Positive Symptoms: The Disorganized Dimension
Disorganized thinking becomes apparent in patients' speech patterns as schizophrenia progresses. Affected people lose their train of thought during conversations, make loose associations of topics (tangentially jumping from one topic to another apparently at random, or on the barest of associations), and give answers to unrelated questions. Speech may be highly circumstantial, meaning that affected people may speak continuously, providing numerous irrelevant details and never getting to the point. Occasionally, speech is so disorganized that it becomes a completely jumbled "word salad" devoid of discernible meaning despite being full of words.
Disorganized behavior may range from simple problems sustaining goal-directed self-care behaviors such as personal hygiene to unpredictable and bizarre socially inappropriate outbursts. For example, people may not dress according to the weather, (i.e., they may wear a heavy coat in the middle of summer), they may wear odd or inappropriate makeup, they may shout at people for no apparent reason, or they may mutter to themselves continuously, etc. They may even strip off their clothing and run naked through the streets, while chewing on road kill. Most anything is possible.
Catatonic motor behaviors are a type of disturbed behavior (and a negative as opposed to a positive symptom) that sometimes occurs when schizophrenia goes untreated. In catatonia, peoples' reaction to their surroundings becomes remarkably decreased. They may assume a rigid, uncomfortable looking posture and then not move for hours or days, resisting efforts to move them. Catatonic patients may also display "waxy flexibility", meaning that they allow themselves to be moved into new positions, but do not move on their own. Most of the time, this is not an act or a show but rather a genuine and unpremeditated symptom of the illness that patients cannot help. Catatonia is observed with less frequency today than in past years due to advances in treating schizophrenia.
Negative Symptoms: Affective Flattening, Alogia, and Avolition
"Affect" refers to emotional expression. Affective flattening, distinguished by a restricted range of expressed emotions, is a fairly common negative symptom among some schizophrenia patients. Patients with affective flattening show relatively immobile and unresponsive facial expressions, often accompanied by poor eye contact and little body language or movement.
Alogia refers to difficulty with speaking. In some schizophrenic patients, alogia manifests as reduced total speech output, and reduced verbal fluency (the ease with which words are chosen). Patients displaying alogia struggle to give brief answers to questions, for example.
Avolition describes a loss of motivation; the will or desire to participate in activities or to do things. Some schizophrenic patients show avolition in that they will sit still for long periods of time, seemingly indifferent to their surroundings, and without displaying any interest in work or social activities. In extreme cases, this behavior becomes catatonia (as described above).
By DeepDiveAdmin, Wed, December 02, 2015
By Dr. Cheryl Lane, PhD
Disorganized schizophrenia is one of five subtypes of schizophrenia. Also known as hebephrenic schizophrenia, this particular subtype often has a poor prognosis. As the name suggests, it is characterized by disorganized behavior and speech, as well as disturbances in emotional expression.
Symptoms of disorganized schizophrenia
Individuals diagnosed with disorganized schizophrenia typically display three distinctive symptoms. These are:
- Disorganized speech (which must be severe enough to significantly interfere with their ability to communicate effectively)
- Disorganized behavior
- Blunted or inappropriate affect
Disorganized speech is actually caused by the individual’s severely impaired thought processes. This makes it extremely difficult – and often impossible – for patients with this diagnosis to speak in a way that is coherent and meaningful. They simply cannot organize their thoughts. If you try to converse with them, they may constantly jump from one subject to another. They may also experience “thought blocking”, which causes them to abruptly stop mid-sentence as if their thoughts were suddenly gone.
Individuals with disorganized schizophrenia will often answer questions with a vague response or one that is completely unrelated to the question. It’s not uncommon for them to actually make up words, referred to as “neologisms”. When their cognitive disorganization is severe, their speech will usually be impossible to understand. When this occurs it is often referred to as “word salad”.
Disorganized behavior may be exhibited in a variety of ways. Patients with this type of schizophrenia are unable to start a specific task (e.g. taking a shower or cooking a meal) or finish it once they begin. This is one of the reasons that the prognosis is especially poor for this type of schizophrenia. Their severe disorganization makes it impossible to function on their own. As a result of their gross disorganization, they often neglect their personal hygiene and appear disheveled.
Individuals with this type of schizophrenia may become agitated for no apparent reason. They may engage in very inappropriate sexual behavior, such as touching themselves while in a public place. Bizarre dress is also not uncommon, such as piling on layers of clothing even though the weather is very warm.
Blunted or Inappropriate Affect
The term “affect” refers to a person’s emotional response (e.g. smiling when happy), including the way it is expressed (e.g. with their body language and tone of voice). In disorganized schizophrenia, individuals often have a blunted or “flat” affect; in other words, they show little or no emotion in their facial expression, mannerisms, or their tone of voice. If they do show emotion it may be completely inappropriate to the situation, such as laughing hysterically at a sad story.
Unlike paranoid schizophrenia, in which hallucinations and / or delusions are primary symptoms, people with disorganized schizophrenia may not have hallucinations or delusions. If they do, they aren’t prominent, nor do they revolve around a specific theme (such as religion or persecution).
In order to meet the criteria for a diagnosis of disorganized schizophrenia, the patient must not exhibit symptoms that meet the criteria for catatonic schizophrenia (another one of the five subtypes).
Other characteristics of this particular subtype include odd or bizarre behaviors. The person may have strange mannerisms, stand or sit in an unusual position, or grimace frequently. They are also often socially withdrawn.
Disorganized schizophrenia usually requires lifelong treatment. Antipsychotic medications can help reduce and control some of the symptoms, enabling the person to live a more functional and fulfilling life. If the medication is effective, he/she may be well enough to participate in individual, group, family, or other types of therapy. Vocational skills training may also be very beneficial.
Other Related Aspects
The signs of disorganized schizophrenia often begin to appear at an earlier age than they do for other types of schizophrenia. Personality disturbances are often noticeable early on. The development of this subtype is usually very gradual, unlike paranoid schizophrenia in which there is usually a distinctive initial “psychotic break”.
Unfortunately, the symptoms of disorganized schizophrenia are less likely to subside significantly like they do with some of the other types. However, with appropriate and ongoing treatment, some individuals with this type of schizophrenia are able to function relatively well.
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