Mark Hillman, Ph.D., (PSY) LMHC My Therapist is Making Me Nuts!Written by Mark Hillman

Take Me Away
From Troubled Times


Schizophrenia



Types


There are two types of schizophrenia - Type I (Reactive or Acute Schizophrenia) and Type II (Process Schizophrenia):

Reactive or Acute Schizophrenia


Reactive schizophrenia is usually sudden and seems to be a reaction to some life crisis. Since the premorbid history is usually good, when the disease does manifest itself, it is in the early phases. Reactive schizophrenia is a more treatable form of the illness than process or chronic schizophrenia.

Process Schizophrenia


Also referred to as poor premorbid schizophrenia, this type is characterized by lengthy periods of its development with a gradual deterioration and only exclusively negative symptoms. It doesn't seem to be related to any major life change or negative event. Usually this type of schizophrenia is associated with "loners" who are rejected by society and tend to not develop social skills and don't excel out of high school.


Symptoms


Positive versus Negative


The positive symptoms are things like bizarre behavior, hallucinations, or delusions. Negative symptoms refer to the absence of any adjustive behavior in the important areas of life, a chronic maladaptiveness, flatness of effect, and absence of developed interpersonal relationships (social skills).

Paranoid versus Nonparanoid


These symptoms are more easily defined, as the presence of heavily paranoid behavior or the absence thereof. The presence of paranoid symptoms early in the disease apparently suggest a good prognosis. There is a relationship between reactive schizophrenia and paranoid thinking.

Content of thought


The principal disturbance in the schizophrenic's thought processes is multiple delusions. This is divided into two sub-categories, persecutory delusions (in which the schizophrenic believes that he/she is being talked about, spied upon, or their death being planned) and delusions of reference (which is when the schizophrenic gives personal importance to completely unrelated incidents, objects, or people). Others include common delusions which primarily includes thought broadcasting (they believe their thoughts are visible to the outside world) and thought insertion, which is what most people perceive schizophrenia as consisting of (their thoughts are not their own and are in truth being inserted into their minds by some outside force). Other delusions such as believing they are Jesus may appear in extreme cases.

Form of thought


Schizophrenics either express their thoughts in a loose manner, where ideas shift from one subject to another with seemingly no purpose, or "poverty of content," where communication is so vague, abstract, or repetitive, that it is meaningless to the listener. Made up words, or illogically stringed together phrases, may appear in writing or speech as well.

Perception


The perception of the world is distorted in the experience of a schizophrenic. This may occur with any of the afflicted's senses, but most often appear as auditory, with voices in the patients head or commands from high authorities which are obeyed at high risk to others or the patient themselves. Visual hallucinations happen less often. Affect(BOLD). This symptom is easiest described as an excessive lack of correlation between what an individual is saying and what emotion they are expressing (i.e. recounting an experience of serious horror while chuckling).

Volition


Simply the occurrence of paralyzation on the patient's will to act out on a decision by their ambivalence.

Sense of Self


Schizophrenics generally are not aware of their individuality to an extent that they maintain a perplexity about who they are.

Relationship to the External World


Although obvious, most schizophrenics are so preoccupied with the effects of their illness, that they tend to be unavailable to others, which is referred to as autism. They don't notice the world that is happening before them.


Classes of Schizophrenia


Paranoid Schizophrenia - Patient displays the psychotic symptoms.

Undifferentiated Schizophrenia - Used when the patient's symptoms clearly point to schizophrenia but are so clouded in that classification into the different types of schizophrenia is very difficult.

Residual Schizophrenia - Advised when an individual has been through at least one episode of schizophrenia (6 months) but then "recover."

Schizophreniform Disorder - Best understood as a schizophrenic disorder that has lasted for more than two weeks but less than six months. A less serious diagnosis, as it has a likelihood for the patient to return to a normal citizen of society.


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