Affecting nearly 1% of the population, schizophrenia is marked by chronic or reoccurring psychosis and behavioral-cognitive deficits. Dr. Kristin Cadenhead and Dr. David Granet of the UCSD School of Medicine discuss schizophrenia and delve into the nature of psychosis, early detection, and possible prevention.

Clinical symptoms of schizophrenia usually begin in late adolescence or early adulthood. They are generally grouped into three broad categories: “positive” or “negative” based on the pathological effects of normal functions, and “cognitive impairments.” Over time, positive and negative symptoms tend to be episodic and vary in intensity.

Positive symptoms include indications that are considered exaggerations or distortions of normal functions: psychosis, false beliefs (delusions; 90% incidence of all subjects), perception of something when indeed nothing exists in the perceptual field (hallucinations; 50% incidence), and bizarre behaviors (Hirsch & Weinburger, 2003).

Negative symptoms are deficit states in which fundamental emotions are either weakened or entirely deficient, including blunted affect, anhedonia (inability to experience pleasure from normal activities), apathy (loss of interest and motivation), social withdrawal, and alogia (diminished speech content). They have an earlier and more subtle onset, and are less episodic than psychotic symptoms.

Schizophrenia may encompass disturbances in cognition, usually related to attention and concentration, learning and memory, psychomotor speed (e.g. prolonged reaction time), and executive processing (e.g. formulating and initiating plans, abstract thinking, and problem-solving).

Schizophrenia is a devastating psychotic disorder for it destroys the social functioning and employability of patients, and the psychiatric community is increasingly recognizing such symptoms as the part of diagnosis and treatment. Generally, negative symptoms and cognitive impairment are the disabling mechanisms of schizophrenia. Patient may no longer have the ability to concentrate on and take pleasure in work, studies, and entertainment. Relatives and other observers may mistakenly identify the patient’s lack of will (avolition) and develop antagonistic thoughts towards the schizophrenic patient (e.g. thinking one is lazy or deliberately preventing an improved life) (Mueser & McGurk, 2004). Moreover, the patient’s lack of medical insight further hinders their ability to take advantage of effective coping strategies which may further agitate social withdrawal, depression, and risk of suicide.

References

Hirsch, S. R., & Weinburger, D. R. (2003). Schizophrenia (2nd ed.). Malden, MA: Blackwell Science.

Mueser, K. T., & McGurk, S. R. (2004). Schizophrenia. Lancet, 363(9426), 2063-207