on life circumstances and is dependent upon receiving adequate treatment. Individuals demonstrating positive symptoms often lack the ability to function in society and cannot acknowledge the real world. Positive symptoms include thought disorders that seem eccentric or display illogical approaches in thinking patterns.

1. One form of a thought processing problem is when someone has difficulty establishing their thoughts or connecting them in a lucid, logical fashion. They may express themselves in a jumbled manner that is impossible for anyone to understand. Scientists and health professionals identify this as being “disorganized thinking.”

2. Someone with a thought disorder might make up meaningless words, or “neologisms.” Neologisms are newly created words whose meaning is unknown to others, and the term is from the Greek word neo meaning new and logos meaning word. The adoption of neologisms in young children is usually benign but is suggestive of brain damage or a thought disorder in adults.

3. “Thought blocking” is when someone abruptly stops speaking and when asked why they cut short communicating they might say that the idea or subject matter escaped from their mind. Thought blocking is similar to the conscious process of deflecting thoughts or talking about particular topics and is common when someone is discussing a psychologically sensitive issue, but it is not a conscious choice.  Those suffering say their thoughts have completely vanished. For example, someone might begin discussing a traumatic event and then stop talking midway through a sentence. When asked to continue, the person responds by stating that they completely forgot what they were saying.

The most-common explanation for thought blocking is schizophrenia. However, trauma, brain injuries, some prescriptions and drugs, such as marijuana, may also induce the difficulty. Treatment may include medication along with learning coping skills to help people focus on and manage their thoughts. Thought blocking differs from casual slips in memory that we all experience and are brought back into the conversation by a reminder or refocusing.

4. “Hallucinations” are symptoms occurring when someone hears, sees, feels or smells, something that is absent. Auditory and visual hallucinations are the most typical types that mental health care workers observe in those with schizophrenia. Auditory hallucinations usually lecture the person about their behavior, commands the person to do things, or warn of danger. Many times they communicate with each other in different tones and offer opposing advice, creating fear, confusion and disorganization.  Other types of hallucinations include smelling aromas (olfactory) that no one else recognizes and have sensations touching their bodies (tactile) when nothing is present. Those who are experiencing schizophrenia may hallucinate for a lengthy period before the family, friends and health care practitioners notice the problem.

Hallucinations are sensory deceptions, as described by Oliver Sacks, and may be the result of illnesses that affect brain function, such as a head injury, brain tumors, neurological diseases, medication side effects, or someone who is using psychoactive drugs such as LSD, mushrooms, ecstasy, or heroin.

5. “Delusions” are false beliefs that are rigid, highly resistant to change and do not identify with someone’s individual culture. A person who is suffering from a schizophrenic crisis believes these delusions despite experts providing evidence that these beliefs are not correct or rational.

Although delusions can have many themes, certain ones are more common, such as believing that friends and acquaintances can regulate their behavior via magnetic streams or that radio stations are broadcasting their thoughts. They may also think that people on television are supplying them with individual personal messages. Delusions of grandeur involve the belief they are someone else, such as an influential historical figure. Some may have paranoid delusions or delusions of persecution, thinking that people are attempting to hurt them, by tormenting, poisoning, following, or plotting to harm.

Delusions may also be the result of illnesses that affect brain function, such as a head injury, brain tumors, neurological diseases, medication side effects, or someone who is using psychoactive or stimulant drugs such as amphetamines, crystal meth, LSD, mushrooms, cocaine, cannabis, ecstasy, or heroin.

6. Movement disorders include excited, repetitive body movements or in the opposite extreme severe psychomotor slowing.  A person with a movement disorder may repeat certain motions over and over, such as repeatedly jumping up and down, or they may become catatonic, standing at attention for hours on end. For example, when the arm is gently, place down by their side, it will slowly return to their forehead.

Observations of movement type behaviors in medical disorders has been frequently observed and include focal neurologic tumors, strokes, neurological diseases, metabolic syndromes, infections along with alcohol and benzodiazepine withdrawal.

Negative symptoms of Schizophrenia

Negative symptoms are difficult to evaluate and at times are mistaken for many other conditions, such as medication side effects, drug or alcohol intoxication, grief reactions, chronic pain, anxiety reactions or depression. Negative symptoms are disruptions in the usual expression of emotions and behaviors. People with these symptoms need assistance with daily functions, such as personal hygiene and may appear reluctant to care for themselves, however, these are problems that relate to the everyday world of those suffering from schizophrenia.

  1. Difficulties with tolerating social situations
  2. Inability to focus which inhibits starting or maintaining an activity
  3. Poverty of speech meaning there is a lack of content or paucity of spoken words that are usually expressed slowly and monotone in quality
  4. Blunted or flat affect is the clinical term describing a lack of emotional awareness and responsiveness, the difference being the degree of facial expression. Gesturing or using one’s hands while speaking is rare, and there may be an inability to detect social cues during conversations.
  5. Anhedonia or the lack of pleasure in everyday life is the inability to experience enjoyment from activities usually found satisfying (reading, working out, hobbies, listening to music). Previous definitions of anhedonia highlighted pleasurable experience; however, current models emphasize various aspects of enjoyable behavior, such as motive or ambition.

Cognitive symptoms of Schizophrenia

Like negative manifestations, cognitive symptoms are profound and may be challenging for professionals to recognize as being signs of schizophrenia. Cognitive Symptoms refer to thinking mechanisms and are often detected following psychological testing.  Those living with schizophrenia often battle with executive functioning or the ability to understand knowledge and apply it to make decisions. Many struggle with organizing their thought patterns and working memory which is the capacity to use information immediately after learning it.

These symptoms can create dreadful emotional pain because they frequently make it impossible to earn a living or enjoy having a successful life. Cognitive Signs include:

  • Inability to concentrate
  • Scattered or slow thinking
  • Problems with understanding
  • Difficulties with remembering
  • Struggles with expressing thoughts
  • Troubles with paying attention or focusing.

How to help someone having an Acute Schizophrenic Psychotic crisis

Helping someone with Schizophrenia

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Speak softly

Sit in comfortable positions

Do not banter or use sarcasm

Resist the urge to hug or touch

Ask casual bystanders to leave the area

Stifle the impulse to express frustration or anger

Maintain a passive attitude and avoid extended eye contact

Be consciously aware that this individual is not capable of reasoning

Maintain a quiet environment by decreasing stimulation and disturbances

Be aware that the person may be very frightened of their feelings of not being in control

Many people who live with this disease lead rewarding and meaningful lives. Treatment of psychosis assists in reducing many symptoms, but most people manage manifestations by learning new ways of coping throughout their lifetime. Scientists are creating more powerful medications and employing new research technologies to comprehend schizophrenia’s biological origins. It is our hope that maintaining this research focus will help cure, prevent and improve current treatment methods.

People who suffer from mental afflictions report that the stigma and intolerance they withstand is worse than the symptoms of the illness. Stigma destroys lives because people suffer in silence, afraid to tell family, friends, colleagues and physicians about what they are experiencing. This isolation encourages feelings of shame and fundamentally discourages people from receiving treatment. The public rarely hears from this silent group, who tacitly moves on with their lives, posing no threat and suffering at times in silence. Unfortunately, society rarely becomes aware of people with Schizophrenia, who manage their symptoms and live for the most part healthy, productive and content lives.

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References

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Addington,J. and Addington D. Positive and negative symptoms of schizophrenia. Their course and relationship over time. Schizophr Research. 1991 Jul-Aug;5(1):51-9.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th. ed.). Washington, DC

Bennett, M. Positive and negative symptoms in schizophrenia: the NMDA receptor hypofunction hypothesis, neuregulin/ErbB4 and synapse regression. The Austrialian and New Zealand Journal of Psychaitry, 2009 Aug;43(8):711-21.

Pillmann F., Haring A., Balzuweit S., Marneros A. A comparison of  DSM-IV brief psychotic disorder with “positive” schizophrenia and healthy controls. Comprehensive Psychiatry, 2002 Sep-Oct;43(5):385-92

Schrank, B., Amering, M., Hay, A., Weber, M., Sibitz, I. Insight, positive and negative symptoms, hope, depression and self-stigma: a comprehensive model of mutual influences in schizophrenia spectrum disorders. Epidemiology and Psychiatric Sciences 2014 Sep;23(3):271-9