18 Schizophrenia Pp165-172

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SCHIZOPHRENIA

Schizophrenia is a mental illness that causes a change in a person’s thinking,emotion, perception and behaviour. Schizophrenia is an illness, it is not aweakness or character fault. It is not a split personality, multiple personality, or

developmental disability. When treated effectively schizophrenia is not anillness that makes people more violent or aggressive.

Prevalence:

Schizophrenia affects on average 1% of the population, It does not affect anyspecific group of people. It can affect anyone regardless of gender, ethnicity,culture, sexuality, class, intelligence or level of education. Most people havetheir first episode of schizophrenia as adolescents or young adults. 20 –30%of people have only one or two psychotic episodes in their life, for othersschizophrenia is more chronic.

Cause:

There are many possible causes of schizophrenia. First-degree relatives ofindividuals with schizophrenia have a risk of developing schizophrenia that isabout ten times greater than that of the general population.

Chemical imbalance in the brain is thought to be involved in schizophrenia.

Environment may also be a cause. Family relationships however are not a

direct cause of schizophrenia. Disharmony in families can however contributeto relapses of illness.

Symptoms:

There are many symptoms that contribute to a diagnosis of schizophrenia.The symptoms are described as positive or negative. Positive symptomsmean that behaviour that is considered normal is present in a distorted or anexcess form. Negative symptoms mean that the person displays a reduceddegree of normal behaviour.

Schizophrenia is also broken into subtypes. There are five of these: Paranoidtype, disorganised type, catatonic type, undifferentiated type and residualtype.

The positive and negative symptoms plus the subtypes of schizophrenia willbe described.

Positive Symptoms include hallucinations, delusions, and disorganisedspeech.

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Hallucinations:

Hallucinations are distortions in perception whereby the world seems differentand even unreal to the person who has schizophrenia. Hallucinations arewhen a person perceives that something is happening in their environment,

when in reality it is not. The most common type of hallucination is auditory – iethe person hears one or more voices. Other types of hallucinations involve thesenses of seeing, touch, feeling, tasting or smelling.

Delusions:

Delusions are convincing beliefs about certain things that are in fact not true.The person may have delusions of grandeur, for example they may believethey are someone famous. They may have delusions about being persecuted.They may feel that they are under the control of something or someone else;or they may feel they have special gifts.

Disorganised Speech:

The person may jump from one subject to another without reason, or thoughtsmay be presented in a confused manner.

Negative symptoms include avolition, poverty of speech, flat affect andahedonia.

Avolition is a lack of motivation.

Alogia: is poverty of speech.

Ahedonia means that a person does not enjoy activities that they previouslyenjoyed. They may therefore not participate in these activities.

Flat affect is a lack of outward emotion, whereby virtually nothing can elicit anemotional response.

Subcategories of schizophrenia:

Schizophrenia of the paranoid type: Occurs when the main part of the illnessis hallucinations and delusions of the paranoid type.

Schizophrenia of the disorganised type: The person presents with a lack ofoutward emotion and has disorganised speech or disorganised behaviour.Disorganised behaviour is characterised by a lack of goal oriented activity.Disorganisation can be so severe that it affects activities that many peopletake for granted, such as showering, dressing and meal preparation.

Schizophrenia of the catatonic type: two or more of the following symptomsdominates this type of schizophrenia:

An excess of purposeless movement. No movement.

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Motor immobility. Extreme negativism. Assuming bizarre or inappropriate postures. Parrot like repetition of words. Repetitive copying of another persons movements.

Undifferentiated Schizophrenia: The characteristics of schizophrenia arepresent, however the subtype is not evident.

Residual type of Schizophrenia: When there are negative or positivesymptoms of schizophrenia without the prominent delusions or hallucinations.

Treatments for schizophrenia:

Medication: Anti-psychotic drugs.

Social support: Support from family and friends is vital as it will help theperson to feel less isolated.

Counselling: Supportive counselling from a trained professional can help theperson through the emotions they are feeling due to the schizophrenia.

Anti-psychotic medications work by altering chemical levels in the brain. Thereare many types of anti-psychotics. All drugs have side effects. Some of theside effects that may affect a person’s ability to be included in activities are asfollows: Stiffness, dizziness, confusion, slow thinking, tiredness, drooling,unsteadiness of movement, and blurred vision.

Other side effects include: Weight gain, sleeplessness, nausea, vomiting andheadaches.

Associations:

Siblink: An education program for brothers, sisters and children of people withschizophrenia. Phone: (02) 9879 2600.

Website: www.sfnsw.org.au

Psychiatric Rehabilitation Association: Newcastle Support Network, HamiltonNewcastle. Ph: (02) 4969 8585. Fax: (02) 4969 8580

Schizophrenia Fellowship NSW Inc.Ph: 9879 2600. Fax: 9879 2699Website: www.sfnsw.org.au

Schizophrenia Fellowship Inc (Canberra branch.)Ph: (02) 6287 4214

Mental Health Association:

Ph: 9816 5688.

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http://www.sfnsw.org.au/







References:

The information provided has been adapted from the following sources:

The Royal College of Psychiatrists. Anti-psychotics [Available online:

http://www.rcpsych.ac.uk]

Mental Health Information Service. Schizophrenia: A fact sheet produced bythe Mental Health Information Service. Gladesville, Sydney.

American Psychiatric Association: (1994)Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition. (DSM –IV). American Psychiatric Association, Washington.

Neale, J; Davison, G; & Haaga, D. (1996).Exploring Abnormal Psychology .

John Wiley and Sons, Inc. Brisbane.

Mental Health Branch of the Department of Health and Aged Care. What isSchizophrenia. Available: Mental Health Branch of the Department of Health and Aged CareCanberra. ACT.

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http://www.rcpsych.ac.uk/

http://www.rcpsych.ac.uk/



Issue: The person hears voices.

Implication:

Hearing voices may

interfere with an activitythe person is doing. Thevoices may be tellingthe person to carry outan action.

Solution: Acknowledge that the person may be hearingvoices, however that the voices they hear cannot

be heard by other people, nevertheless you realisethat hearing voices feels real for the personexperiencing them.

If the person is hearing voices try to distract theminto an activity that they enjoy. If the person is verydistracted by a voice, methodical activities, such asdrying the dishes is often easier for them to do thancreative activities.

If the voices are directing the person to carry out an

action, try to remain with the person to ensure theyare safe. While they are with you, acknowledge theperson is hearing voices. Ask the person to identifywhere the voices are coming from and encouragethem to work toward telling the voices to go away.Help them to recognise that no one else is hearingthe voices, therefore they are not based on reality.

Issue: The person has delusions.

Implication:

Delusions may makethe person think theyare someone famous,or they possess specialgifts or that they arebeing persecuted.

They may try todominate an activity inthinking they are specialin some way.

Solution:

Help the person to understand that what they areexperiencing is not reality for any one else, butacknowledge their feelings.

Encourage them to participate in activities they likedoing, as channelling their energy into activities canbe helpful.

If delusions of being persecuted involve themthinking their food is being poisoned, allow them toprepare their own meal/morning tea.

Provide a space where they can take time out andrelax. Time out is useful if their delusional thinkingis scaring other people, and it also may save themfrom feeling uncomfortable or embarrassed abouttheir delusions once the delusion has passed.

Treat the person as an adult with adult rules, andlet them know that inappropriate behaviour towardsother people is not acceptable.

If the delusions are intrusive they may needencouragement to visit their doctor.

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Issue: The person may have disorganised speech.

Implication:In conversation theperson may jump from

one subject to another.

Solution:In conversations provide directions that do not havetoo many complex steps. Ask questions that require

one answer at a time, rather than multiple/complexresponses.

Do not treat the person like a child, just becausethey are disorganised in their speech.

Listen to the person and give them time to expresstheir ideas.

Activities with small groups or one other personmay make it easier for the person to communicate.

Provide activities that do not require too muchspeech. For example activities requiring vision ormovement may be considered: walks, films, craft,cooking, gardening.

Issue: The person may have a poverty of speech.

Implication:The person may not be

forthcoming inconversations.

Solution:Remember the person is not being rude by not

responding. Their illness is preventing them frombeing more forthcoming in conversations.

Be content with having monosyllabic answers orgestural answers, as this may be the only way theycan express themselves at this stage.

Provide activities that do not rely on speech,(examples are listed in the previous table.)

Activities with small groups or one other person

only may make it easier for the person tocommunicate.

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Issue: The person may appear to have low motivation.

Implication:The person may requiremore encouragement to

join activities.

Remember low motivation is a symptom of theillness. The person is not choosing to respond toyou with poor motivation.

Encourage the person to join you for activities. Ifthe person declines, still ask them to other activitiesat another time. Giving them the choice of joining inany activities may help them to feel less isolated,and as they are feeling better they may wish toparticipate in some way.

Provide activities that can be broken down to allowit to be recommenced if required, or to allow themto participate in the sections of the activities in

which they feel capable of achieving at this stage.

Issue: The person does not enjoy activities they previously enjoyed.

Implication:The person may notwish to participate inactivities in which theypreviously participated.

Solution:Reduce your expectations of them participating inthe whole activity. The person may wish to onlyparticipate in part of the activity.

The person may decline to be involved in activities.Do not cut them off by not asking them to beinvolved in activities. Let them know they can beinvolved in any activity when they wish toparticipate.

Find out which activity they enjoy and plan to dothese when they are feeling more capable ofparticipating.

If they do not join activities, try to reduce their

isolation by visiting them.

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Issue: The person is disorganised, and activities are not based onreaching a goal.

Implication:The person may require

activities to bestructured.

Solution:Structure the activities in the time of the day when

you know the person functions best.

Structure the activity itself, so that the person isable to clearly see how they will be able to join theactivity. Ensure the person understands thepurpose of the activity.

Be prepared to help the person with the activity toenable them to participate. Help may be in the formof prompting them to participate in the next step.

Accept that at times their hygiene may be reduced.It is important to still include people in activitieswhere possible.

Issue: The side effects of the anti psychotic medications may cause theperson to be confused and or slow thinking.

Implication:Concentrating forlengthy sessions may

not be possible. Theperson may bedisoriented in thesurroundings.

Solution:Hold the activity in familiar surroundings.

Hold activities that do not take too long to complete.

Give the person plenty of time to think thingsthrough and to clarify any issues that are confusing.

Orient the person to the surroundings, activity andother people present prior to commencing anactivity.

Give the person plenty of time to expressthemselves.

Do not treat them like a child.

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18 Schizophrenia Pp165-172

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