Schizophrenia and its characteristics

Schizophrenia is a chronic disorder that can affect any part of a person’s life. Acute phases of schizophrenia can be recognized by bizarre behavior, lack of logical thinking, incoherent speech, delusions and hallucinations. In between these acute phases, people still have difficulty with things, such as thinking clearly or reading emotions from someone’s face. People with schizophrenia also show little emotion in their facial expressions and they can also speak in a monotone. The clinical symptoms and cognitive decline in certain areas make it difficult for people with schizophrenia to function in daily life and work.

Origin and course

Schizophrenia usually develops when the brain fully matures. This is around the twentieth year of life. In 75% of cases, the first symptoms appear around the age of 25. Schizophrenia develops suddenly.
Despite the fact that schizofrenia is immediately thought to be a psychosis, early signs of deterioration are visible in the preceding years. This period is called the prodromal phase. Characteristic of this phase is a decrease in interest in having a social life and increasing difficulties in fulfilling the responsibilities that everyday life entails. In the beginning, the appearance is also less well taken care of. Behavior also changes casually. They no longer go to school or work and when they speak it is vague and incoherent. At first, personality changes are gradual so that it seems like a person is going through one phase. When the behavior becomes increasingly strange, the acute phase begins. This also causes clear psychotic symptoms such as delusions, hallucinations and even stranger behavior. After an acute phase, someone can enter a residual period. The behavior is then the same as it was in the prodromal phase.
Even though people suffer from schizophrenia their entire lives, 50 to 60% improve over time. In some cases, people may even return completely to normal behavior, but this is not common.

Prevalence

There is no difference in the percentage of people with schizophrenia compared to developing countries. This is approximately 0.8 to 1% for both. About 24 million people in the world suffer from schizophrenia. In the Netherlands, approximately 60,000 to 80,000 people between the ages of 18 and 65 suffer from schizophrenia. This is approximately 0.9%. Men are more likely to develop schizophrenia than women and they also develop it at a younger age. In men, the disorder begins between the ages of 18 and 25, while in women it occurs between the ages of 25 and 35.

Diagnostic features

Schizophrenia is a comprehensive disorder that affects various psychological processes, such as behavior, affect and cognition. According to the DSM-IV criteria, psychotic behavior must occur at some point during the disorder. Also, the signs of the disorder must be present for at least six months.
Schizophrenia affects various behavioral aspects, such as conscious behavior, thinking, attention and perception processes, speech and emotional processes. The symptoms of schizophrenia can be grouped by, for example, distinguishing between positive and negative symptoms. The positive symptoms relate to having a break with reality, such as during hallucinations and delusions. The negative symptoms involve the loss or deterioration of normal functions, such as loss of pleasure in usually enjoyable activities.

Perceptual disturbances

Hallucinations

Hallucinations are perceptions that are felt with the senses (hearing, taste, smell, touch and sight) without actually being there. Auditory hallucinations, or hearing voices, are most common among schizophrenia patients. This occurs in approximately 75%. In addition, tactile (tingling, burning sensations) and somatic (feeling like spiders are crawling around in the stomach) hallucinations are also common. The visual (seeing things that are not there at all), gustatory (tasting things that are not there) and olfactory (smelling things that are not there) hallucinations are a lot rarer.
People suffering from schizophrenia may hear female or male voices, which may be present inside or outside the head . Those voices can speak in the third person and talk through their good and bad qualities. Some voices can be friendly while others can be critical or frightening. People with schizophrenia may also suffer from command hallucinations. Commands are given that they must then carry out, usually these are certain actions, such as cutting themselves. These people are often admitted because of the fear that they will harm themselves or others. It turned out that 80% of the people who had command hallucinations also carried out these commands.

Emotional disorders

Disturbances of affect (emotional response) in schizophrenia are characterized by blunted or flat affect and by inadequate affect . The blunted or flat affect can be noticed because schizophrenia patients do not show emotion in the face or voice. When talking without intonation or expressions, there is an incongruent affect. This means that the facial expressions and emotions do not correspond to the topic discussed. Research shows that people with schizophrenia experience more intense negative feelings than others, but less intense positive feelings. Although it is not always clear to schizophrenia patients that they experience emotions, they do. People with schizophrenia may not be able to express their emotions. In addition, they also have difficulty recognizing emotions in others, or social recognition.

Motor disorders and drive disorders

These disorders are characterized by the loss of initiative to engage in goal-directed activities. People suffering from schizophrenia may be unable to carry out plans and lack interest or drive. In addition, a group of schizophrenia patients exhibit highly agitated or wild behavior or are slowed down to a state of stupor. They exhibit strange gestures and bizarre facial expressions or they stop responding and abort spontaneous movements. In extreme cases, as can occur with the katanone type, a person is unaware of the environment in which he is. He walks around excitedly but without purpose or he appears to be standing motionless or sitting in a strange position.

Subtypes of schizophrenia

The DSM-IV mentions several specific types of schizophrenia, of which the disorganized type, the catatonic type and the paranoid type are the most common.

Disorganized type

The disorganized type is a form of schizophrenia characterized by incoherent speech, disorganized delusions, strange and inappropriate laughter, flattened or inadequate affect, chaotic behavior, and vivid and frequent hallucinations. A social obstacle is also common in this type. People with the disorganized type of schizophrenia have erratic moods, giggle and speak nonsense, and exhibit foolish behavior. Neglecting appearance and personal hygiene is also common and they may be incontinent at times.

Catatonic type

The catatonic type is a form of schizophrenia characterized by marked motor inhibition and a slowing of activity to a stupor, which may suddenly progress to the agitated phase. People suffering from the catatonic type of schizophrenia exhibit unusual mannerisms and can maintain a specific, bizarre posture for hours at a time even as the limbs become stiff or swell. Waxy pliability is a less common feature of the catatonic type. This involves a person assuming a position where he or she has been deployed by another person. This period can last for hours, and during this period a person will not respond to comments or questions.

Paranoid type

The paranoid type is a form of schizophrenia characterized by preoccupations with the presence of one or more delusions or with the presence of auditory hallucinations on a regular basis. The behavior and speech of a person with the paranoid type of schizophrenia does not exhibit the characteristics of the disorganized and catatonic type. Schizophrenia patients with the paranoid type can become very confused, scared and agitated.
According to the DSM-IV, schizophrenia can also be classified into two basic types: type I and type II. Type I is characterized by prominent symptoms (positive symptoms) such as delusions, hallucinations and isolated symptoms . Type I begins suddenly. Type II is characterized by a pattern of mainly defects (negative symptoms) of schizophrenia. This can be understood as the loss or reduction of normal functions, such as not showing facial expressions, no longer enjoying fun activities, etc. Type II develops gradually.