Is schizoaffective a personality disorder

schizophrenia

Schizophrenia is a term used to describe mental illnesses that trigger changes in thoughts, perception and behavior. They belong to the group of psychoses.

Short version:

  • Schizophrenia is not a multiple personality disorder.
  • The exact causes of the disease are not yet known. Today we assume a multifactorial interplay of biological and psychosocial causes.
  • The basic complaints of schizophrenia include the disturbance of thinking, the loss of reality and the so-called ego disturbance.
  • Schizophrenia is treated with medication and psychotherapy.
  • Schizophrenia is a long-term disease.

 


People with schizophrenia are at times unable to differentiate between reality and their own ideas, but they do not believe that they are another person or groups of other people (multiple personality disorder), as in the story of Dr. Jekyll and Mr. Hyde is the case.

Who Does Schizophrenia Affect?

About 1% of the world's population will experience schizophrenia at some point in their life. No significant differences are known between the countries. In Austria about 80,000 people are affected by schizophrenia. There are more than 1,000 new cases each year. Men get sick a little more often, earlier and often more severely than women. Women are mostly affected between the ages of 25 and 35, men often between the ages of 15 and 30. Properly administered treatment nowadays enables the majority of patients (80%) to live permanently outside the hospital. Most of these people can work at least temporarily.

How does schizophrenia develop?

The exact causes of the disease are unknown. Today we assume a multifactorial interplay of biological (e.g. genetic, infectious) and psychosocial (e.g. social environment, psychological stress) causes.

Biological and psychosocial factors

Chemical messengers that transmit nerve signals (neurotransmitters) probably play a decisive role in the development. Schizophrenia used to be interpreted as the result of an overproduction of the neurotransmitter dopamine. However, recent studies indicate that some of the dopamine signaling pathways are overactive.

Some parts of the brain are also changed. For example, the ventricles - these are chambers in the brain filled with cerebrospinal fluid - are often enlarged or parts of the hippocampus are reduced in size.

genetics

Inheritance also plays a role. The risk of developing schizophrenia at some point in life increases from 1% to 3% if part of the grandparents is affected and to 10% if one of the parents is affected. Identical twin siblings are only 40–60% both affected, so that hereditary (genetic) factors cannot be the only possible cause of schizophrenia.

It is likely that some people inherit a particular susceptibility to schizophrenia, which is ultimately triggered by additional stress. Birth complications or serious physical illnesses can be such triggers. In 50% of cases, however, an illness or relapse is preceded by psychological stress (e.g. unhappy childhood, stress at work, in interpersonal relationships).

What are the symptoms of schizophrenia?

Schizophrenia can change practically all mental functions. There are a number of complaints that do not have to appear in the individual patient all and not to the same extent. They sometimes combine to form syndromes - a typical combination of complaints that can also vary.

A distinction is made between so-called positive symptoms and negative symptoms as well as cognitive disorders.

Positive symptoms

Positive symptoms are understood as an increase ("excess") of normal experience. This includes:

  • Delusion: Those affected have a distorted picture of reality that cannot be refuted even by logical arguments from outside. Schizophrenics can firmly believe that they are being persecuted, that the environment has conspired against them, or that they are about to be poisoned. Patients have no way of realizing (for example with the help of logical arguments) that they are mistaken.
  • Hallucinations: Affected people perceive something with their senses (e.g. hearing, smelling, seeing) that is not there. Patients hear noises and voices or smell toxins that are not there. Mostly they are threatened in the context of paranoia. Here, too, it is impossible to use arguments to lead those affected out of this world of ideas.
  • Formal thinking disorders: The use of terms or logical reasoning becomes less precise. The language seems disorganized. The patient perceives his own thoughts as strange, sometimes he thinks that they are withdrawn from him. Thinking is incoherent, not logical, confused, thoughts and words break off in the middle of a sentence. Terms lose their exact meaning or different terms are newly combined with one another (e.g. "sad" from sad and cruel).
  • Disorders of the I experience: Schizophrenic patients also experience their own personality split, incoherent, and shattered. Sometimes they have difficulty being sure that they are really alive or that they are themselves.
  • Motor symptoms, movement disorders: Affected people are more noticeable in their gestures and facial expressions, and gait and motor skills are often impaired. Sometimes the disease greatly slows the patient's movements. He hardly moves and no longer speaks (stupor). In the worst case, an affected person can no longer move at all, he remains in uncomfortable positions (catalepsy). If there is also a fever (pernicious catalepsy), the condition becomes life-threatening. On the other hand, schizophrenics often repeat movements again and again in states of mental excitement. They run back and forth, do squats and other gymnastics, clap their hands or constantly tap their fingers.

Negative symptoms

Negative symptoms are limitations in normal experience and psychological functions that were previously present in those affected, but are reduced or completely absent due to the disease.

Negative symptoms can be:

  • Apathy: Apathy, lack of interest, lack of energy, insensitivity to external stimuli
  • Alogy: Lack of linguistic utterances, delayed, taciturn answers, poorly differentiated language
  • Anhedonia: inability to experience joy, pleasure, or indulgence
  • Affect flattening: Impoverishment of feeling, emotional expression and responsiveness; Those affected appear little affected by the pleasant or the unpleasant.
  • Social withdrawal: Social isolation, lack of interest in dealing with other people, limited ability to deal with conflict, little sexual interest

Cognitive disorders

Affected people usually have problems with their attention, their memory and their planning of actions. Thinking can be restricted and complex relationships can no longer be grasped. The ability to interpret emotional facial expressions or signals is also often limited.

Disturbances of the emotional life (affect) and of the drive

The feeling that dominates everything is fear. Sometimes schizophrenic people are silly, uninhibited and exuberant (upscale, hebephrenic mood), but more often helpless, helpless and in need of support (depressive mood). The risk of suicide in such situations is unpredictable, the risk is 10%. The mood and the current situation do not match (inadequate affectivity). Opposing emotions are felt next to each other, the patient cries and laughs at the same time.

How does schizophrenia work?

Creeping or acute course

The disease can be gradual or acute. One speaks of a creeping process when the patient withdraws more and more, isolates himself from family and friends, does not want to worry about anything and loses all interest in education, work or hobbies. Sleep disturbances, difficulty concentrating, indecision, abrupt changes in feeling, substance abuse and an interest in occult topics can also be part of the clinical picture.

In some patients one observes constant complaints. More than half of the patients are affected in waves by acute phases and are symptom-free in the time between, whereby the processing of the symptoms experienced as threatening can lead to considerable personality disorders.

How does the doctor make a diagnosis?

The diagnosis is made through a detailed discussion with the patient. The doctor pays particular attention to the typical symptoms at the time of the examination and in the previous history. Since the affected person is sometimes unable to perceive their illness themselves, it may be important to ask family members, friends or teachers. Tests (Rorschach test, questionnaires, concentration exercises) are rarely used to establish a diagnosis.

Even with typical schizophrenic complaints, the doctor must rule out other possible causes, such as drug and medication abuse, a brain tumor and other neurological diseases, by means of examinations.

The general diagnostic characteristics according to ICD-10: F20 include:

  1. Thoughts: becoming loud, inspiration, withdrawal, expansion
  2. Delusional content: delusion of control, delusion of influence, feeling of what has been done (conviction that the experience and the feelings are controlled from outside), delusional perceptions
  3. Delusional characteristics: inappropriate, unrealistic
  4. Voices: commenting, dialogue
  5. Hallucinations
  6. Formal thinking: tearing off thoughts, confusion, talking alongside, neologisms (word creations)
  7. Catatonic symptoms: negativism, excitement, stupor ("numbness"), mutism (silence, inability to speak in certain situations), postural stereotypes (prolonged persistence in one posture)
  8. Negative symptoms: apathy, impoverishment of speech, social withdrawal, flattened affect

According to ICD-10, the diagnosis is made if

  • a symptom from Groups 1–4 occurs OR
  • there are two symptoms in groups 5–8
  • AND symptoms keep occurring for a month or more.

Depending on the symptoms, schizophrenia is divided into different subgroups. This includes:

  • Paranoid schizophrenia (ICD-10: F20.0): predominance of hallucinations and delusions
  • Hebephrenic schizophrenia (ICD-10: F20.1): flattened or inappropriate affect (violent emotional excitement, mental tension), aimless and incoherent behavior or formal thought disorders (e.g. lack of language)
  • Catatonic schizophrenia (ICD-10: F20.2): The presence of a catatonic symptom for at least two weeks
  • Undifferentiated schizophrenia (ICD-10: F20.3): Patients do not meet the criteria for any type or have so many symptoms that the criteria meet more than one type.
  • Postschizophrenic depression (ICD-10: F20.4): criteria for schizophrenia were met in the last twelve months, the symptoms must meet at least the criteria for a mild depressive episode.
  • Schizophrenic residual (ICD-10: F20.5): Chronic course of the disease with a clear deterioration compared to an earlier stage. There must be at least four negative symptoms.
  • Schizophrenia simplex (ICD-10: F20.6): Gradual progression of all three of the following characteristics over at least one year:
  1. significant and persistent change in some personality traits
  2. gradual appearance and exacerbation of negative symptoms
  3. significant decrease in the level of performance

How is schizophrenia treated?

In the treatment of schizophrenia, psychotherapy is often used in addition to drugs such as antipsychotics, neuroleptics or antidepressants.

+++ More on the topic: Schizophrenia treatment +++

What can those affected do themselves?

In the first step, it is important that those affected know about their own illness and deal with it (so-called "psychoeducation"). An open and open relationship with the treating doctor or therapist can also help to positively influence the course of the disease. It is also important that those affected take their medication reliably and speak to their doctor in the event of possible side effects in order to find the best possible treatment option. It can also be useful to involve relatives in the therapy or to use them for support in order to further increase the chances of success of the treatment.

What is the prognosis?

Schizophrenia is a protracted illness that is also mentally stressful for relatives. Yet it is generally judged to be more serious and dramatic than the sober numbers show.

In one in five, an initial illness heals without recurrence. Even after years of illness, the condition of some patients suddenly improves. Others recur at different intervals and with different frequencies. The inherent laws of the disease itself also determine the course.

In addition, further development depends on the patient's personal and social coping abilities. However, everything has a decisive influence on the prognosis if sufficient and reliably observed neuroleptic therapy. If the medication is taken regularly, the number of relapses drops to 30%.

Every third chronic course is easy. A third of the patients achieve a certain improvement with intermittent relapses and a further third have an unfavorable prognosis with permanent and increasing personality changes, which intensify with each relapse. It is beneficial if the disease begins suddenly in later years and is more likely to have the additional symptoms.

A permanent stay in the hospital is only necessary for one in four, 60% of those affected reintegrate into the social environment and can work. The disease reduces the life expectancy of those affected by an average of ten years.

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Authors:
Dr. med. Werner Kissling (2004), Tanja Unterberger, Bakk. phil. (2019)
Medical review:
O. Univ. Prof. Dr.h.c. mult. Dr med Siegfried Kasper
Editorial editing:
Dr. med. Stefanie Sperlich, Mag. Julia Wild

Status of medical information:
swell

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Guideline of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN): Schizophrenia - short version. March 2019, valid until March 2023; https://www.awmf.org/uploads/tx_szleitlinien/038-009k_S3_Schizophrenie_2019-03.pdf

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ICD-10: F20.0, F20.1, F20.2, F20.3, F20.4, F20.5, F20.6