If you’ve watched the movie, ‘A Beautiful Mind’, you would have seen how it not only portrays the achievements of the American mathematician, John Nash—a Nobel Laureate in Economics, and Abel prize winner—but also about his struggles with his mental health. The film showcases how, during the prime of his career, he started hallucinating, and was eventually diagnosed with schizophrenia. Although the film shows that he sought help only briefly, in real life, he spent a considerable amount of time in psychiatric institutions, where his condition got better before he returned to his profession and won many awards for his work.
What Is Schizophrenia?
Now, the film may have shown a happy ending. But in reality, schizophrenia is one of the most chronic neurodegenerative disorders in mental health care. According to Ms Mehezabin Dordi, clinical psychologist, rehabilitation, and sports medicine department, Sir HN Reliance Foundation Hospital, Mumbai, “Schizophrenia is a serious mental illness that affects a person's ability to think, act, and express emotions, perceive reality and interact with others. Schizophrenia is the most persistent and devastating of the major mental diseases, despite its rarity. Schizophrenia patients frequently struggle in society, a job, education, and relationships.”
Are There Different Types Of Schizophrenia?
A quick search on the internet also throws up the fact that there are different types of schizophrenia. But, is that true? And if yes, then what are they? Dordi says, “Despite the fact that the subtypes no longer exist as distinct clinical diseases, they might nevertheless be useful as specifiers and for treatment planning.” She adds that there are five different sorts of classical subtypes:
1. Paranoid Schizophrenia
The most frequent kind of schizophrenia used to be paranoid schizophrenia. However, because of how frequent it is, the subtype description is still utilised. Delusions, hallucinations, chaotic speech (word salad, echolalia), difficulty concentrating, behavioural impairment (impulse control, emotional lability), and/or flat affect are some of the symptoms.
2. Hebephrenic/Disorganised Schizophrenia
Despite being excluded from the DSM-5, hebephrenic or disorganised schizophrenia is still recognised by the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The person does not exhibit hallucinations or delusions with this type of schizophrenia. Rather, they exhibit disordered behaviour and speech. Flat affect, verbal difficulties, disorganised thinking, improper emotions or facial reactions, and/or difficulty with daily activities are all examples of this.
3. Undifferentiated Schizophrenia
The phrase "undifferentiated schizophrenia" was used to describe when a person's behaviours might be applied to more than one type of schizophrenia. There are no fixed symptoms, rather a mix of them.
4. Residual Schizophrenia
This "subtype" is a little more difficult. It's been used when a person has previously been diagnosed with schizophrenia but no longer exhibits any of the disorder's symptoms. The severity of the symptoms has largely decreased. More "negative" symptoms of residual schizophrenia include flattened affect, psychomotor issues, delayed speech, and/or poor hygiene.
5. Catatonic Schizophrenia
Although catatonic schizophrenia was previously classified as a subtype in the DSM, it has been claimed that catatonia should be classified as a specifier. This is because it can arise in several psychiatric and general medical diseases. Immobility is the most common symptom, however, it can also take the form of copying behaviour, mutism, or a stupor-like state.
The Signs and Symptoms of Schizophrenia
Dordi explains that schizophrenia is characterised by difficulties with thinking (cognition), acting (behaviour), and feeling (emotions). Delusions, hallucinations, or confused speech are common signs and symptoms, and they indicate a reduced ability to perform.
She lists out the signs and symptoms as:
1. Delusions: These are erroneous views that are not supported by evidence. For instance, you believe you are being harassed or hurt; particular gestures or statements are directed at you; you have a special skill or fame; another person is in love with you; or that a catastrophic disaster is imminent. Most patients with schizophrenia have delusions.
2. Hallucinations: Seeing or hearing things that don't exist is a common occurrence. The individual with schizophrenia, on the other hand, is subjected to the full force and effect of a typical experience. Hearing voices is the most common hallucination, though these can occur in every sense.
3. Disorganised Thinking/Speech: Chaotic speech can be used to infer disorganised thought. Communication can be hampered, and responses to queries may be partially or entirely unconnected. Rarely, speech may include the use of nonsensical words that are difficult to understand, a practice known as word salad.
4. Abnormal Motor Behaviour: This can manifest itself in a variety of ways, ranging from childish silliness to erratic agitation. It's difficult to complete activities when behaviour isn't focused on a goal. Resistance to directions, incorrect or strange posture, a complete lack of response, or unnecessary and excessive movement are all examples of behaviour.
5. Negative Symptoms: This is a term that describes a diminished or absent ability to function regularly. The person may, for example, neglect personal hygiene or appear emotionless (i.e., does not make eye contact, does not change facial expressions, or speaks in a monotone). In addition, the person may lose interest in routine tasks, retreat socially, or be unable to enjoy pleasure. The kind and degree of symptoms might change over time, with periods of worsening and remission. Some symptoms may be present at all times.
Diagnosis And Treatment
When it comes to diagnosis, first a full physical medical examination is done, which accounts for any medical history of illnesses that could contribute to the symptoms. Dordi expounds, “A doctor will conduct a comprehensive medical history and physical examination if any of the symptoms are present. It's critical to rule out any physical issues that could be causing the symptoms. If the doctor cannot find a medical cause for the symptoms, he or she may refer the patient to a psychiatrist or psychologist, who are trained to diagnose and treat mental diseases.”
She further continues, “To examine a person for schizophrenia, psychiatrists and psychologists employ specifically designed interview and evaluation techniques. The doctor or therapist makes a diagnosis based on the patient's description of symptoms as well as his or her observations of the patient's attitude and behaviour.”
As for treatment, Dordi mentions, “Counseling and medications are the most common treatments for reducing or eliminating psychotic symptoms. The majority of people will be able to control their psychotic symptoms with medication. Medication may not be necessary for milder forms of schizophrenia.”
If you or some you know is unwell, seek expert advice and help immediately.
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