The Social Ties Between Autism And Schizophrenia
Autism and schizophrenia share a long and tangled history. Comparing the social features of the two conditions could lead to better treatments and a deeper understanding of each.
by Daisy Yuhas / 12 July 2017
When the shy, dark-haired boy met with clinicians for a full psychiatric evaluation two years ago, almost everything about him pointed to autism. W. had not spoken his first words until age 2. He was at least 4 before he could form sentences. As he got older, he was unable to make friends. He struggled to accept changes to his routine and maintain eye contact. And despite having an average intelligence quotient, he was unusually attached to objects at age 11, he still lugged a bag of stuffed animals with him everywhere he went.
But something else was clearly at work, too. He had these things that he would call day dreams, recalls Jennifer Foss-Feig, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York. When she evaluated W., she noticed that he would often gaze into an empty corner of the room particularly when he seemed to suspect that she wasnt paying attention to him. Occasionally, he would speak to that space, as though someone else were there.
What there generally hasnt been in the literature are very many studies comparing autism and schizophrenia directly, Foss-Feig says. Thats what I think were moving towards.
Concept Of Third Psychosis
Distinguishing between acute remitting psychoses and schizophrenia remains challenging. , – Using WHO data, Susser and Wannderling concluded that the acute remitting psychoses differed epidemiologically from schizophrenia. Current diagnostic nomenclature deals with these distinctions more successfully than earlier nosology.-
Neurodevelopmental Model Of Schizophrenia
Difficulty in finding lesions in schizophrenia led to the aphorism that schizophrenia was the graveyard of neuropathology. To have forgotten that schizophrenia is a brain disease will go down as one of the great aberrations of 20th century medicine. Within the past two decades, there has been increa-sing support for a neurodevelopmental model of schizophrenia. This model represents changes in nervous system structure and functions that arise as a consequence of maturation it is a process that characterizes the entire lifespan. The neurodevelopmental approach to schizophrenia does not constitute a single theory, rather it represents the bringing together of a number of disparate approaches and theoretical concepts to the understanding of schizophrenia.
Other neurodevelopental factors that have been studied include season of birth, maternal influenza, obstetric complications, and minor physical anomalies, and CT/MRI scans support dementia praecox as a brain disease. – Slater and Beard observed that the psychosis associated with temporal lobe epilepsy mimicked schizophrenia. Murray used this observation to support a neurodevelopmental model of schizophrenia in which left-sided lesions in temporal lobe epilepsy had schizophrenia-like features., ,
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Introducing The Group Of Schizophrenias
In 1908, Bleuler publicly introduced the term and concept schizophrenia in a lecture given at the meeting of the Deutscher Verein fur Psychatrie in Berlin. In the opening paragraph, he summarized his reasons for abandoning Kraepelin’s earlier concept dementia praecox:
I wish to emphasize that in Kraepelin’s, dementia praecox it is neither a question of an essential dementia nor of a necessary precociousness. For this reason, and because from the expression dementia praecox one cannot form further adjectives nor substantives, I am taking the liberty of employing the word schizophrenia for revising the Kraepelinian concept. In my opinion the breaking up or splitting of psychic functioning is an excellent symptom of the whole group
The connections between associations are lost. The disease interrupts the threads that give direction to our thoughts in an irregular fashion, sometimes affecting only a few, sometimes a large proportion of them. Thus, the result of the thought process is rendered unusual, and often logically incorrect .
The characterization of schizophrenic symptoms as bearing individually meaningful content is one of the important novelties in Bleuler’s understanding of schizophrenia. In the words of his son Manfred Bleuler:
The Name Schizophrenia Is Heard Worldwide
Robert M. Kaplan, MBChB, MA , MPhil , FRANZCPPsychiatric Times
This month in history: Determined to regard his patients as individuals, Swiss psychiatrist Eugen Bleuler sought to understand his patients and coined the term schizophrenia.
Looking Back to Look Forward
-Series Editor Gregory Eghigian, PhD
THIS DAY IN HISTORY
Dr Eugen Bleuler became Director of the BurghÃ¶lzli Hospital in 1898. He attracted outstanding psychiatrists-including Carl Jung, Herman Rorschach, Ludwig Binswanger, and Karl Abraham-encouraging them to try new methods and tests. Determined to regard his patients as individuals, Bleuler made prolific notes, taking as much time as necessary to understand his patients.
On April 24, 1908, at the German Psychiatric Association meeting, Bleuler delivered a lecture titled Die Prognose der Dementia Praecox .1 Thus the world first heard the name schizophrenia defined as a disease characterised by a specific type of alteration of thinking, feeling and relation to the external world.
Bleuler wanted to widen Kraepelins characterization of dementia praecox. He conceived of schizophrenia as a genus, rather than a species.2 His list of secondary symptoms, largely derived from psychoanalysis, implied an etiology. This was the critical difference with Kraepelins view: a disturbance or exaggeration of normal psychic function was light years away from his categorical distinction between psychosis and sanity.
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What Are Schizophrenia Causes Is Schizophrenia Hereditary
One frequently asked question about schizophrenia is if it is hereditary. As with most other mental disorders, schizophrenia is not directly passed from one generation to another genetically, and there is no single specific cause for this illness. Rather, it is the result of a complex group of genetic and other biological vulnerabilities, as well as psychological and environmental risk factors. Biologically, it is thought that people who have abnormalities in the brain neurochemical dopamine and lower brain matter in some areas of the brain are at higher risk for developing the condition. Other brain issues that are thought to predispose people to developing schizophrenia include abnormalities in the connections between different areas of the brain, called default mode network connectivity. Recent research is emerging that implicates potential abnormalities in the transmission of the brain neurochemical glutamate as a risk factor for having schizophrenia.
According to the Diagnostic and Statistical Manual of Mental Disorders , symptoms of schizophrenia include the following:
Positive, more overtly psychotic symptoms
- Delusions are beliefs that have no basis in reality. Types of delusions include erotic, grandiose , jealous, persecutory, physical , mixed, and nonspecific.
- Hallucinations: hearing , seeing, feeling , smelling, or tasting things that have no basis in reality
- Disorganized speech: incoherent or often grossly off-topic speech
- Disorganized behaviors
What Are Potential Complications Of Schizophrenia What Is The Prognosis For Schizophrenia
Possible complications for schizophrenia range from more medical conditions or shortened life span to negative impacts on their family members as well. For example, people with schizophrenia who continue to suffer from residual symptoms have more trouble thinking than those whose negative symptoms are adequately managed with treatment. Women with schizophrenia are thought to be more likely to suffer from complications during their pregnancies, at delivery and during their children’s newborn period.
Individuals with schizophrenia have more than twice the rate of death than those without the disorder. Almost half of people with schizophrenia will suffer from a drug-use disorder during their lifetime. Research shows that people with schizophrenia or schizoaffective disorder have a better quality of life when their family members tend to be more supportive and less critical of them.
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Family Education: People With Schizophrenia Are Often Discharged From The Hospital Into The Care Of Their Families So It Is Important That Family Members Know As Much As Possible About The Disease With The Help Of A Therapist Family Members Can Learn Coping Strategies And Problem
Cognitive behavioral therapy:Cognitive behavioral therapy is a type of psychotherapy that focuses on thinking and behavior. CBT helps patients with symptoms that do not go away even when they take medication. The therapist teaches people with schizophrenia how to test the reality of their thoughts and perceptions, how to not listen to their voices, and how to manage their symptoms overall. CBT can help reduce the severity of symptoms and reduce the risk of relapse.
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Psychological And Social Interventions
Psychotherapy is also widely recommended and used in the treatment of schizophrenia, although services may often be confined to pharmacotherapy because of reimbursement problems or lack of training.
Cognitive behavioral therapy is used to reduce symptoms and improve related issues such as self-esteem, social functioning, and insight. Although the results of early trials were inconclusive, more recent reviews suggest that CBT can be an effective treatment for the psychotic symptoms of schizophrenia. Another approach is cognitive remediation therapy, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia. Based on techniques of neuropsychological rehabilitation, early evidence has shown it to be cognitively effective, with some improvements related to measurable changes in brain activation as measured by fMRI. A similar approach known as cognitive enhancement therapy, which focuses on social cognition as well as neurocognition, has shown efficacy.
Is It Possible To Recover From Schizophrenia
Many people who live with schizophrenia have recovery journeys that lead them to live meaningful lives.
Recovery can be thought of in terms of:
- clinical recovery, and
- personal recovery.
What is clinical recovery?
Your doctor might have talked to you about recovery. Some doctors and health professionals think of recovery as:
- no longer having mental illness symptoms, or
- where your symptoms are controlled by treatment to such a degree that they are not significantly a problem.
Sometimes this is called clinical recovery.
Everyones experience of clinical recovery is different.
- Some people completely recover from schizophrenia and go on to be symptom free.
- Some who live with schizophrenia can improve a great deal with ongoing treatment.
- Some improve with treatment but need ongoing support from mental health and social services.
What is personal recovery?
Dealing with symptoms is important to a lot of people. But some people think that recovery is wider than this. We call this personal recovery.
Personal recovery means that you can live a meaningful life.
What you think of as being a meaningful life might be different to how other people see it. You can think about what you would like to do to live a meaningful life and work towards that goal.
Below are some ways you can think of recovery.
What can help me recover?
You may want to think about the following questions.
The following things can be important in recovery.
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The New Techniques Driving Psychiatric Research
But Bleuler’s agreement with Freud went only so far. Bleuler believed firmly that both biochemistry and psychoanalysis were needed to make sense of an affliction as complicated as schizophrenia. He proposed a middle path and, in the process, became perhaps the first psychiatrist to advocate for a unified theory of schizophrenic disease.
Freud, however, had no tolerance for middle paths and, as history clearly shows, shunned anyone who expressed even slight disagreement with his psychoanalytic ideas. To Freud, psychoanalysis was his scienceand his science alone. Bleuler’s balanced approach to schizophrenia deviated too far from Freud’s dogmatic teachings, and the two split ways in 1911 when Bleuler tendered his resignation from the International Psychoanalytic Association .
Nevertheless, Bleuler’s point had been made. In standing up to Freud and insisting the need to understand the biological and genetic in addition to the psychological, Bleuler paved the way for future psychiatrists interested in the problem of schizophrenia. Silvano Arieti, the psychoanalytically-trained Italian American psychiatrist, echoed Bleuler’s integrated approach in his award-winning 1974 book The Interpretation of Schizophrenia. Arieti became perhaps America’s foremost authority on schizophrenia, and his work continues to serve as a basis for a unified biopsychosocial approach to psychotic illness .
Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness.
What Research Is Being Done On Schizophrenia
Repetitive transient magnetic stimulation , a procedure that involves multiple sessions of applying magnetic pulses to the brain, has been shown in some studies to decrease hearing voices in schizophrenia sufferers as a result of stimulating certain areas of the brain. However, more studies are needed to determine the effectiveness of this intervention before it is widely used.
Cognitive remediation continues to be an experimental treatment that addresses the cognitive problems that are associated with schizophrenia . Clinical trials using this intervention in combination with vocational rehabilitation to improve work functioning have shown some promise, but more research is needed, particularly that which focuses on improving how well the person with schizophrenia functions in real-world situations as a result of this treatment.
Peer-to-peer treatment is a promising possible intervention since it promotes active constructive involvement from people who have schizophrenia, provides role models for individuals whose functioning is less stable, and may be accessible in individual and group settings, in person as well as by telephone or through the Internet. However, further research is necessary to demonstrate its effectiveness in decreasing symptoms or otherwise clearly improving functioning for people with schizophrenia.
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It’s About Historic Honour Recognition And Remembrance Not Semantic Onomasiology
Heroic clinicians and pioneering researchers of the past, in dark superstitious ages, took a stand on evidence based diagnoses in order to better care for their patients.
They combined two ancient Greek words to express a complex new pathological concept, and used accessible scientific data of that era.
Nowadays it is easy, yet indecent, for us to criticize their nomenclature, based on recent scientific research.
Instead of indulging ourselves in pointless onomatopoeic exercises, we should wonder if we retain ourselves capable of ever discovering and describing a novel disease.
After all, even if psychosis spectrum syndrome might sound more appropriate today, many Agnostics and Materialists would still oppose the unfitting word “psychosis”, since they doubt the presence of the soul .
Skeptics would opt for something like “telencephalic regional dysfunction”.
Competing interests: No competing interests
05 February 2016
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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.
Controversies Over Validity In The 1970s
In 1970 psychiatrists Robins and Guze introduced new criteria for deciding on the validity of a diagnostic category and proposed that cases of schizophrenia where people recovered well were not really schizophrenia but a separate condition.
In the early 1970s, the diagnostic criteria for schizophrenia was the subject of a number of controversies which eventually led to the operational criteria used today. It became clear after the 1971 US-UK Diagnostic Study that schizophrenia was diagnosed to a far greater extent in America than in Europe. This was partly due to looser diagnostic criteria in the US, which used the DSM-II manual, contrasting with Europe and its ICD-9. David Rosenhan’s 1972 study, published in the journal Science under the title On being sane in insane places, concluded that the diagnosis of schizophrenia in the US was often subjective and unreliable.
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Politicization In The Soviet Union
In the Soviet Union the diagnosis of schizophrenia has also been used for political purposes. The prominent Soviet psychiatrist Andrei Snezhnevsky created and promoted an additional sub-classification of sluggishly progressing schizophrenia. This diagnosis was used to discredit and expeditiously imprison political dissidents while dispensing with a potentially embarrassing trial. The practice was exposed to Westerners by a number of Soviet dissidents, and in 1977 the World Psychiatric Association condemned the Soviet practice at the Sixth World Congress of Psychiatry. Rather than defending his claim that a latent form of schizophrenia caused dissidents to oppose the regime, Snezhnevsky broke all contact with the West in 1980 by resigning his honorary positions abroad.
What If I Am Not Happy With My Treatment
If you are not happy with your treatment you can:
- talk to your doctor about your treatment options,
- ask for a second opinion,
- get an advocate to help you speak to your doctor,
- contact Patient Advice and Liaison Service and see whether they can help, or
- make a complaint.
There is more information about these options below.
You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try.
Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment, ask your doctor to explain why it is not suitable for you.
A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.
You dont have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.
An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.
There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like.
The Patient Advice and Liaison Service
You can find out more about:
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