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Schizophrenia and Other Psychoses

Schizophrenia is a very serious mental illness. It is characterized by a breakdown in normal thought processes and a loss of reality contact.

This loss of reality contact is called psychosis, and is marked by the presence of hallucinations and/or delusions (false beliefs).

Thankfully, schizophrenia is fairly uncommon, affecting roughly one percent of the population. However, because of the severity of schizophrenia, it can have devastating effects on the person's life. It also can be a source of considerable heartache and stress for family members.

In the sections below, we discuss symptoms of schizophrenia and other psychotic disorders, some general issues regarding treatment, and the role of psychologists in diagnosis and treatment.


Symptoms of Schizophrenia

Schizophrenia is a thought disorder. This means that you usually see some form of mental disorganization, such as thought processes and speech that seem disconnected or illogical.

In its milder forms, this mental disorganization can lead the listener to feel puzzled because what the person says just doesn't quite fit together or make sense. At its worst, their speech is completely incoherent.

Schizophrenia also is characterized by the presence of hallucinations and/or delusions. Usually, these are present in conjunction with the mental disorganization described above, but someone can have hallucinations and delusions without grossly disorganized thought processes.

Other symptoms that are characteristic of schizophrenia include a lack of emotional response or depth, called "flat affect." Sometimes, however, there can be strong emotional reactions and volatility, particularly in response to delusional beliefs. Also, you sometimes see inappropriate affect, such as laughing when hearing that someone has died.

People with schizophrenia often seem unmotivated, and may just sit and stare at the television for hours without moving. You might also see deterioration in self-care, like refusal to bathe or change clothes. Withdrawal from social interactions is common.

Behavior problems can occur in response to the hallucinations, delusions, and mental confusion. Sometimes these behaviors are relatively benign, like mumbling to themselves or putting multiple layers of clothes on. Other times, the behavior can be hazardous for the person, who might, for example, wander in the road or go into dangerous environments. Finally, people with schizophrenia sometimes act out in threatening or aggressive ways, usually in response to their psychotic symptoms.

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Other Psychotic Disorders

Other psychotic disorders also exist. Some of these are mentioned briefly here.

Delusional Disorder is present when the person is generally intact except for a distinct area of his life that is marked by a delusional belief. For example, the person might believe that he has a special romantic relationship with a celebrity, or he might be certain that there is a conspiracy against him among his coworkers. Apart from the delusional belief, the person usually appears fairly normal.

A person can experience a brief, transient psychotic reaction, during which there could be mental disorganization, hallucinations, or delusions. Often, when this occurs, it is in response to extreme stress. It also can occur in the weeks after childbirth. When it resolves, the person returns to their normal state.

Severe mood disorders (depression or mania) can include psychotic symptoms.

Alcohol and other drugs can provoke psychotic symptoms. In some cases, the symptoms are directly caused by the drug and resolve fairly quickly after a period of sobriety. In other cases, the symptoms can persist for weeks or even months. In a subset of people, drugs seem to provoke a dormant mental illness that becomes a chronic problem requiring ongoing treatment.

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General Treatment Issues

The primary treatment for schizophrenia and other psychoses is medication. Once a diagnosis is established, the psychologist can refer the person to a physician for medication management.

In some cases, the disorder is severe enough that hospitalization is necessary. In such circumstances, the psychologist will refer the person to the treating physician, who can admit the person, or to the Emergency Department of the hospital.

Schizophrenia often responds well to medications, particularly with the newer, more effective drugs that have come out in recent years.

However, medications also can have some unpleasant side effects, such as extreme drowsiness. Compliance can suffer if the person does not develop tolerance for these side effects.

Another major difficulty in treating schizophrenia is the tendency of the person to deny they have the disorder. This denial is a common human response to something that is very frightening or that threatens the person's self-image. Unfortunately, along with this denial comes a tendency to discontinue medications, since taking the medications implies that one needs them.

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The Role of the Psychologist

Diagnosis:

The psychologist can establish the diagnosis of schizophrenia. This involves evaluating the presence of schizophrenic symptoms, while also assessing whether other disorders could account for the symptoms.

The psychologist establishes the diagnosis through the clinical interview, during which thought processes can be observed directly, and through reports of symptoms by the person or loved ones. Sometimes, psychological testing can be useful to clarify whether there is a thought disorder present, particularly when that mental disorganization is subtle and relatively mild.

Treatment:

The psychologist can provide therapeutic services for the person with schizophrenia, including support and help in communicating any problems with their medications.

A significant role for the psychologist is dealing with denial of the disorder. Because denial is based on the instinct for self-protection, it can be a very strong obstacle to successful treatment.

The psychologist tries to overcome the need for denial by working with the person to identify and reduce the anxiety associated with having schizophrenia. This involves coming to understand the meaning of the disorder for the person who has it, dealing with the real losses they experience because of the disorder, and addressing their expectations for the future.

In addition, the psychologist works to strengthen the person's sense of self-appreciation and empowerment in order to counter the negative impact of the disorder on his self-image. Part of this work also involves developing the person's ability to respond to the stigma of schizophrenia -- to respond in constructive ways to negative biases they might encounter with other people.

In addition to directly helping the person with schizophrenia, the psychologist can provide support for family members. The role of the family member can be very stressful, emotionally painful, and often thankless. In particular, family members can be central figures in delusional beliefs and can suffer antagonism, harassment, or abuse as a result.

Also, the family may be forced to take responsibility for the person's well-being during periods when they are too ill to care for themselves appropriately. This might include taking them to treatment against their will, and facing considerable anger and resentment for doing so. It also can mean pursuing civil commitment through the probate court in order to mandate treatment or hospitalization.

The psychologist can help by providing a place where family members can express their feelings, their frustrations, and their questions. In addition, communities often have support groups that can be very worthwhile.

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Disclaimer:  You know, we see a disclaimer like this in every ad that lawyers put out, and it probably is a good idea for us to use one, too:  "No representation is made that the quality of the psychological services to be performed is greater than the quality of psychological services performed by other psychologists.  The outcome of assessments or psychotherapy, or individual client satisfaction, cannot be guaranteed and is dependent on many factors.  Material on this site regarding symptoms, disorders, and treatment is informational only.  Diagnosis and treatment of mental disorders requires the expertise of a trained professional."

The information on this site regarding psychological disorders and treatment comes from many sources that cannot be credited, simply because they have been integrated over the years into our general knowledge base. However, one important source is the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994) published by the American Psychiatric Association.