Conditions on the Schizophrenic Spectrum include Schizophrenia and Schizoaffective Disorder, among other debilitating disorders.
These severe disorders are characterised by a wide range of symptoms – including psychosis, a difficulty in understanding reality, changes in thoughts, feelings and actions and mood disorders.
The Schizophrenic Spectrum features some of the most difficult mental health conditions to live with. For those that do suffer, their life is usually impacted heavily.
The main focus when treating these conditions is to improve quality of life. Total recovery is rarely possible. But with the right treatment, support and lifestyle choices, positive strides can be taken.
Types of Schizophrenic Spectrum Disorders
There are a few different conditions on the Schizophrenic Spectrum. These conditions share some similarities, but some differences are also apparent.
Schizophrenia: Schizophrenia is a severe and long-term mental health condition characterised by a range of symptoms, normally revolving around a difficulty in understanding reality, due to changes in the way someone thinks, feels and acts. The condition usually involves a breakdown in the connection between thoughts, emotions and behaviour – leading to psychotic symptoms. While the exact symptoms range from case to case, generally delusions, hallucinations, disorganised speech, catatonia, poor concentration and a lack of interest may be displayed. With the right treatment, support and lifestyle, it is possible for symptoms to be controlled more.
Schizoaffective Disorder: Schizoaffective Disorder is severe mental health condition which involves both symptoms of Schizophrenia, along with symptoms associated with a mood disorder, like Depression or the Mania stage of Bipolar Disorder. Symptoms can therefore include hallucinations, delusions, low mood and mania among others. Someone with Schizoaffective Disorder will often have lost touch with reality. Treatment normally involves some form of talking therapy and medication.
Schizophreniform Disorder: This disorder features identical symptoms to Schizophrenia, however these symptoms will not have caused distress for most days in a month, as seen with Schizophrenia itself. For instance, symptoms may have been present for a few weeks, but not caused much functional impairment. Around two-thirds of people with Schizophreniform Disorder go on to develop Schizophrenia.
There were formerly multiple types of Schizophrenia. However, there has recently been more of a movement towards Schizophrenia being one disorder that encompasses the supposed types that had originally been put forward.
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Symptoms of Schizophrenic Spectrum Disorders
In general, someone with a Schizophrenic Spectrum Disorder struggles with the way they think, feel and acts. Most of the time, symptoms of Schizophrenia are classed as either “negative” or “positive”.
Essentially, positive symptoms refer to the symptoms that “add” a behaviour, thought or feeling, while negative symptoms are ones that will take away a behaviour, thought or feeling.
Positive symptoms refer to the symptoms that involve any change in the behaviour or thoughts of an individual – such as hallucinations or delusions. Positive symptoms are often associated with psychosis. Other examples include Disorganised behaviour, disorganised speech and catatonia.
Negative symptoms meanwhile refer to the lack of function or withdrawal from an individual that is suffering from Schizophrenia. In particular, these are symptoms that would not normally be seen in a healthy person. As an example, a negative symptom would be someone exhibiting a flat affect due to Schizophrenia, or withdrawing socially. Other examples include poverty of speech or avolition.
Cognitive symptoms normally take place as a result of the symptoms seen above. These symptoms are ones that are associated with cognitive defects that take place due to positive and negative symptoms. For instance, thought disorder is a common symptom, as are poor concentration and trouble in matching thoughts, feelings and behaviours.
Schizoaffective Disorder also involves one of the above areas, and either Bipolar Disorder or Depression. Therefore, for Schizoaffective Disorder, symptoms of one of the following will be found:
- Continuous low mood or sadness.
- Hopelessness and helplessness
- Low self-esteem
- Lack of emotion or excessive crying
- Concentration Difficulties
- Excessively happy feeling, euphoria
- Racing thoughts
- Very confident
- Not needing much sleep
- Acting impulsively
There are many symptoms possible across the various conditions on the Schizophrenic Spectrum. As such, not everyone will experience all of these symptoms, sometimes only a few symptoms are present.
But the above symptoms give an idea on the symptoms seen across the spectrum. You can see further details at the article below [construction].
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Causes of Schizophrenic Spectrum Disorders
Given the complexity of conditions on the Schizophrenic Spectrum, the cause isn’t entirely known. However, it is believed that a range of factors may be involved. Possible causes include:
- Genetics: It appears that Schizophrenia can run in families. One study found that heritability rates for Schizophrenia are around 80% – suggesting genetics plays a big role in the onset of the condition . However, there doesn’t appear to be a certain gene that causes this. Having a parent with Schizophrenia raises the risk of an individual developing the illness. But this is purely a risk factor, and not always a cause.
- Chemical Imbalance: It is believed that some neurotransmitters in the brain may be unbalanced. Neurotransmitters, such as dopamine and serotonin, are chemicals that help regulate mood and communication in the brain. When these chemicals become unbalanced, it is possible that a mental health condition may develop.
- Abuse: Physical, sexual or emotional abuse can lead to Schizophrenia developing, as it can commonly disrupt the development of the brain.
- Childhood Events: Childhood events help shape the personality of an individual. Personality defects can often appear as a result, or someone may struggle to make friends or trust someone. This can lead to loneliness. Being bullied or the death of a parent when young also act as risk factors.
- Trauma: A traumatic event is often seen as a trigger of any mental health condition. A stressful or distressing event like bereavement, abuse or relationship difficulties can act as a trigger.
- Brain Differences: Scans on the brains of individuals with Schizophrenia suggest there are minor differences in brain structure. As a result, it is possible that Schizophrenic Spectrum disorders may develop as a result of a brain disorder. Further research is needed however in this area.
- Other Mental Health Conditions: Schizophrenia can potentially start off as another mental health condition, like Depression, Brief Psychotic Disorder or Schizotypal Personality Disorder, before exacerbating.
- Substance Abuse: Any form of substance abuse can increase the likelihood of Schizophrenia developing. Many street drugs have been particularly linked to the onset of Schizophrenia. Amphetamines, cannabis and cocaine have all been linked.
- Birth Complications: Some more research into Schizophrenia has yielded the belief that complications during birth can lead to an increased risk of Schizophrenia developing in later life. Such complications include premature birth, a lack of oxygen in birth, along with a low birth weight. This could also cause brain development issues, which is referred to above.
It is normally not possible to pinpoint one singular cause. It seems that often, a combination of factors are responsible. However, there are many other potential causes.
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Diagnosis of Schizophrenic Spectrum Disorders
Schizophrenic Spectrum disorders are normally diagnosed by mental health specialists. They are often misdiagnosed, owing to their similarities with other mood disorders and psychosis-related conditions.
The first step is to visit a regular doctor. They will ask the patient a range of questions about their symptoms – including how often episodes occur, any substance abuse issues, possible causes, and anything else relevant.
Normally, the patient will be referred to the Community Health Team (CMHT) – or in cases of first experiences of psychosis, the Early Intervention Team (EIT). These are teams of mental health professionals that care for those with more severe mental health conditions.
The specialist will go into further detail, and carry out a full assessment of the individual. A diagnosis should then be made, and treatment options discussed.
The exact diagnostic criteria differs between each individual Schizophrenic Spectrum disorder. Some key facts are outlined below:
- Schizophrenia: The patient will have normally experienced either a delusion, hallucination or disorganised speech, and at least one “negative” symptom.
- Schizoaffective Disorder: The patient will have normally experienced at least two episodes of psychosis – with at least one of these featuring an overlap of a mood disorder of psychotic symptoms.
- Schizophreniform Disorder: The patient will have experienced some of the symptoms of Schizophrenia – albeit without experiencing significant impairment to their day-to-day functioning. These symptoms will normally have been present for less than six months.
There are other requirements too for each diagnostic criteria to be satisfied – but the above provides an outline. For example, all three require the assurance that the conditions haven’t been caused by a substance, or fit another mental health condition better.
It is very important for a person to seek immediate mental health treatment if they believe they have a Schizophrenic Spectrum disorder. These are serious conditions.
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Treatment of Schizophrenic Spectrum Disorders
Schizophrenic Spectrum disorders are severe conditions. However, with the right treatment and support, symptoms can be controlled, leading to an improvement in quality of life for those with a condition on the spectrum.
Treatment for Schizophrenic Spectrum disorders usually involves a form of talking therapy, and at least one type of medication. Treatment is normally handled by the CMHT or EIT. The exact treatment that is provided will differ for each condition.
- Talking Therapy: While medication is a staple of treatment for Schizophrenic Spectrum disorders, talking therapy also has a role to play. Therapy can help the patient to try and minimise the impact that a Schizophrenic Spectrum disorder has on their life. There are many types of therapy that could be helpful, including:
Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.
Arts Therapy: Arts and creative therapy (also known as expressive arts therapy, creative arts therapy, expressive therapies etc) can help people find a way to express their thoughts and feelings in an easier way. This type of therapy involves an individual creating art, an object or piece of music, which can normally be used by a therapist to link to certain problems. Arts therapy can be a good alternative to talking therapy if needed.
Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.
Electroconvulsive Therapy (ECT): Electroconvulsive Therapy (commonly referred to as shock treatment) is a treatment that sees an electric current sent through the brain of an individual. The aim is to trigger an epileptic seizure, with the ultimate objective to relieve symptoms of a mental health problem. The human body is fully restrained during the procedure, which also involves a general anaesthetic. Electroconvulsive therapy is normally a last resort. Despite this, ECT actually has an impressive efficacy rate, with many people finding it helps immeasurably.
- Medication: Medication is the most important intervention when it comes to Schizophrenic Spectrum disorders. For Schizophrenia and Schizophreniform Disorder, antipsychotics are normally used. However, for Schizoaffective Disorder, other medication classes like antidepressants and mood stabilisers can be used in conjunction with an antipsychotic. The CMHT will put together a treatment plan. Medications include:
Antipsychotics: Antipsychotics (also known as neuroleptics) block the effect of dopamine – a chemical in the brain that is heavily linked to psychotic symptoms like hallucinations. They can also be useful for stabilising mood, and treating anxiety. They are not suitable for everyone however, and are often associated with many side effects like weight gain, dizziness and dry mouth.
Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.
Mood Stabilisers: Mood stabilisers can help level out moods, meaning fewer lows, and fewer euphoric highs are felt. Lithium Carbonate is the best-known mood stabiliser. Valproate is a well-known anticonvulsant which is often used as a stabiliser for people who cannot take Lithium Carbonate.
As seen, there are many different interventions that can help. However, it can take time to find a treatment plan that works. The aim is to find a treatment combination that leads to an improvement in quality of life.
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Living with Schizophrenic Spectrum Disorders
Schizophrenic Spectrum disorders are severe conditions that can cause enormous suffering to those diagnosed with a condition on the spctrum.
While the treatment plan for schizophrenia can appear daunting, when done correctly it can lead to the condition not having a profound impact on the life of the patient.
The onus is on the patient to look after themselves, follow their treatment plan and engage in any therapy that they have.
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Schizophrenic Spectrum conditions usually have a rather bleak prognosis, but this isn’t always the case. Sometimes, recovery is possible.
Factors that affect the prognosis include reaction to medication and therapy, the severity of symptoms and the support network around a person.
Sadly, suicide rates are high for those with a Schizophrenic Spectrum disorder. But there is hope, and it is important to remember that every individual is different.
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 Combs, D. R., Mueser K. T., & Gutierrez, M. M. (2011). Schizophrenia: Etiological considerations. In: Hersen, M., & Beidel, D. C. (Eds). Adult psychopathology and diagnosis. 6th ed. John Wiley & Sons.