Overview of Schizophrenia
MAY 21, 2020
Dawn Velligan, PhD: Schizophrenia is typically more than 1 illness. It is a constellation of signs and symptoms that come together to allow us to form a diagnosis. There are multiple groups of symptoms. First of all, the positive symptoms. Positive symptoms are sensory experiences in the absence of external stimuli.
Patients hear voices telling them to run over here or do this or do that. People may see things that others don’t see. I’ve had individuals who have said that they felt as if people were punching them and they could actually feel it on their body. Hallucinations are 1 of the important symptoms. There are delusions, which are false beliefs in the absence of external evidence. People may believe that they’re being followed or that they are in the CIA [Central Intelligence Agency].
Those kinds of delusions can be annoying for family members. Family members will often argue with people. Nobody is following you or trying to hurt you, which isn’t very helpful. So the positive symptoms include unorganized speech and behavior. People will not be able to get their ideas across. Their sentences and word structure might be confused and made up, and you’re not really able to follow what they’re saying. And then, their behavior may be unorganized.
They may engage in unusual rituals. They may be afraid to shower because if they go in the shower, they don’t know who will be there to get them when they get out, and they won’t be able to run away because they won’t have clothes on. There are positive symptoms that are dramatic with schizophrenia, and they will need an ER [emergency department] visit or to be admitted to the hospital. There are also negative symptoms. Negative symptoms are abnormal because they’re things that are absent that people should have. They’re either absent or diminished. People should have motivation, goals, and physical emotion on their face when they talk, social relationships, and physical activity. They might not shower as much. Negative symptoms are experienced when family members will encourage someone to please go out with them, and they won’t go.
They don’t have friends, and they spend a lot of time idle. They might wake at 2 PM, smoke a cigarette, have something to eat, and smoke another. If this behavior consists, life becomes so negative and can be very difficult to treat. We don’t have good treatments for them at this point.
Schizophrenia is characterized by cognitive impairments. This is true for multiple domains. The ability to pay attention that requires effort is impaired. If you tried to explain to someone how to take their medicine, it’s very difficult for them to understand. You have to be succinct.
If you tried to give them important information and there are a lot of distractions, they’re not going to be able to pay attention and understand information they need.
Memory is also impaired—memory for faces and for verbal information. It’s difficult to learn new skills without help. Lastly, executive functions are impaired. This is our ability to plan and carry out goal-directed activity. Understanding an idea and be able to know what comes first and what comes second. This is impaired in many individuals with schizophrenia.
Their judgment might be impaired. They have difficulty because of these cognitive impairments in functioning. They also have difficulty with what we call social cognition. Social cognition is our ability to make good guesses about what other people are thinking, what their intentions are, what they want from me.
People with schizophrenia can’t follow conversations and understand what’s expected. This causes a lot of difficulty in social relationships. All the cognitive impairments cause severe role functioning in many people with schizophrenia. Only 20% of individuals with schizophrenia have jobs in the competitive marketplace. Many people have low education, lower than you would expect by their socioeconomic status. The disability associated with schizophrenia is attributable to cognitive impairments.
There are multiple risk factors that are associated with schizophrenia. When a mother is pregnant during influenza outbreak, when there are birth complications of any kind, there is a higher risk to someone to have the child develop schizophrenia. There’s a genetic reason: schizophrenia tends to run in families. You inherit vulnerability, and those vulnerabilities become a problem when you’re exposed to a certain amount or kind of stress that you have difficulty coping with.
Vulnerability will come out in symptoms of psychosis. There is some evidence that individuals who use certain drugs when they’re in their developmental years, and they’re 13, 14, 15 and they’re using marijuana and psychedelic drugs that they’re more likely to convert to psychosis later than people who don’t use those drugs. It’s difficult to tell. It doesn’t happen to everyone, but it can be 1 of the risk factors. Stress, poverty, abuse, any kind of long-term stress can be a risk factor for people if it interacts with that genetic vulnerability.
Transcript Edited for Clarity