Schizophrenia: Practical Strategies for Relapses & Reducing Symptoms

To make sure we are all on the same page, on this track we will examine the diagnosis of schizophrenia.  As you know, schizophrenia can be the result of numerous abnormalities in brain structure and function.  However, as you are also aware, there is no single area that can be measured and from which we can say, "Yes.  This is schizophrenia."

 But, clearly, definition of schizophrenia through symptoms can also be misleading because different diseases can present similar symptoms.  Therefore, we will examine three topics regarding this diagnosis.  The three topics are Schneider’s Guidelines for Suspicion of Schizophrenia, symptoms of schizophrenia, and subtypes of schizophrenia.  You are obviously already aware of this information, but we thought its inclusion into this home study course could benefit you if you have not treated a schizophrenic client in some time.  Therefore, as you listen to this track, you might consider the information a reminder.

3 Topics Regarding Schizophrenia

#1  Schneider’s 11 Guidelines for Suspicion of Schizophrenia
In addition to DSM criteria for diagnosing schizophrenia, you may also find Schneider’s Guidelines for Suspicion of Schizophrenia useful as guideline for the elevation of suspicion regarding suspected schizophrenia.  Schneider’s list contains eleven Guidelines for Suspicion of Schizophrenia.  As I list the eleven symptoms, you might consider your schizophrenic client and evaluate him or her for one or more of the following symptoms.

1. Auditory hallucinations in which the voices speak one’s thoughts aloud.
2. Auditory hallucinations with two voices arguing.
3. Auditory hallucinations with the voices commenting on one’s actions.
4. Hallucinations of touch when the bodily sensation is imposed by some external agency.
5. Withdrawal of thoughts from one’s mind.
6. Insertion of thoughts into one’s mind by others.
7. Believing one’s thoughts are being broadcast to others, as in radio or television.
8. Insertion by others of feelings into one’s mind.
9. Insertion by others of irresistible impulses into one’s mind.
10. Feeling that all one’s actions are under the control of others, like an automation.
11. Delusions of perception, as when one is certain that a normal remark has a secret meaning for oneself

As you can see, some of Schneider’s Guidelines for Suspicion of Schizophrenia correlate to DSM criteria. However, studies show that while 75% of schizophrenic clients present Schneider’s symptoms, so do about 25% of manic-depressive clients.  Therefore, Schneider’s list is an informal guide to suspicion, rather than a guideline for diagnosis like the DSM.  Even so, you might consider your diagnostic interview process.  Would you find Schneider’s Guidelines for Suspicion of Schizophrenia a  helpful adjunct the DSM ?

#2  Symptoms of Schizophrenia
As you know, there are two types of symptoms of schizophrenia.  Negative symptoms or the absence of normal behavior may include apathy, reductions in speech, incongruous emotional responses, social withdrawal, or reduced social performance. These negative symptoms will be discussed in more detail on the next track. 

The second type of symptoms of schizophrenia are positive symptoms.  Positive symptoms of schizophrenia include delusions, hallucinations, and thought disorder or the presence of a behavior.  Tyler, now age 28,  experienced delusions as strange beliefs that he held in spite of clear evidence to the contrary.  Tyler was intelligent and well adapted as a child.  However, Tyler became increasingly moody and withdrawn as a teenager.  Tyler later did poorly in college. 

He began to spend more time in his room, sleeping during the day and watching TV late into the night.  Tyler later stated that during this time, he believed his parents were reading his thoughts and controlling his behavior.  Tyler’s delusion was so strong that he thought his mother was controlling his eating. Tyler stated, "Whenever I had a meal, I really thought that she was actually eating the food for me. I could tell when it was happening by the way she looked."  Tyler’s delusions increased until he came to believe his parents were plotting against him. Tyler left home to avoid this, but later sought therapy and began to learn to analyze his delusions and contrast them with reality.  

#3  Subtypes of Schizophrenia
In addition to Schneider’s Guidelines for Suspicion of Schizophrenia and symptoms of schizophrenia, the third topic we will briefly discuss regarding the diagnosis of schizophrenia is subtypes of schizophrenia.  Generally, the symptoms of schizophrenia dictates the correlating subtype.  There are four main subtypes of schizophrenia.  These four main subtypes are paranoid schizophrenia, disorganized schizophrenia, catatonic schizophrenia, and undifferentiated schizophrenia.

Clearly, delusions and hallucinations typify paranoid schizophrenia, while disorganized speech or behavior and incongruous emotional responses relate to disorganized schizophrenia.  Catatonic schizophrenia is obviously characterized by motor immobility, but can also reflect excessive motor activity, extreme negativism or mutism, or repetition of words or actions of others. 

If a client doesn’t specifically fit into one of these three subtypes, then he or she is diagnoses with undifferentiated schizophrenia.  Think of your client.  Which subtype is he or she?  How was he or she diagnosed?

On this track we have discussed three topics regarding diagnosis.  The three topics we discussed are Schneider’s Guidelines for Suspicion of Schizophrenia, symptoms of schizophrenia, and subtypes of schizophrenia. 

On the next track we will discuss negative symptoms.  As stated earlier, there are five common negative symptoms.  These five negative symptoms are apathy, reductions in speech, incongruous emotional responses, social withdrawal, and reduced social performance.

QUESTION 1
What are the three topics regarding diagnosis that we discussed? To select and enter your answer go to Answer Booklet.