Schizophrenia Course - OmniMedicalSearch.com

Conditions & Diseases: Psychological & Mental Health

Schizophrenia

Schizophrenia Course

Schizophrenia is a disorder characterized by a "profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thoughts, perception, affect, and sense of self." (12) Its course is difficult to study because it does not follow a single pathway and varies considerably from person to person and for the same person, being influenced by different personal risk factors (biological and genetic vulnerabilities or neurocognitive impairments), family support (warmth, supportive versus critical, hostile attitude), and professional specialized support (skill-rebuilding assistance and rehabilitation). Some individuals experience periods of acute psychotic symptoms and remission, others have a relatively stable course, while some show a progressive worsening associated with moderate to severe disability.

Schizophrenia usually onsets in the early to mid 20s for men and late 20s for women. In rare cases, schizophrenia can start before adolescence or later in life, after the age of 45. The onset age seems to have a significant influence on the pathophysiological evolution of the disorder and its prognosis. Unfortunately, those that undergo an early onset are more often men, have a worse outcome, and the prominent manifestations are negative symptoms. Individuals with a later onset are more often women, display a better outcome, and have less cognitive impairments.

The disease onset can be abrupt or insidious. Usually, schizophrenia develops gradually with a prepsychotic stage, also known as the prodromal phase or prodrome. Approximately 80 to 90 percent of the patients diagnosed with schizophrenia go through this phase, while in 10 to 20 percent of the cases, the disease debuts straight with psychotic symptoms (delusions and hallucinations). The length of the prodromal phase varies from patient to patient and can last between few weeks to few years. In general, it lasts for at least a year and is usually dominated by negative symptoms and behavioral changes.

The person slowly withdraws from family, friends, and society, exhibits different sleeping patterns than usually (either by sleeping to much, or to little), becomes agitated, irritable, oversensitive, or rebellious. Behavioral changes are accompanied by cognitive impairments. The person becomes easily confused, manifests difficulties concentrating and poor memory, becomes preoccupied with odd ideas, religion, or philosophy, and can be excessively suspicious. Some individuals can self-inflict injuries and attempt suicide. One in ten individuals that suffer from schizophrenia commit suicide.

These cognitive impairments trigger social changes (social withdrawal) and changes in the general functioning (difficulties in the work setting, noticeable decline in academic performance, deterioration in personal hygiene and grooming, lack of interest or motivation, alcohol or drug abuse). Mood changes can also be evident during prodrome, and manifest as rapid mood changes, lack of emotional responses, or inappropriate moods (inappropriate smiling, laughing, or silly facial expressions). Altogether, these symptoms create significant disturbances in the daily life of these individuals, who find this period very frightening and in most of the cases, they prefer to not talk about what is happening in their live.

The prodrome's manifestations increase in intensity (in 75 percent of the cases the disorder worsens after its onset), and in time, they will become psychotic symptoms. The presence of psychotic symptoms marks the beginning of the active or acute phase of the disease. During the active/acute phase, symptoms usually fluctuate between episodes of severe positive symptoms (known as acute episodes of psychosis) and periods of stabilized symptoms (known as remission). An acute episode of psychosis is characterized by the presents of positive symptoms such as delusions and hallucinations, and negative symptoms such as avolition (lack of motivation) and anhedonia (inability to feel joy). Usually, in the first 5 to 10 years after the onset, each person develops a unique pattern of disorder manifestation.

In most cases, in this phase most individuals with schizophrenia are admitted for treatment. At admission, positive symptoms dominate the clinical picture, although in 10 percent of the cases extreme forms of disorganized symptoms can be present. In time, positive and disorganized symptoms tend to decrease while the negative symptoms become more prominent. Each acute episode of psychosis causes notable dysfunctions and is accompanied by distressing effects. It is highly unlikely that the person will return to normality or regain complete function after such episodes.

While positive symptoms can be effectively treated and decrease in frequency, negative symptoms increase over time for most patients and remain prominent during the residual phase of the disorder. The residual phase is characterized by the decrease of positive symptoms and worsen of the negative symptoms. However, the disease becomes easier to manage during the residual phase and individuals may regain some social and job-related skills, although a full recovery is not possible.

Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com