Schizophrenia

Synonyms in a broader sense

• Splitting of consciousness
• Endogenous psychoses
• Schizophrenic Psychoses
• Psychoses from the schizophrenic form

Definition

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 (real life). 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 psychotic state both can be disturbed. Schizophrenia is a form of psychosis, in which on the one hand the sensory perception can be disturbed and hallucinations can occur, on the other hand the thinking itself can be severely disturbed. The processing of perceptions can, for example, lead to delusions.

All in all, people in a psychotic state gradually lose touch with reality and thus with their lives. They find it increasingly difficult to perform 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!

Symptoms

Overall, the clinical picture or symptomatology can vary greatly from patient to patient. Although it is therefore a disease with many faces, there is a division of clinical symptoms into 3 classes: Particularly specific for schizophrenia, for example, are disorders of the own ego-feeling in the sense of an external control, in which the affected persons have the feeling that their thoughts are not their own, as if ideas were given or taken away from them. The experience of delusion also belongs to the schizophrenia, for example in the form of paranoia or delusions of grandeur.

Also very typical are acoustic hallucinations in the form of commenting, mostly negative voices, possibly accompanied by other hallucinations. In addition, thinking and logical combining is usually limited and the environment and experiences can no longer be interpreted correctly. The affect, i.e. their emotional experience, is also affected, which explains the apparent apathy.

In some contexts, however, inappropriate overreaction and incomprehensible reactions are also possible. The severity of these symptoms varies depending on the form of schizophrenia. Multiple personalities, as often staged in film and television, are a rather rare manifestation of schizophrenia.

Some of the symptoms described above are very specific to schizophrenia, whereas some symptoms are more likely to be accompanying. For this reason, they are divided into 1st and 2nd rank symptoms.

• Positive symptoms
• Negative symptoms
• Psychomotoric symptomatology

The term “first-degree symptom” refers to symptoms that can give a clear indication of the possible presence of schizophrenia, as they are very specific to schizophrenia.

One of the most common first-order symptoms is hearing voices. A distinction is made here between dialoguing and commenting voices, as well as the sound of thoughts, i.e. the feeling that one’s own thoughts are being repeated by another person. The latter often causes people to feel that they are being dictated the thoughts of others.

In addition, physical experiences of influence can be present, which describes that affected persons have the feeling that someone else has access to their body and, for example, raises their arm, although they do not want to. Many people compare these experiences with the feeling of being a puppet. Further symptoms of the first rank are thought inspirations, thought expansions, thought withdrawal.

With the latter, affected persons feel that mostly a supernatural being, like the devil, would ask them their thoughts and they therefore can no longer grasp clear thoughts. To this symptom spectrum belong further the feeling of the will influence and the delusional perception, that thus real perceptions are attached a delusional meaning. Second degree symptoms are not very specific to schizophrenia, unlike first degree symptoms.It is important to understand that this ranking does not indicate the severity or effects of individual symptoms, but alone describes the specificity of these symptoms for schizophrenia.

An example of such a symptom is hallucinations, which can also occur in other mental disorders. A distinction is made between acoustic, visual and olfactory hallucinations. But affective disorders can also be part of the symptom spectrum of schizophrenia.

These disorders include, for example, depressive moods, exaggerated euphoria, perplexity or so-called parathymia, i.e. a difference between the expression and the feeling. An example of the latter would be when a person laughs even though they actually feel great sadness. In addition, delusions or ideas may be present in the person affected.

These delusions are usually linked to the other symptoms of schizophrenia. For example, people with visual hallucinations often imagine that they are being persecuted or punished by a higher power in the sense of a delusion. The symptoms of many mental disorders are divided into positive and negative symptoms.

In schizophrenia, for example, these include acoustic and optical hallucinations, such as hearing voices. In combination with the delusions or ideas that are usually present, these can lead to a complete distortion of reality for those affected and drastically reduce the quality of life. Further symptoms that can be attributed to positive symptoms are formal and content-related thinking disorders.

The former are usually described by schizophrenic patients as a blockage of thought or as the theft of thoughts by a higher power, which means that they are no longer able to follow logical thought processes. In contrast, content-related thought disorders are accompanied by delusions or ego disorders. So often normal circumstances are related to the person itself and an attempt is made to find an explanation for them, which is mostly not understandable for outsiders.

Further positive symptoms are: Positive symptoms are responsible for the typical picture of schizophrenia and are especially pronounced in acute attacks. They respond well to common antipsychotic medications and are much easier to treat than negative symptoms.

• Behavioral changes
• Disturbances in emotional expression
• Associative relaxation (Zerfahrenheit)
• Perseverations (repetitions)
• Neologisms (neologisms)

In contrast to positive symptoms, the term negative symptoms covers all symptoms associated with the loss of normal physical and mental abilities, such as mental deficits or speech deprivation.

Affective disorders also belong to this spectrum of symptoms. These are usually accompanied by a reduction in drive and a lack of interest, which can then also lead to social withdrawal. In the area of mental performance, there can often be severe limitations that increase as the disease progresses.

In addition, there is a strong reduction in the ability to concentrate and speech impoverishment. If the schizophrenia already occurs in childhood and adolescence, limitations in motor skills, in the sense of muscle weakness and coordination problems, can also be described. Unfortunately, medication has little effect on these symptoms, so the treatment of negative symptoms is extremely difficult.

In the so-called delusion, the content of thinking (ideas, beliefs) is disturbed. Within the framework of the delusion, patients develop ideas of which they are convinced (in the sense of “knowing”) that they are true, even though they do not correspond to the truth. They stand up for their conceptions and ideas with tremendous effort and usually do not allow any contradiction.

Occasionally, but by no means always, these conceptions appear quite logical and well thought out even to outsiders, so that one can speak of a real “madness”. There are some “typical” delusions in schizophrenia.

• Paranoid Delusion (Paranoid Delusion) In this type of delusion, patients feel persecuted, threatened or even suppressed.

  For example: passing cars can suddenly belong to the secret service. The neighbor who does not greet is planning an eavesdropping attack. The ringing letter carrier suddenly becomes a contract killer.On the street you feel constantly watched or followed.

• Megalomania: The content of this megalomania is the magnificence of the patient.

  For example: The patient thinks he is the savior of the world, the most brilliant scientist, direct descendant of Napoleon or Jesus or any other overly capable person.

• Control Delusion: This leads to the idea that one’s own actions, thoughts or impulses are influenced and controlled by other “powers” or people. For example: a patient who experiences his thoughts as strange and changed may be firmly convinced that his neighbor across the street is “irradiating” him with a device. Physical complaints such as restlessness or stomach pain are also explained by “actions” of other people.
• Relationship delusion: In relationship delusion, the patient sees in certain actions, situations, objects or even people an important meaning for him.

  For example: The patient believes that television or radio broadcasts transmit texts for him personally. Traffic signs can also have a hidden message about the direction in which the patient should move.

• Here the sick person knows about his imminent financial ruin, although the danger is not realistically given. Here the worries often revolve in particular around the care of relatives
• Hypochondriac delusion: Here the patient knows that he or she is suffering from at least one serious physical illness.

  This disease is often perceived by the patient as incurable and fatal. Negative findings and insurances of several doctors cannot dissuade him from this conviction.

• Delusion of sin: The sick person knows that he has sinned against a higher or lower power. If the person is a believer, the content of the delusion is often religiously influenced.

  If there is no special spirituality, the sin can extend to worldly concerns.

• Nihilistic Delusion: This is a delusion that is particularly disturbing to outsiders. As a result of the perceived emptiness, the sick person denies his own existence as a person and, if necessary, the existence of the world around him.

Many schizophrenia patients show a conspicuous mode of expression, which is mostly due to a change in formal thinking. Formal does not mean what one thinks in terms of content, but how one thinks.

For a better explanation, the most frequent formal thinking changes are listed below. For the sake of completeness, it should be mentioned that such formal thinking disorders can of course also occur with other disorders, such as mania, dementia, etc.

• Associative looseness (Zerfahrenheit): This means that patients come from “Höcksken auf Stöcksken”.

  Even small stimuli from outside cause a patient to lose the thread. All in all, the whole flow of speech seems incoherent and not or only with great difficulty comprehensible. For example: a patient is asked whether he has already received his medication today.

  He replies: “No, I don’t want them … they always have such stupid side effects. My brother-in-law is stupid too. He has been together with my sister for two years now.

  The 2 comes before the 3… in front of the house is better than behind the house etc.

• Perseverations (repetitions): In this type of mental disorder, individual words or sentences or parts of sentences are constantly repeated. However, it also means the rigid adherence to a train of thought or a lack of flexibility in thinking.
• Neologisms: Patients “invent” new words and incorporate them into their speech flow as a matter of course.
• Emotional Expression Disorders This type of disorder refers to abnormalities that many schizophrenics exhibit. They often have great difficulty in behaving emotionally in a way that is appropriate for the situation.

  A sad message is ridiculed, a nice situation can lead to desperate crying. Overall, the overall mood can be relatively unpredictable. In a relatively short period of time, outbursts of joy can occur, followed by outbursts of anger.

Hallucinations are loosely translated as “misperceptions of the senses”.

Our 5 senses provide us with stimuli with which we deal with the environment. In the context of schizophrenia it can happen that one or more of these senses pick up and transmit non-existent stimuli.The most common is the “heard” hallucination (acoustic hallucination). Here, patients hear either directional or non-directional hallucinations.

Undirected hallucinations are, for example, banging or engine noises. Directed hallucinations are more frequent and usually occur in the form of voices. As a practitioner, you have to distinguish exactly what these voices say to the patient.

On the one hand, it is possible that a conversation between the patient and the hallucination occurs (dialoguing voices), on the other hand, the voices do not speak to the patient but about him (commenting voices). A third possibility is particularly problematic. These are the commanding voices (imperative voices).

Often patients have a very strong urge to give in to these commands in the hope of finding peace. An imperative hallucination is therefore always a reason for inpatient treatment, since there is an increased risk of self-damage. (If necessary also against the will of the patient.

See also the topic of care law). The second most frequent hallucination is the “seen” hallucination (optical hallucination). All kinds of things (animals, people, objects) can occur here.

A typical and well known example of an optical hallucination are the so-called “white mice” in an alcohol withdrawal delusion. Rarely there are the taste (gustatory) hallucinations whose content is mostly about eating and drinking; the smelled (olfactory) hallucinations, where often bad smells (e.g. smoke and smell of decomposition) are in the foreground or the felt (tactile) hallucinations, where often “insect crawling”, electric shocks or itching are described. In schizophrenic patients, increased perception can often be observed even before the appearance of real hallucinations.

Colors are perceived as brighter, sounds as louder. The term psychomotorics describes the parts of a movement sequence that can be modulated by mental processes. In the context of mental illnesses, such as schizophrenia, this link between psyche and movement can be disturbed, which can result in various symptoms.

This includes the development of movement automatisms, which can present themselves in many different forms. For example, people can develop the automatism of always having to repeat everything they hear immediately or always performing a movement that is opposite to that of the people observed. A further symptom is the development of tics, i.e. involuntary muscle twitches that repeat rapidly.

There can also be strong motor restlessness, such as constantly running back and forth in a room, for example. In contrast to the symptoms mentioned above, which are associated with increased movement, psychomotor disorders can also be associated with a severe lack of movement and drive. Nervousness, which occurs in most schizophrenic patients, is considered a negative symptom and is often one of the first signs of the manifestation of schizophrenia.

The development of this pronounced nervousness can be traced back to a fundamental disturbance of well-being, which can exist in the context of these diseases. However, other possible symptoms of schizophrenia, such as hallucinations, can also lead to nervousness, as the affected persons do not know how to deal with this situation. In addition, many patients with psychomotor disorders experience motor restlessness, which can reinforce the image of nervousness.

Pronounced restlessness is also very common in schizophrenic patients. On the one hand, this restlessness results from a psychomotor disorder, which can be accompanied by the development of tics, automatic movements or the urge to move constantly. However, psychological aspects also play a major role in the development of restlessness.

For example, schizophrenic patients are often no longer able to think clearly and, as the disease progresses, they usually develop delusions that can be intensified by optical and acoustic hallucinations. All these factors lead to the fact that affected persons are never able to find peace physically and mentally. The onset of schizophrenia is accompanied in about half of the cases by a depressed mood or depressive moods.

This is mainly due to a general mental and spiritual slowdown, which can be accompanied by the development of joylessness. Some patients report a feeling of inner emptiness.The consequence is often the cooling of social contacts with friends or family, which can lead to complete social isolation. These symptoms can easily be confused with depression, which is one of the reasons why schizophrenia can rarely be diagnosed at such an early stage.

Thoughtfulness beyond the normal level can also be observed. This is classified as one of the formal thinking disorders described above and means that thoughts revolve around the same, unpleasant topic over and over again without a solution being found. In addition, many patients look for a possible explanation for the occurrence of the hallucinations, which then often ends in delusions.

The development of a lack of concentration is a very early symptom of a beginning schizophrenia and is present in almost all patients. On the one hand, this is due to the general disturbance of well-being that is present in many schizophrenic patients. But also the so-called loss of thought, which many affected persons complain about, can be causal for this.

They then describe that they could no longer grasp clear thoughts because someone else, usually a higher power, robs them of their thoughts. In addition, the often existing acoustic and optical hallucinations can lead to a constant stimulus satiation and distraction, which then leads to a severe lack of concentration. Most schizophrenia patients suffer from severe sleep disorders during the course of the disease, which is the result of the many possible symptoms.

For example, the mental and motor hyperactivity that often exists can mean that those affected cannot get to rest. With the common form of paranoid schizophrenia, many patients also suffer from delusions, which are accompanied by a persecutional delusion and lead to sleep disorders. Furthermore, the possible acoustic hallucinations are a possible reason for the development of sleep disorders.

Sleep disorders are usually treated with the administration of sleeping pills even in schizophrenia. The neglect of the personal appearance is another early symptom of a beginning schizophrenia besides other symptoms like a depressive disgruntlement or memory disorders and occurs in about 20-40% of the affected persons. This symptom is classified as a general health disorder and is accompanied by a loss of hygiene.

This is due to the fact that many schizophrenic patients are introverted and their personal appearance plays an increasingly minor role for them. This symptom is usually intensified by increasing social isolation. It is very common in schizophrenic patients that outsiders feel that they are being lied to when the patient describes his or her delusions or talks about hallucinations he or she has seen or heard.

However, this usually makes people forget how real a person suffering from schizophrenia feels when they have such hallucinations or voice perceptions. Thus, affected persons usually cannot distinguish whether something is really real or only part of a hallucination. These impressions are intensified by the development of delusions and a superior reason for the perceptions is sought, which then quickly appear to be a lie to outsiders.

In contrast, however, schizophrenic patients may actually lie in order to conceal the actual presence or extent of the disease from relatives. This phenomenon is usually more pronounced at the beginning of the illness. One of the early signs of incipient schizophrenia can be impairment of well-being, such as increased irritability.

This is especially true for the most common form of the disease, paranoid schizophrenia, which focuses on the development of delusions and auditory hallucinations. Patients quickly get the impression that they are being lied to by all other people and that they do not want to believe them, which can then manifest itself as severe irritability. Many schizophrenic patients have problems following a slowly moving object continuously with their eyes, and they fail due to fast and jerky gaze sequences.

Whether this can be attributed purely to mental stress or specifically to schizophrenia has not yet been clearly established. At present, studies are underway on this topic in order to be able to detect schizophrenia at an early stage using the eyes, but eye examinations are not yet part of today’s diagnostics.The term “residual symptoms” covers all symptoms that still exist after a successful therapy or healing of a disease. In schizophrenia, this is usually the case after an acute episode.

In general it can be said that negative symptoms are much more dominant than positive symptoms. For example, many patients who have had an acute episode of schizophrenia show personality changes to varying degrees, often accompanied by depressive moods and social withdrawal. In addition, the memory and concentration disorders may be permanent in some patients. Only in a small proportion of patients, no residual symptoms can be detected after the acute episode has subsided.