Symptoms:
The symptoms experienced by persons with Schizophrenia can differ in type and severity over time, and there are often periods where remission or worsening of symptoms can be observed, although some symptoms remain present. The diagnostic criteria for Schizophrenia provided by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) (2013) are accepted globally as the standardised diagnostic criteria for Schizophrenia including in South Africa.
According to this manual to be diagnosed with Schizophrenia, the person must exhibit two or more of the following characteristics of Schizophrenia for a significant time during 1 month:
a). Delusions: False beliefs that are not founded or shared by others in the same culture, and holding firm to this belief, despite evidence to the contrary. This characteristic occurs in most people with the illness, and often includes suspicions or paranoia about the intentions of others.
b). Hallucinations: This is false sensory experiences, the most common being. These can include hearing, seeing, or feeling things that are not there. Persons with Schizophrenia can find it difficult to differentiate between hallucinations and reality, as they experience both with the same force and impact.
c). Disorganised thinking and speech: Thought patterns and communication is often impaired and disorganised, making it difficult to make sense of what the person is saying or to understand the reasoning of the person. This also involves vague thoughts, loose associations of ideas, thought blocking, as well as the formation of new words (neologisms), or thought poverty.
d). Extremely disorganised or abnormal motor behaviour: This might range from childlike silliness to severe agitation. It is often observed that behaviour is not motivated by goals, making tasks hard to accomplish. Behaviour can include inappropriate or bizarre posture (catatonia), a lack in responsiveness, or movement that is excessive/unmotivated. This abnormal movement can include wandering aimlessly, laughing, and talking to self, and dressing inappropriately.
e). Negative Symptoms: These symptoms are not treated by medication, and require additional psychosocial interventions. Examples of negative symptoms are:
- Flat affect/blunting (no eye contact, does not change facial expressions or tone of voice).
- Disturbances of emotions, such as marked apathy or limited emotional expressions and responsiveness. This could also include a disconnect between reality and response, for example, inappropriate reactions or facial expressions.
- Losing interest in everyday activities (anhedonia), or those activities which they used to enjoy e.g., hobbies.
- Lack of motivation/drive. The most debilitating of these can be the decrease in motivation and drive, and a decrease in self-care, such as personal hygiene.
- Withdrawing socially, including a decrease in speech.
Extended psychosis can have a very negative impact on long-term prognosis and decreases capacity of functioning. The treatment outcome is related to how soon the illness is identified and treated.
The importance of on-going treatment and adherence to medication prescribed by a psychiatrist cannot be emphasised enough. It is essential to stick to the treatment plan to prevent relapse or the worsening of symptoms.