Symptoms of schizophrenia
Split consciousness, split insanity, endogenous psychoses, schizophrenic psychoses, psychoses from the schizophrenic circle of forms
To understand the term schizophrenia, one must first clarify the term "psychosis". A psychosis is a condition in which the patient loses touch with reality (reality).
Normally we humans perceive our reality with the help of our senses and then process it in our thinking. In the context of a psychosis or a psychotic state, both can be disturbed.
Schizophrenia is a form of psychosis in which, on the one hand, sensory perception can be disturbed and hallucinations can occur, and on the other hand, the thinking itself can also be severely disturbed. The processing of perceptions can e.g. lead to delusions.
All in all, people in a psychotic state gradually lose touch with reality and thus with their life. They find it increasingly difficult to fulfill the tasks assigned to them (as partners, employees, drivers, etc.).
What psychosis or schizophrenia does not mean is a split personality or multiple personality disorder!
Overall, the clinical picture or the symptoms can vary greatly from patient to patient. Although this is a multi-faceted disease, the clinical symptoms are divided into 3 classes:
- Positive symptoms (the positive symptoms can be found under our topic Schizophrenia)
- Negative symptoms
- Psychomotor symptoms
Also read: What is schizophrenic psychosis?
The negative symptoms include all those symptoms that can be described as "basic symptoms" and which are not a "product", i.e. incorrect processing by the patient. The main negative symptoms are:
- Flat emotional life
Many schizophrenics appear "jaded" in their emotional experience. You hardly react emotionally. Much seems "irrelevant". The facial expression appears very still, the voice seems monotonous and the gaze is lowered.
- Lack of words
What many schizophrenics have in common is that they speak very little. They are then very monosyllabic in their answers or remain completely silent. A possible explanation for this lies either in a general lack of thought or in the so-called "thought tearing off". Thoughts simply disappear, so that the patient is no longer able to respond to requests or questions.
- physical exhaustion
Patients gradually lose their physical capabilities. On the one hand, due to the disease itself, but also often in the context of drug therapy, there is often a very high level of fatigue.
- Social withdrawal
People who suddenly experience the world in which they live and the people they have known in a completely different way are gradually withdrawing more and more. They are increasingly preoccupied with their own thoughts and fears. This not infrequently leads to a state of neglect, which can even become life-threatening if there is insufficient food intake.
- Sleep disorder
Almost all schizophrenic patients develop problems falling and staying asleep sooner or later. In the treatment of sleep disorders, only medication is often helpful.
Further information on the topic can also be found at: Sleep disorder.
- Increased susceptibility to stress
In addition to physical exhaustion, there can also be "emotional exhaustion", in which the patient can no longer tolerate stress well. They are less resilient and have to withdraw more often (e.g. at work).
These symptoms can also be found in bipolar disorder. To make sure that it isn't bipolar disorder after all, read also: What are the symptoms of bipolar disorder?
It is not uncommon for schizophrenic patients to experience a loss of spontaneous and unconstrained movement and the development of strange-looking movement patterns. Here, too, the symptoms can vary in their manifestations.
Catatonia is probably the most extreme form of psychomotor symptoms, and this occurs only rarely. Katatone patients are initially motionless. They do not react to any external stimuli and sometimes remain silent for days.
Some sit or lie very still, others adopt certain postures and stay that way for hours. Some can passively be brought into other postures and remain that way. These patients have what is known as waxy flexibility (flexibilitas cerea)
- Catatonic excitation
This results in a completely undirected back and forth movement with rowing the arms. In the worst case, this can lead to self-harm or harm to others.
Causes of Schizophrenia
For many years the search was on for one hypothesis that could explain the cause of schizophrenia. Today science is certain that there is no single reason for the disease. Rather, it is now assumed that there are a number of causal factors that favor the triggering of schizophrenia. This theory sees the patient as more vulnerable if they have some of the factors listed below.
Factors that increase a person's vulnerability / vulnerability are:
- Inheritance (genetic factors):
It is considered certain that people who have schizophrenic relatives have an increased risk of developing the disease. The probability that one parent is sick is around 10-13%, when both parents are sick, the probability increases to about 40%.
On the other hand, however, this shows that this can by no means be the exclusive disease factor, as 60% of relatives do not develop schizophrenia.
- Biochemical factors:
Today we know that the nerve cells in the brain (neurons) communicate with each other with the help of messenger substances (transmitters). With regard to schizophrenia, the so-called "dopamine hypothesis" is known today, according to which the messenger substance dopamine is overly active and thus unbalances the entire brain metabolism. (This is exactly where the drug therapy of schizophrenia comes in)
Recent research shows that other messenger substances also show an altered activity.
- Altered shape of the brain:
There is research showing that the structure of the brain in sick people shows changes. Changes were detected both on the microscopic cell level (change in the cell arrangement in the hypocampus, etc.) and in large structures (enlarged 3rd ventricle, reduced frontal lobe, etc.). These changes do not occur in all patients.
- A viral infection before birth:
There is the hypothesis that a viral infection of the mother in the second trimester of pregnancy can favor the development of schizophrenia.
You can find further information under our topic: Viral encephalitis
- Psychological factors:
As knowledge about the biological and genetic factors of schizophrenia began to emerge in the 1950s and 1960s, psychological theories took a back seat.
However, the biological factors alone cannot explain the development of schizophrenia.
As mentioned above, the likelihood of developing schizophrenia due to genetics in a child of two schizophrenic parents is approximately 40%. If the disease were exclusively biological, the probability should be 100%.
This realization made psychological theories more interesting again, although they always have to be considered in connection with the biological factors.
Find out more about the topics here:
- Causes of Schizophrenia
- Inheritance of schizophrenia
Family theoretical models
Family-theoretical models of the development of schizophrenia summarized the cause of impaired communication in the family. However, the following theories could not be scientifically proven:
- In 1924, Siegmund Freud saw the development of schizophrenia as two-tiered. In the first stage he saw a regression of the patient to a state that precedes the actual differentiation of the ego (higher development of personality). In the second stage Freud saw an attempt by the patient to regain control over his own ego. He made an environment with numerous deprivations responsible for the fact that the patient fell back into an earlier state of so-called "primary narcissism".
- In 1948, Fromm-Reichmann put forward the hypothesis of the so-called "schizophrenogenic mother". According to this hypothesis, the mother of the schizophrenic patient is emotionless and cold. She cannot cater to her child's needs. Rather, the mother uses the child to satisfy her own needs.
- In 1978, Bateson wrote the hypothesis of the so-called "double bind". Here the parents constantly convey double messages and thus plunge the children into great decision-making difficulties.
- In 1973, Litz supplemented the hypothesis of the “eheschism”, in which father and mother live in open conflict and vie for the child's affection.
The “High-Expressed Emotions” concept
The fact that these older family-theoretical explanations of schizophrenia have not been scientifically confirmed does not mean that the behavior of family members has nothing to do with the development of schizophrenia.
There was a very well-known study that was able to prove that the behavior of family members had a decisive influence on the likelihood of relapse in schizophrenic patients 9 months after discharge from inpatient treatment. This concept of "high-expressed emotions" could be proven:
The “High-Expressed Emotions” concept
High-Expressed Emotions (High EE) can be described as an emotionally charged atmosphere in the family.
This includes not only criticism, devaluation, anger and hostility, but also emotional over-engagement and extreme concern and caring, as well as constant brooding, apprehension, dependence of one's own condition on the patient. "I keep thinking about what should become of him "," I will do everything for him, if only he's okay! "
The research group around this concept conducted interviews with the families of schizophrenic patients and then evaluated the statements with the help of a tape recording, so that at the end a classification into "low" and "high" emotionality in the sense of the EE concept.
The result was the following:
In the families with high stressful emotionality, 48% of the patients had another psychotic relapse, in the low stressful emotionality only 21%.
This finding was integrated into the following model and is therefore part of the current model of the development of schizophrenia. It was also important in psychological therapy for schizophrenics in the sense that a program of family communication training was developed which is used to prevent relapse in schizophrenic patients.
As already mentioned above, the VSM is now considered to be the most likely cause of the development of schizophrenia. A wide variety of factors (biological, social, familial, etc.) lead to increased "vulnerability" (vulnerability).
The vulnerability-stress model according to Libermann (1986)
- An unfavorable environmental factor creates stress
- Autonomous hyper-arousal occurs due to insufficient coping strategies
- Cognitive deficits are exacerbated, which in turn increases social stress
- Prodromal stage (without interventions or own coping attempts, the deficit worsens further)
- Onset of schizophrenic symptoms with further impairment of social and professional performance
- The further course depends on the stress factors, as well as coping skills and neuroleptic medication
Read more on the topic: Can schizophrenia be cured?