The Vexing Issue Of Validity Versus Utility
There is no single agreed meaning of validity in science, although it is generally accepted that the concept addresses the nature of reality. Psychologists generally adopt the distinction between content, criterionrelated, and construct validity, and their main concern has been with the validity of psychological tests. Borrowing terminology from psychometric theory, psychiatrists have mainly been concerned with concurrent and predictive validity, partly because of their relevance to the issue of the validity of diagnoses. The ability to predict outcome, both in the absence of treatment and in response to specific therapies, has always been a crucial function both of physicians and of their diagnoses. Robins and Guze proposed several formal criteria for establishing the validity of psychiatric diagnoses: clinical description laboratory studies delimitation from other disorders follow-up studies and family studies. This schema was elaborated by Kendler who distinguished between antecedent validators concurrent validators and predictive validators . Andreasen has proposed a second structural program for validating psychiatric diagnosis and listed several additional validators-molecular genetics and molecular biology, neurochemistry, neuroanatomy, neurophysiology and cognitive neuroscience all potentially capable of linking symptoms and diagnoses to their neural substrates.
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What Is Schizophrenia An Overview Of Schizophrenia Signs Symptoms And Treatments
What is Schizophrenia?
Schizophrenia is a severe and debilitating brain and behavior disorder affecting how one thinks feels and acts. People with schizophrenia can have trouble distinguishing reality from fantasy, expressing and managing normal emotions and making decisions. Thought processes may also be disorganized and the motivation to engage in lifes activities may be blunted. Those with the condition may hear imaginary voices and believe others are reading their minds, controlling their thoughts or plotting to harm them.
Most people with schizophrenia suffer from symptoms either continuously or intermittently throughout life and are often severely stigmatized by people who do not understand the disease. Contrary to popular perception, people with schizophrenia do not have split or multiple personalities and most pose no danger to others. However, the symptoms are terrifying to those afflicted and can make them unresponsive, agitated or withdrawn. People with schizophrenia attempt suicide more often than people in the general population, and estimates are that up to 10 percent of people with schizophrenia will complete suicide in the first 10 years of the illness particularly young men with schizophrenia.
While schizophrenia is a chronic disorder, it can be treated with medication, psychological and social treatments, substantially improving the lives of people with the condition.
What are the Symptoms of Schizophrenia?
What are the Subtypes of Schizophrenia?
Negative Symptoms Of Schizophrenia
The negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode.
These initial negative symptoms are often referred to as the prodromal period of schizophrenia.
Symptoms during the prodromal period usually appear gradually and slowly get worse.
They include the person becoming more socially withdrawn and increasingly not caring about their appearance and personal hygiene.
It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else.
Negative symptoms experienced by people living with schizophrenia include:
- losing interest and motivation in life and activities, including relationships and sex
- lack of concentration, not wanting to leave the house, and changes in sleeping patterns
- being less likely to initiate conversations and feeling uncomfortable with people, or feeling there’s nothing to say
The negative symptoms of schizophrenia can often lead to relationship problems with friends and family as they can sometimes be mistaken for deliberate laziness or rudeness.
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Brief History Of Dopamine Hypothesis In Schizophrenia
The revised dopamine hypothesis proposes hyperactive dopamine transmission in the mesolimbic areas and hypoactive dopamine transmission in the prefrontal cortex in schizophrenia patients . In addition to the mesolimbic brain areas, dopamine dysregulation is also observed in brain regions including the amygdala and prefrontal cortex, which are important for emotional processing . PET-studies have identified differences in dopamine contents in the prefrontal cortex, cingulate cortex, and hippocampus between schizophrenia patients and neuropsychiatric healthy control subjects . In particular, the dopamine system in the hippocampus is overactive in schizophrenia patients .
What Are The Positive And Negative Symptoms Of Schizophrenia
The symptoms of schizophrenia are usually classified into: positive symptoms any change in behaviour or thoughts, such as hallucinations or delusions. negative symptoms where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat.
Hallucinations. People with schizophrenia might hear, see, smell, or feel things no one else does. Delusions. Confused thoughts and disorganized speech. Trouble concentrating. Movement disorders.
Subsequently, What does schizophrenic mean?
Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling. People with schizophrenia require lifelong treatment.
Also, What are positive symptoms of schizophrenia?
Hallucinations. People with schizophrenia might hear, see, smell, or feel things no one else does. Delusions. Confused thoughts and disorganized speech. Trouble concentrating. Movement disorders.
What does positive symptoms mean in schizophrenia?
Schizophrenia symptoms are typically separated into 2 categories: Positive symptoms: Feelings or behaviors that are usually not present, such as: Believing that what other people are saying is not true Hearing, seeing, tasting, feeling, or smelling things that others do not experience
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Antipsychotics With A Dose
Only three drugs presented dose-response curves that were still increasing at the high end of the investigated dose range, suggesting that higher doses could be more efficacious. This concerns olanzapine and quetiapine ER for negative symptoms and ziprasidone for positive symptoms. However, it has to be noted that effects beyond the maximum dose used in the included studies can only be extrapolated and that we cannot draw conclusions on the shape of the curve in higher dose ranges.
For oral olanzapine, the results for negative symptoms were based on a maximum dosage of 16.3mg/day at which the curve plateaued for positive symptoms. The results for long-acting olanzapine also showed an ascending curve at the maximum dose, but the plateau shape for positive symptoms was less clear than that for the oral formulation. For quetiapine ER, a similar pattern to oral olanzapine was observed, with a curve still ascending at a dose of 800mg/day for negative symptoms, while the curve plateaued at this dose for positive symptoms. In particular for oral olanzapine the ED50 and the ED95 were higher for negative symptoms than for positive symptoms. While these findings should be interpreted with caution due to the limited number of available, the possibility of higher effectiveness for negative symptoms at higher doses cannot be discarded.
What Are Schizophrenia Negative And Positive Symptoms
Schizophrenia symptoms are often classified as negative or positive symptoms. These symptoms are grouped based on whether they reflect diminished or excess function. Positive and negative schizophrenia symptoms have been seen ever since schizophrenia was first noted in medical literature over 100 years ago.
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Best Practices For Managing Negative Symptoms In The Clinic
Negative symptoms are common in schizophrenia and over half of patients will experience clinically relevant negative symptoms that need treatment at some point., In addition to the limited efficacy of most available pharmacological treatments, negative symptom characteristics are a challenge in the clinic since some patients may lack insight into the extent and impact of their symptoms. Patients rarely present with negative symptom complaints and more immediately pressing positive symptoms may distract clinicians from the negative symptom burden. Given the difficulty in differentiating negative symptoms that are intrinsic to schizophrenia from negative symptoms resulting from another underlying cause, clinicians should carefully monitor and actively manage all clinically relevant negative symptoms .
Changes In Behaviour And Thoughts
A person’s behaviour may become more disorganised and unpredictable.
Some people describe their thoughts as being controlled by someone else, that their thoughts are not their own, or that thoughts have been planted in their mind by someone else.
Another feeling is that thoughts are disappearing, as though someone is removing them from their mind.
Some people feel their body is being taken over and someone else is directing their movements and actions.
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Search Strategy And Data Extraction
We conducted a systematic search for double-blind, randomized controlled trials comparing antipsychotic drugs with placebo or another active antipsychotic for the treatment of acute exacerbation of schizophrenia .
The MEDLINE, Embase, ScienceDirect, PsychINFO, PsycARTICLES, and Cochrane Database of Systematic Reviews databases were searched until June 2020. Trial registries were also searched for relevant articles . The search strategy with the full list of search terms can be found in the .
The following search limits were applied: English language, human studies, adult population and RCTs. This search was performed in accordance with the PRISMA Statement.
The titles and abstracts were screened by two reviewers . In addition, the full texts of all included RCTs and recent meta-analyses were obtained, and snowball searches of reference lists were conducted. Studies from mainland China were excluded to avoid systematic bias because randomization procedures raised substantial questions in these studies.
What If I Am A Carer Friend Or Relative
It can be distressing if you are a carer, friend or relative of someone who has schizophrenia. You can get support.
How can I get support for myself?
You can do the following.
- Speak to your GP about medication and talking therapies for yourself.
- Speak to your relatives care team about family intervention. For more information about family intervention see the further up this page.
- Speak to your relatives care team about a carers assessment.
- Ask for a carers assessment.
- Join a carers service. They are free and available in most areas.
- Join a carers support group for emotional and practical support. Or set up your own.
What is a carers assessment?NICE guidelines state that you should be given your own assessment through the community mental health team to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support.
The CMHT should tell you about your right to have a carers assessment through your local authority. To get a carers assessment you need to contact your local authority.
How do I get support from my peers?You can get peer support through carer support services or carers groups. You can search for local groups in your area by using a search engine such as Google. Or you can call our advice service on 0808 801 0525. They will search for you.
How can I support the person I care for?
You can do the following.
There is no definition for what high risk means. It could include:
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What Myths Are There About Schizophrenia
There are some myths or mistaken beliefs about schizophrenia which come from the media. For example,
- Schizophrenia means someone has a split personality
This is not the case. The mistake may come from the fact that the name ‘schizophrenia’ comes from two Greek words meaning ‘split’ and ‘mind’.
- Schizophrenia causes people to be violent
Research shows that only a small number of people with the illness may become violent. The same way as a small minority of the general public may become violent.
People with schizophrenia are far more likely to be harmed by other people than other people are to be harmed by them. But as these incidents can be shocking, the media often report them in a way which emphasises the mental health diagnosis. This can create fear and stigma in the general public.
How Is Schizophrenia Diagnosed
You may be diagnosed with schizophrenia if you experience at least two of the following symptoms for at least 1 month, and signs of the condition possibly in milder form persist for at least 6 months. Also, at least one symptom must be from among the first three on this list:
- delusions
- disorganized speech, such as frequent derailment or incoherence
- grossly disorganized or catatonic behavior
- negative symptoms, such as reduced emotional expression or total lack of motivation
To be diagnosed with schizophrenia, your healthcare provider will also consider what degree symptoms negatively affect different aspects of your life, such as your work, academic performance, interpersonal relationships, or self-care.
Your medical professional will also rule out any other possible causes of your symptoms, such as schizoaffective disorder, mood disorder with psychotic features, autism spectrum disorder, a general medical condition, or substance use disorder.
Keep in mind that about half of people with schizophrenia have co-occurring mental or behavioral health conditions, such as
Delusions
If you experience delusions, you believe an untruth.
For instance, you may think that youre in danger and someone wants to hurt you when theres no evidence to that effect.
Hallucinations
If you see, hear, smell, taste, or feel something that isnt real, youre experiencing hallucinations.
For example, people with schizophrenia may hear voices.
Disorganized thinking
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What Are Negative Positive And Disorganized Symptoms Of Schizophrenia
The characteristic symptoms of schizophrenia have been classified into three broad categories: positive, negative, and disorganized. Positive symptoms include delusions and hallucinations. Negative symptoms include decreased thought and speech productivity , loss of ability to experience pleasure , decreased initiation of goal-directed behavior , and speech with little or no change to their tone, little or no change in their facial expression, even if they are talking about something upsetting or exciting . Disorganized symptoms include disorganized speech , and disorganized behavior and attention.
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Can You Prevent Schizophrenia
There is no guaranteed way to prevent schizophrenia, as this is a very complex and serious mental disease. However, consistently following the treatment plan, as prescribed by the physician, can prevent worsening of schizophrenia symptoms. Researchers are currently researching about the other risk factors associated with the disease and are trying out various ways to diagnose schizophrenia at an early stage.
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How Doctors Treat Negative Symptoms
Schizophrenia means youll always need mental healthcare. Treatment is typically managed by a mental health professional such as a psychiatrist or psychiatric nurse practitioner.
Positive symptoms are treated with antipsychotic drugs. These medications can effectively address positive symptoms. Most have little effect on negative ones.
Negative symptoms can have a profound effect on quality of life. They can also affect your ability to live independently. In this respect, they may have greater impact than positive symptoms. Theyre also more difficult to treat.
Secondary negative symptoms may be easier to treat than primary ones.
Dopamine Receptors And Antipsychotic Effects In Schizophrenia
A slightly increased density of D -receptors in basal condition and a significant increase in D -receptors in the striatum of schizophrenia patients has been found . This increase of striatal dopamine D -receptors in schizophrenia has also been demonstrated in neuroimaging and molecular imaging studies . Specific neurotransmitter pathways such as those of glutamate, GABA, and acetylcholine lead to a high-affinity of the D -receptor . Dopamine receptors such as the D -receptor contain receptor mosaics . These D2/NMDA receptor mosaics have also been found in the ventral striato-pallidal GABA neurons. Decreased D -receptors in the thalamus and anterior cingulate cortex in schizophrenia might suggest that they are involved in abnormalities in dopamine transmission from the thalamus to the prefrontal cortex .
Low doses of D -receptor antagonists and signaling enhancers of NMDA-receptors are recommended as new treatments in schizophrenia . In the associative striatum, an increased D -receptor availability has been found in schizophrenia patients . Increased dopamine release in the striatum is linked to substance dependence, such as amphetamine dependency, in schizophrenia . For example, stimulation of NMDA/AMPA and kainate receptors by direct application of glutamate or glutamate agonists increases the dopaminergic cell-firing rate . However, the role of dopamine in the dysfunction of the striatum in schizophrenia patients requires future research .
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What Causes Schizophrenia
Nobody knows exactly what causes schizophrenia, it is likely to be the result of several factors. For example:
- Stress. Some people can develop the illness as a result of a stressful event, such as the death of a loved one or the loss of a job.
- Genetics. You are more likely to develop schizophrenia if you have a close relation with the illness.
- Brain damage. This is usually damage that has stopped your brain from growing normally when your mother was pregnant. Or during birth.
- Drugs and alcohol. Research has shown that stronger forms of cannabis increase your risk of developing schizophrenia.
- A difficult childhood. If you were deprived, or abused, as a child this can increase your risk of developing a mental illness. Including schizophrenia.
There is research to suggest that may be an association between menopause and schizophrenia. This may be due to the hormonal changes during this stage of life for women.
You can find more information about:
- Does mental illness run in families? by clicking here.
- Drugs, alcohol and mental health by clicking here.
- Cannabis and mental health by clicking here.
Etiology And Risk Factors
Genetics have an important role in the etiology of schizophrenia, even though most patients diagnosed with the disease have no family history of psychosis. The genetic variation responsible for the disease has not been identified. Relatives of persons with schizophrenia are also at risk of schizoaffective disorder, schizotypal personality disorder, bipolar disorder, depression, and autism spectrum disorder.1,5
Environmental factors may have a role.1 Possible environmental factors include being born and raised in an urban area, cannabis use, infection with Toxoplasma gondii,2,6,7 obstetric complications, central nervous system infection in early childhood, and advanced paternal age .1
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Current Psychiatry
Dr. Karadag is a PGY-3 Psychiatry Resident, Rutgers New Jersey Medical School, Newark, New Jersey. Dr. Aggarwal is Director, Residency Training Program, Associate Professor, Department of Psychiatry, Rutgers New Jersey Medical School, Newark, New Jersey.
DisclosuresThe authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
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