Harini ini kita akan cerita sedikit tentang psikologi abnormal yang juga adalah cabang psikologi yang mengkaji tingkah laku yang menyimpang dari norma, yang sering kali dikaitkan dengan gangguan mental. Salah satu gangguan mental yang paling kompleks dan sukar difahami ialah skizofrenia. Skizofrenia adalah gangguan mental kronik yang mempengaruhi cara seseorang berfikir, merasai, dan berkelakuan. Individu dengan skizofrenia mungkin kelihatan seperti telah hilang hubungan dengan realiti, yang boleh menyebabkan penderitaan yang besar bagi mereka dan orang-orang di sekeliling mereka. Dalam karangan ini, kita akan meneroka skizofrenia dari pelbagai sudut, termasuk simptom, punca, dan rawatannya. Untuk memberikan pemahaman yang lebih komprehensif, kita juga akan menyertakan contoh kes yang menggambarkan bagaimana skizofrenia mempengaruhi kehidupan seharian seseorang.

 

 

Schizophrenia is a psychotic disorder characterized by major disturbances in thought, emotion, and behavior – disordered thinking in which ideas are not logically related; faulty perception and attention bizarre disturbances in motor activity; and flat or inappropriate affect.  Schizophrenia patients withdraw from people and reality, often into a fantasy life of delusions and hallucinations. Eugen Bleuler (1908), a Swiss psychiatrist has introduced the term schizophrenia. Schizophrenia comes from the combination of words (Greek) –
“split” (skhizein) and “mind” (phren). DSM-TR-IV: Table 13.1 (Diagnostic Criteria for Schizophrenia)

 

Clinical Description, Symptoms and
Subtypes 

Mental health worker distinguish schizophrenia into 3 different dimensions of positive symptoms, negative symptoms and disorganized symptoms. Positive symptoms generally include the more active manifestations of abnormal behavior or an excess or distortion of normal behavior these include delusions and hallucinations. Negative symptoms involve deficits in normal behavior in such areas as speech and motivation.

1. Disorganized symptoms include rambling speech, erratic behavior and inappropriate affect for example, smiling when you are upset.

1. A diagnosis of schizophrenia requires that 2 or more positive, negative and/or disorganized symptoms be present for at least 1 month. 

 

Positive Symptoms 

Between 50% and 70% of people with schizophrenia experience hallucinations, delusions or both (Lindenmayer & Khan, 2006). 

Delusions: 

• Delusion has been called “the basic characteristic of madness”. 
• Somatic (physical) delusion – believing, for example, that their bodies are rotting internally and deteriorating into nothingness. 
• Delusions of grandeur – believing, for example they are supernatural or supremely gifted. 
• Delusions of persecution – believing others are “out to get them”. 
• Capgras syndrome – the person believes someone he or she knows has been
  replaced by a double.
• Cotard’s syndrome – the person believes he is dead. 
• Why someone come to believe such obviously improbable things? 
• It can be summarized into 2 themes – motivational or deficit theories. 
• A motivational view of delusions would look at these belief as attempts to deal with and relieve anxiety and stress. A person develops “stories” around some issues that in a way helps the person makes sense out of uncontrollable anxieties in a tumultuous world. 
• Deficit view of delusion sees these beliefs as resulting from brain dysfunction that creates these disordered cognitions or perceptions.

Hallucinations: 

• The experience of sensory events without any input from the surrounding environment is called hallucination. 
• Auditory hallucination – hearing things that are not there (is the most common form experienced by people with schizophrenia). 
• Exciting research on hallucinations – using Single Photon Emission Computer Tomography (SPECT). 
• It was found that the part of the brain most active during hallucinations was Broca’s area. This is surprising because broca’s area is known to be involved in speech production, rather than language comprehension. Because auditory hallucinations usually involve understanding the “speech” of others, you might expect more activity in Wernicke’s area, which involves language comprehension. 
• These observations support the metacognition theory that people who are hallucinating are not hearing voice of others but are listening to their own thoughts or their own voices and cannot recognize the difference. 

 

 

 

Negative Symptoms 

Usually indicate the absence or insufficiency of normal behavior. They include apathy, poverty of thought or speech and emotional and social withdrawal 25% people with schizophrenia display these symptoms. 

 

Avolition: 

• Prefix “a” meaning without and volition, which means “an act of willing, choosing or deciding.” 
• Avolition is the inability to initiate and persist activities. 
• People with this symptom show little interest in performing even the most basic day-to-day functions – including personal hygiene. 

Alogia

• Combination of “a” (without) and logos (“words”). 
• Alogia refers to the relative absence of speech. 

Anhedonia

 

Affective Flattening: 

• Imagine that people wore masks at all times: You could communicate with them verbally, but you would not be able to see their emotional reactions.

Disorganized Symptoms

Disorganized Speech: 

• The person who have been diagnosed as having this symptom typically
  can share their thought with others, sometimes they jump from topic to
  topic. 

 

Other Psychotic Disorders 

Schizophreniform Disorder (DSM-IV-TR: Table13.6): 

• Some people experience the symptoms of schizophrenia for a few months
  only; they can usually resume normal lives. 
• The symptoms sometimes disappear as the result of successful treatment but they often do so for reasons unknown. 

Schizoaffective Disorder (DSM-IV-TR: Table 13.7): 

• People who had symptoms of schizophrenia and exhibited the characteristics of mood disorders (for example, depression or bipolar disorder). 
• Presence of mood disorder, delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. 

Delusional Disorder (DSM-IV-TR: Table 13.8): 

• Is a persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia. 
• For example, a woman who believes without any evidence that coworkers are tormenting her by putting poison in her food and spraying her apartment with harmful gases has a delusional disorder. 
• This disorder is characterized by a persistent delusion that is not the result of an organic factor such as brain seizures or of any severe psychosis. 
• Individual with delusion disorder tend not to have flat affect, anhedonia, or other negative symptoms of schizophrenia; importantly, however, they may become socially isolated because they are suspicious of others. 

Brief Psychotic Disorder (DSM-IV-TR: Table 13.9): 

• Brief psychotic disorder – characterized by the presence of one or more positive symptoms such as delusions, hallucinations, or disorganized speech behavior lasting 1 month or less. 

Shared Psychotic Disorder (DSM-IV-TR: Table 13.10): 

• The condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual. 

 

Prevalence and Causes of Schizophrenia 

Cultural Factors: 

• Kraepelin, who was described as developing the modern-day view of schizophrenia, traveled to Asia at the turn of the last century to confirm that this unusual set of behaviors was experienced by cultures other than those of Western Europe. 
• People in extremely diverse cultures have the symptoms of schizophrenia,
  which supports the notion that is a reality for many people worldwide. 
• Schizophrenia is thus universal, affecting all racial and cultural groups
  studied so far. 

Genetic Influences: 

• Genes are responsible for making some individuals vulnerable to
  schizophrenia. 

Family Studies: 

• Gottesman (1991) summarized the data from about 40 studies of schizophrenia. 
• The risk of having schizophrenia varies according to how many genes an individual shares with someone who has the disorder. 
• For example – you have the greatest chance (48%) of having schizophrenia if it has affected your identical (monozygotic) twin, a person shares 100% of your genetic info. 

 

 

Twin Studies: 

 

 

 

 

 

Adoption Studies: 

Dopamine: