Schizophrenia, without a doubt, is one of the disorders best known to all. Even so, many people tend to mitigate it, exaggerate it or demonize it. It is a disorder that arouses both fascination and fear. Since the psychological processes began to be studied, schizophrenia is one that has been investigated the most and of which there are still many unknowns. Its etiology is still not clear and its treatment includes different therapies.
Throughout this article the diagnostic criteria of schizophrenia will be exposed, as well as its most prominent symptoms. It will differentiate between positive, negative and disorganization symptoms. Finally, evaluation and treatment will be addressed. The DSM-V has been used as a reference for the diagnostic criteria. This is the last update in 2013 of the "Diagnostic and Statistical Manual of Mental Disorders", published by the APA (American Psychiatric Association).
- 1 Diagnostic criteria of schizophrenia
- 2 Positive, negative and disorganization symptoms
- 3 Evaluation of schizophrenia
- 4 Treatment of schizophrenia
Diagnostic criteria of schizophrenia
A. Two (or more) of the following symptoms. Each of them present for a significant part of time during the period of one month (or less if it was treated successfully). At least one of them must be 1, 2 or 3:
- Disorganized speech.
- Very disorganized or catatonic behavior.
- Negative symptoms.
B. The individual's level of functioning in different areas is well below the level prior to the onset of the disorder for a significant part of time.
C. Continuous signs of the disorder persist for at least six months. At least one month of criteria A symptoms must be included in the six month period and may include periods of prodromal and residual symptoms.
D. Schizoaffective disorder and depressive disorder or bipolar disorder with psychotic characteristics have been ruled out because:
- There have been no major manic or depressive episodes concurrently with the symptoms of the active phase.
- If these episodes have occurred during the active phase, they have been present only for a minimum part of the total duration of the active and residual periods of the disease.
AND. The disorder is not due to the direct physiological effects of any substance or another medical condition..
F. If there is a history of an autism spectrum disorder or an early childhood communication disorder, the diagnosis of schizophrenia will be made only if delusions or hallucinations are notable and present for a minimum of one month.
After one year of the disorder, the following points must be specified:
- First episode, currently in acute episode. An acute episode is one in which the symptomatic criteria are met.
- Multiple episodes, currently in acute episode. These types of episodes can be determined after a minimum of two episodes.
- First episode, currently in remission. The diagnostic criteria are only partially met and are in remission.
- Multiple episodes, currently in partial remission.
- First episode, currently in total remission. The symptoms of the disorder are no longer present after an initial episode.
- Multiple episodes, currently in total remission.
- The current gravity. It is performed on the symptoms of criterion A.
Positive, negative and disorganization symptoms
Despite the name, positive symptoms are those that occur in excess or as an exaggeration of normal functions. Negative symptoms, on the other hand, represent the absence of behaviors or loss of normal functions. By last, disorganization symptoms they have been included in the positives for many years, but after several investigations, it was decided to create a different category claiming that they represent a "thought disorder factor".
- Delusional ideas. These are wrong ideas or beliefs that cannot be understood in the cultural context in which they take place. The convictions of the subject are strong despite demonstrating that they have no validity. At the same time, the person cares about his belief and is emotionally involved. On the other hand, this thought usually causes discomfort and who suffers it does not usually try to alleviate it. The most common delusions are: prejudice (conspiracy thinking), persecution, control, reference (elements of the environment refer to the person), grandiosity and guilt.
- Hallucinations Hallucinations they take place in the absence of a real external stimulus. The most frequent are auditory (voices, noises and voices that speak to the patient). Usually they are usually unpleasant although it doesn't always have to be that way. However, the most dangerous are those that give the patient negative orders. In this case hospitalization may be required. In visual hallucinations the most frequent is to see people. With respect to olfactory and gustatory tends to be unpleasant stimuli. The tactiles can range from burning to itching.
- Motor symptoms or catatonia. Stuporous states stand out (paralysis without speaking and isolated from the outside world), psychomotor agitation or inhibition, catalepsy or immobility and ecopraxia (repeat movement just performed by another person).
- Praise. These are alterations of thought that are expressed through language disorders such as lack of production or fluency. Brief responses, monosyllables or blockages can be seen.
- Abulia-apathy. It is appreciated by a lack of energy and motivation in behavior, both to start it and to keep it. It can also be observed in the lack of hygiene of the subject.
- Anhedonia Loss to experience pleasure. The activities that could previously cause entertainment have ceased to interest.
- Affective flattening or dullness. Decrease or absence of emotional reactions to different stimuli. It can be seen through poor eye contact and impaired body language. You can also see that they leave their eyes fixed or no tone is added to the words.
Symptoms of disorganization
- Disorganized language or formal thought disorder. When the subject speaks it goes from one sentence to another or from one subject to another without relation of contents. If the patient is asked, the answers may be indirect and the meaning irrelevant.
- Disorganized behavior. It is an unpredictable behavior. This type of behavior usually occurs in patients with disorganized or catatonic schizophrenia. Disorganization could also be a symptom of hallucinations.
- Inappropriate Affection The emotion expressed by the person is not related to the situation.
The evaluation of schizophrenia should be as complete as possible. The areas in which the patient usually develops daily should be evaluated. In this way, you can obtain results of your coping style and capabilities. This type of evaluation can be carried out through interviews, for example, the "Structured clinical interview for the DSM-III-R" (First and Gibbon, 2004) or the "Evaluation of the current state" (Cooper and Sartorius, 1974).
There are also scales and inventories such as:
- Brief scale of psychiatric evaluation (Overall and Gorham, 1962).
- Positive and negative symptoms scale (Kay, Fiszbein and Opler, 1987).
- Inventory for affective disorders and schizophrenia (Endicott and Spitzer, 1978).
- Negative symptoms evaluation scale (Andreasen, 1983).
- Positive symptom evaluation scale (Andreasen, 1984).
As the psychologist and researcher Vicente Caballo (2014) states: "Taking into account the enormous diversity of symptoms that characterize it, the treatment of schizophrenia should be directed to their control and the rehabilitation of neuropsychological deficits that the patient presents". Because of this, a lot of psychological techniques are often used.
On the one hand, there is the Pharmacotherapy, among which we find medications such as atypical antipsychotics. This treatment together with psychological and psychosocial therapy is indicated for positive-type schizophrenia. On the other hand, atypical antipsychotics and the rehabilitation of basic function deficits would be indicated for schizophrenia with predominantly negative symptoms.
It should also include:
- Training in complex skills (day-to-day skills).
- Family intervention
- Relapse prediction.
- Training in protection factors.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Edition). Madrid: Pan American Medical Editorial.
- Caballo, V., Salazar, I. and Carrobles, J. (2014). Manual of psychopathology and psychological disorders. Madrid: Pyramid Editions.
- Depression test
- Goldberg depression test
- Self-knowledge test
- how do others see you?
- Sensitivity test (PAS)
- Character test