Abstract
The paper analyses the recent researches on the problem of schizophrenia. The works that study the historical, statistical and medical aspects are reviewed. Particular attention is given to the positive, negative, and psychomotor symptoms of schizophrenia like delusions, hallucinations, poor speech, confused thinking, etc. The importance of their early identification is underlined, as timely diagnosing increases the chance for the positive outcome of the illness. The approaches to diagnosing this disorder are presented. It is underlined that not only the symptoms but their duration are essential for diagnosing schizophrenia. The epidemiology and the possible preconditions for this disorder both in men and women are outlined. The gender differences in schizophrenia development are considered. The research reveals that schizophrenia most frequently develops in early adulthood. That is why special attention should be given to the study of this disorder in young men and women. Besides, the treatment methods which take into account the gender peculiarities are stated. The causes of the differences in schizophrenia development in young men and women are analyzed.
Introduction
Many people in the modern world experience depression, panic attacks, and other mental disorders. These symptoms are the subject of abnormal psychology which studies the pathologies of the mind. Schizophrenia is among the common mental disorders. It occurs in people regardless of culture or status. Butcher, Hooley, and Mineka (p.444, 2013) state that this “disorder is characterized by an array of diverse symptoms, including extreme oddities in perception, thinking, action, sense of self, and manner of relating to others.” Still, the major sign of schizophrenia is a critical loss of connection with reality. Miller (2015) mentions that the diagnosis of schizophrenia is usually applied to the people who behave so differently from the way they used to, that they look like different people. This state is also called psychosis, which is a psychological condition of breaking or delusion of the person’s mind. The majority of researchers agree that the symptoms of this condition are hallucinations, incoherent speech, delusions, bizarre behaviors, disregard for personal safety, erratic dangerousness to self or others, becoming immobilized or completely withdrawn, or being uninterested in self-care and personal hygiene (Miller, 2015). The psychotic symptoms (like hallucinations and delusion) usually appear in men in early adulthood, or just after the age of 20. In women, they are revealed between the age of 25 and 30. The occurrence of schizophrenic symptoms after 45 is rare as well as before adolescence. That is why schizophrenia should be considered first of all as the illness of young men and women. The early disclosure of characteristic symptoms, further diagnosing together with adequate treatment increase the chance of the positive outcome. Thus, the research of the problem among the young people is the primary task.
Literature Review
According to Long et al. (as cited in Comer, 2015, p. 467), about 1 of every 100 people in the world has schizophrenia at some time in his or her life. The statistics of 2010 estimated the number of people with schizophrenia in the world as 24 million, among them 2.5 million people in the United States (Comer, 2015, p. 467). Apart from moral and financial resources, this illness increases the risk of other diseases which are often fatal. Laursen (as cited in Comer, 2015, p.467) states that people with schizophrenia live on average 20 years less than other people.
McNally (2016) investigates schizophrenia in the historical context. He studies the symptoms suggested by researchers throughout the history. He also analyses the problem of defining the notion of schizophrenia by different scholars and psychiatrists. He mentions “the historic lack of agreement and inability to find an essential characterization of schizophrenia” (2016, p.199). Still, McNally mentions the numerous approaches to schizophrenia treatment already as of 1936 (2016, p.208).
Abel and Nickl-Jockschat (2016) consider schizophrenia “a severe neuropsychiatric disorder that not only causes a high burden of disease but also challenges our understanding of how the mind and brain work” (p.3). If a healthy person controls actions or thoughts, the one suffering from schizophrenia cannot do it. Thornicroft, Brohan, and Kassam (as cited in Barlow & Durand, 2014, p.477) define schizophrenia as “a complex syndrome that inevitably has a devastating effect on the lives of the person affected and on family members.” This illness disorganizes the individual’s perception, thought, language, and activity. Thus, it affects almost all components of everyday life. In spite of numerous researches and substantial progress in the treatment of schizophrenia, the number of absolute recovery examples is limited. This destructive disorder demands a lot of emotions from the sufferer and the surrounding people. Apart from emotions, it is a very expensive illness. According to Barlow and Durand (2014), schizophrenia costs about $60 billion to the United States every year. This amount includes the cost of treatment, care in the family, and the loss of earnings, for the people with this disorder do not work.
Symptoms
It is certain that schizophrenia is a clinical diagnosis. It has definite symptoms and signs, but there is still no test to discover and prove this disorder. International Classification of Diseases of World Health Organization (as cited in Castle & Buckley, 2015, p.4) states the following symptoms of schizophrenia. If a person observes at least one of those: “thought echo, insertion, withdrawal, broadcast; passivity phenomena or delusional perception; third-person conversing or running commentary hallucinations” or at least two of the following: “persistent hallucinations in any modality, with delusions; disorganized speech; catatonia” or any negative symptoms (which are primary), a visit to a doctor should be planned. Comer (2015) speaks of three types of schizophrenia symptoms. They are positive, negative, and psychomotor.
Positive Symptoms
Positive symptoms usually are the extremities and strangeness in an individual’s behavior. Among these symptoms are delusions, confused thinking and speech, heightened perceptions, and hallucinations. Delusions are observed by most people with schizophrenia. Those ideas seem true but confuse the people. Some patients experience one dominating delusion during the illness. The others may have various delusions. Among the most frequent delusions is that of persecution. People believe they are chased or spied on. Other common delusions are those of reference, grandeur or control. Confused thinking and speech mean that people lose the ability to think logically, and speak unusually. It complicates the communication with the ill person.
As for heightened perceptions and hallucinations, the researchers agree that some people with schizophrenia observe the intensified perceptions and attention (Comer, 2015). Consequently, any important event becomes a torture for them. The problems with attention and perception may appear long before schizophrenia develops. Thus, they can be a signal of the coming disorder. Another frequent symptom of schizophrenia is hallucinations. Auditory hallucinations are the most common. People may hear voices or other sounds in their heads. The voices often give directions, thus stimulating the people for certain actions. Hallucinations can also be tactile, somatic, visual or gustatory (Comer, 2015). Apart from the mentioned above, people with schizophrenia demonstrate emotions inappropriate to the situation. For example, they may smile when telling bad news, or be sad in a situation happy for a healthy person.
Negative Symptoms
Negative symptoms can be explained by the absence of certain characteristics in people, or “pathological deficits” (Comer, 2015, p.474). Among the typical characteristics of schizophrenia are poor speech, weakened affect, lack of volition, and retraction from society. These deficits certainly influence the life of a person. The poor speech, or alogia, is usually characterized by little speech content. The people experiencing this disorder do not speak and think much. Some people may speak more, but their utterances lack sense. A lot of individuals with schizophrenia observe a blunted or weakened effect. It means that they are less sad, angry or happy compared to other people in their reactions to the reality. Some of them are unemotional. They are characterized with little eye contact and monotonous voices. As for the loss of volition, it is also observed among the people with schizophrenia. It is often called avolition, or apathy. The people with this symptom feel exhausted, uninterested, and having no aim. As a rule, it is typical of the people who have had schizophrenia for a long time. As a result, they are drained and purposeless. The feelings of people with schizophrenia are contradictory and uncertain. Another negative symptom is social withdrawal. The individuals with schizophrenia often prefer to retract from the society. They are obsessed with their fantasies and ideas; thus they do not need anyone. This withdrawal takes them even further from reality, as their ideas are disorganized and absurd. Such retraction may result in the loss of major social skills, which in its turn can make the treatment more complicated.
Psychomotor Symptoms
Apart from positive and negative, people with schizophrenia may observe psychomotor symptoms. The examples of those symptoms may be slow or strange movements, repeated grimaces, and unusual gestures. They pretend to have a certain magical or ritual purpose. The ultimate form of the psychomotor symptoms of schizophrenia is known as catatonia. The individuals in a catatonic stupor do not react to the surrounding. They may not move and be silent for long periods of time. People who experience catatonic rigidity can stay in a fixed, upright position for hours. Moreover, they turn down the attempts to move them. Besides, other people with schizophrenia may take clumsy and strange poses and hold that way for long periods of time. Another type of catatonia, the catatonic excitement, is characterized by excited and uncontrolled movements of arms and legs (Comer, 2015).
Diagnosing Schizophrenia
Both physical and mental illnesses have a set of characteristic symptoms. The discovery of symptoms, their correct interpretation, and the resulting timely diagnosing is half the way to the successful treatment. Some mental disorders are harsh. As a result, the people who experience them do not realize that their beliefs are not real. Consequently, they are not aware of the problem at all. Oltmanns and Emery (2015, p.4) define schizophrenia as “a form of psychosis, a general term that refers to several types of severe mental disorders in which the person is considered to be out of contact with reality.” A set of symptoms that are observed simultaneously during a certain period characteristic of a definite disorder is called a syndrome (Oltmanns & Emery, 2015). Every separate symptom is an untrustworthy indicator of a disease. Every feature here is important. The complex of person’s behaviors is unique for every disorder. Apart from the complexity of symptoms, their duration is also significant. Constant inadequate behavior may be a sign of a mental disorder. Some accidental awkward behaviors disappear if ignored. Still, if they are repeated, they may be the symptoms of problems.
A problem with diagnosing mental disorders is that the symptoms are varied. Very often two people diagnosed with schizophrenia experience essentially different symptoms. The American Psychiatric Association (as cited in Awad & Voruganti, 2016, p.3) states that “the degree of suffering and the degree of subsequent disability varies among individuals similarly diagnosed.” Schizophrenia is a symptom-based diagnosis at the moment. The symptoms are confirmed by certain questionnaires. The most significant criterion for diagnosing is the functional decline (Awad & Voruganti, 2016). It means that people see the individuals with schizophrenia as disabled.
The American Psychiatric Association (as cited in Comer, 2015, p.476) considers a diagnosis of schizophrenia true only when the symptoms of the disorder last for at least six months. An individual should be in an active phase in minimum one of these months. This period is characterized by serious delusions, hallucinations, or disorganized speech. Moreover, the degradation of the person’s performance in work and social life is observed. Some scholars believe that there is a possibility to predict the way of schizophrenia development. The so-called Type, I and Type II schizophrenia, should be distinguished (Comer, 2015). The individuals having Type I schizophrenia usually reveal mostly positive symptoms. Among these symptoms are delusions, hallucinations, and some thought disorders. The individuals with Type II schizophrenia observe mainly negative symptoms, for example, those of restricted affect, poverty of speech, and loss of volition. Marchesi et al., Corves et al. (as cited in Comer, 2015, p.478) mention that patients with Type I on the whole show more improvement, particularly with the application of medical treatment.
Epidemiology
Schizophrenia is a widespread disorder and is diagnosed all over the world (Awad & Voruganti, 2016). The illness has influenced approximately 50 million people in different countries. Men show a little higher incidence than women. Also, they may first experience this disorder in the earlier age. They also observe more negative symptoms, greater neurologic deficits, a worse course of illness (Awad & Voruganti, 2016). Thus, sex-specific factors are implied. During one’s lifetime, the risk of having schizophrenia is less than 1 percent, about 0.7 percent in fact (Butcher et al., 2013, 445). Certainly, the statistics do not mean equal risk for everyone and just evaluates the average risk. There are certain categories of people who are under the high danger of developing schizophrenia. Among them are, for example, the individuals whose fathers were aged 45 to 50 years or more when they were born. Most of the schizophrenia cases start in late adolescence or early adulthood, within the age range of 18 to 30 years. There are the cases of schizophrenia onset in the middle age, but they are rare. Speaking of men, schizophrenia is discovered between ages 20 and 24. As for women, the age range is almost the same. Still, the peak is less obvious. As a rule, after the age of 35, the number of schizophrenia cases among men decreases. At the same time, the number of equal women remains the same.
The discovery of sex differences in neuropsychological measures is not new (Li & Spaulding, 2016). It has already been described. Still, the appearance of strong differences on tests could be connected to certain brain systems. The discrepancies discovered look like “sex differences in height and weight rather than sexually dimorphic differences… Men on average are taller and heavier, yet we can readily think of women who are taller and heavier than most men or men who are shorter and lighter than most women” (Li & Spaulding, 2016, p.210).
Schizophrenia in Men and Women: The Difference
Generally speaking, the diagnostic criteria for schizophrenia in men and women are the same. Nevertheless, certain differences can be observed between the two genders. As it was mentioned above, there is a slight difference in the age when schizophrenia first develops. For men, it occurs at the age of 15-20. Women may face the illness later, between 20-25 years. Another fact apart from the earlier occurrence for men is that schizophrenia in men often runs harder than in women. Probably, a female hormone estrogen has a protective function and prevents schizophrenia (McNally, 2016). The symptoms of schizophrenia also have some gender differences. When it comes to men, they observe the lack of will and low energy; they are not able to make decisions and plan their actions. As a rule, men with schizophrenia are less affected by medical treatment. As for women, the symptoms they experience are not so serious. The women are likely to give up the job and not make a problem of it, while men suffer the loss of the job severely. On the whole, men are expected to develop more severe forms of schizophrenia than women. While estrogen is efficient, the women have less risk of severe disorder than men (Butcher et al., 2013). Still, with the beginning of the menopause when the quantity of estrogen decreases, the percent of women observing schizophrenia symptoms increases.
Speaking of the preconditions of this mental disorder, the gender differences are also noticed. Women who were born to mothers with a viral infection have more chances to develop schizophrenia. At the same time for men, a birth trauma is a more probable reason to have schizophrenia in adulthood. It may be interesting to deal with male and female peculiarities of schizophrenia in more detail.
Schizophrenia in Men
Schizophrenia in men is a widespread mental illness. In fact, it is a group of progressing illnesses which can develop both slowly and rapidly, resulting in changes in personality, thought disorders, alterations in emotion and volition. Schizophrenia in men is a chronic illness which demands longitudinal observation of a specialist. The symptoms of schizophrenia in men scare their family and may cause the denial of the sufferer. Still, the disorder may be cured only with the support of the close people.
The reasons for schizophrenia in men may be various. One of them is an inherited predisposition. It results in the functional disorder of brain cells performance. The statistics prove that often the relatives of the man observing schizophrenia also suffer from some mental disorders. Then signs of negative inheritance may be obsessions, character oddness, alcoholism, the seasonal change of mood, suicides in the family. In addition to inheritance theory of schizophrenia development, the autoimmune and virus theories should be reviewed (Castle & Buckley, 2015).
The symptoms of schizophrenia in men can be both positive and negative. The positive ones are evident symptoms like hallucinations. The men start behaving strangely. This odd behavior usually includes delirium, pseudo-hallucinations, automatic actions, catatonia, unmotivated foolish behavior, obsessions, mood disorders, and depersonalization. The negative symptoms result in restraint, indifference, unsociable demeanor, the loss of emotional and volition qualities. They have more diagnostic value that the positive ones. However, these are not the only mental disorders characteristic of men with schizophrenia. Schizophrenia in men is often characterized with alcohol addiction. It can also be influenced by the previous traumatic brain injuries, which interfere the effective treatment (Castle & Buckley, 2015). If the illness develops in adulthood, the functions of memory and intellect are not affected. The non-standard perception and thinking may have striking results. There are famous scientists, writers, musicians or poets among the men with schizophrenia.
Schizophrenia can be diagnosed and treated by a qualified and experienced psychiatrist. The disorder may have various cases, both mild and severe. The modern techniques allow treatment out of clinics. The initial treatment stage includes intensive therapy necessary for the general condition stabilization. It is crucial to reduce the major symptoms as they have negative impact on the quality of life. Nevertheless, the treatment within a specialized clinic may have its benefits. In this case, there is no need to transport the patient who is often inadequate. After the basic stabilization, a further complex therapy is applied. It is aimed at the restoration of mental processes and is designed considering individual symptoms. The necessary corrections should be made in the course of treatment depending on patient’s reactions. In case of early diagnosing and appropriate treatment, the patients can restore their self-care skills and the social status.
Schizophrenia in Women
Schizophrenia in women is a complicated mental disorder with multiform clinical picture. Often it is a smoldering illness characterized by periodic attacks and remission periods. One of the theories of schizophrenia development in women is that of defective gene inheritance. The gene is considered to provoke the personality disorder. The obvious symptoms are observed in adolescence. It may include the low maternal instinct and hormonal disorders. Together they lead to the misbalance of perception, both of the surrounding world and the personality. The initial complex provoking personality pathologic changes is connected with the dissatisfaction of one’s appearance. The denial of the social role is the next step. The first symptoms of schizophrenia in women reveal at the age of 25-30. The development of the disorder after the age of 50 is very rare. Apart from genetics, the roots of schizophrenia in women may be found in the change of family atmosphere, lasting stress, post-natal depression, various phobias and complexes (Castle & Buckley, 2015). Up to 2% of the diagnosed cases have virus or bacterial nature. In this case schizophrenia in women may develop as a result of bacterial or virus meningitis.
Among the symptoms of schizophrenia in women are hallucinations (both audial and visual), the persuasion in the influence from outside, the poorness of thoughts and emotions, apathy, the inability to make decisions, etc. The first symptoms are usually revealed in adolescence. Sometimes they may be conditioned by the lack of attention, both in family and from the opposite sex. In some cases, mental disorders lead to the physical ones. For example, bulimia is diagnosed together with schizophrenia among teenage girls. After some time, the symptoms of schizophrenia are followed by some personality changes. The patient may experience bad depression and aggressive behavior. The other symptoms of schizophrenia in women include the characteristic appearance, repetitive movements, delirium, monotonous voice, poor emotions. The patient is not able to feel joy or grief. The hygiene habits also suffer.
The treatment of schizophrenia in women should be organized in a clinic. However, a long stay in a medical institution may have negative results (Awad & Voruganti, 2016). The treatment usually includes biologic and social therapy. Particular attention should be given to prevention of recrudescence, as they make the illness more complicated.
Conclusions
The examination of schizophrenia symptoms, types, and possible variations of this disorder development gives an opportunity to evaluate the risks of the illness. Generally speaking, the disorder development is characteristic of the young age. The illness is widely spread and is not influenced by the race or place of living. It has certain genetic and gender-related roots. The core idea is that the knowledge of the symptoms and their correct interpretation may help to diagnose the disorder timely. As a result, the probability of the successful treatment increases. The treatment should consider the patient’s peculiarities, which include age, sex, personal characteristics, and the individual symptoms observed by a sufferer. Special approach and the professionalism of a doctor are the factors that influence the illness outcome. Despite the complexity of the disorder, the suitable treatment at the right time may result in the patient’s recovery and the return to the usual life.
References
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