Psychosis (Schizophrenia)
Psychosis (Schizophrenia)
Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
Welcome
Dear Reader,
IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.
Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.
Psychosis vs. Psychotic Disorder
Please note that “psychosis” itself is not a diagnosis and may be differentiated from “psychotic disorders”.
Psychosis is not an illness, but rather, a symptom. It is a term that is utilized to describe a range of out-of-the-ordinary or abnormal experiences that may result from a range of mental or physical factors. When experiencing extreme adversity, members of the general population may endure fleeting periods of psychosis.
Psychotic disorders, on the other hand, refer to a range of mental health conditions (disorders). This chapter of our Library will refer to one such condition that falls under the umbrella of psychotic disorders, schizophrenia.
Definition
Schizophrenia vs Fleeting Subjective Experience
On some occasions, members of the general population may endure subjective, fleeting psychotic experiences. These are typically transient and do not appear alongside others symptoms of schizophrenia; as such, these symptoms in of themselves sufficient indicators of the condition.
Individuals with schizophrenia typically experience a multitude of symptoms. These are recurrent, and result in marked impairments in cognitions and issues with psychosocial functioning.
What is Schizophrenia?
Schizophrenia is a mental health condition that is characterized by multi-modal disturbances over a period of at least one month. The core symptoms of the condition centre around persistent delusions, hallucinations, disordered thoughts, and the experience of passivity, or control.
Collectively, the symptoms of Schizophrenia are spread over the following modalities:
- Thinking (such as the disorganization of thoughts)
- Perception (such as experiencing hallucinations)
- Affect (for instance, flattened emotions such that one may feel “emotionless”)
- Self-experience (such feeling as though one’s feelings, impulses, thoughts or behaviours controlled by external forces)
- Cognition (for instance, impairments in attention, verbal memory and social awareness)
- Volition (for instance, a lack of motivation)
- Psychomotor disturbances (for instance, catatonia)
- Behaviours (for instance, engagement in behaviours that may appear purposeless, inappropriate, or unpredictable; emotional responses that interfere with the behavioural organization)
Importantly, disruptions are not attributable to other mental health conditions, substances, or medication on central nervous system. Further, symptoms are not better attributable to withdrawal.
Whilst distress is not a necessary symptom of the condition, schizophrenia is often detrimental to one’s day-to-day life and is consequently accompanied by considerable distress and impairment across important life domains (social, occupational or otherwise).
Positive Symptoms
What are “Positive” Symptoms?
- Delusions
- Hallucinations
- Experiences of Passivity and Control
- Disorganized Thought patterns (that typically manifest as disorganized speech)
- Disorganized Behaviour
What are hallucinations?
Hearing, feeling, tasting, smelling or feeling things that primarily exist within one’s mind.
For instance;
- Hearing someone telling you to do something when there is no one in sight
What are delusions?
Untrue beliefs or convictions. For instance, this may include:
- The belief that one is God
- The belief of being chased or traced by the police
Negative Symptoms
What are “Negative” Symptoms?
- Flattened emotions
- Avolition: Lacking motivation (for instance, not eating, not being able to get changed or brush one’s teeth)
- Alogia: For instance, difficulty speaking or verbalizing
- Demonstrating asociality
- Inability to feel pleasure
List of symptoms
For a comprehensive list of schizophrenia symptomatology, we recommend you visit the ICD-11 webpage.
Comorbidities
Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside schitzophrenia include but are not limited to:
- Mood disorder such as depression
- Anxiety disorders
- Substance use
Development and Course
Below, we present research findings. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.
- The condition rarely develops in childhood.
- Amongst males, the condition generally appears in the early 20s, whereas amongst females, the typical age of onset is in their late 20s.
- The condition follows a heterogeneous course and may gradually increase in severity over time. Some individuals maintain residual symptoms, whereas others enter into remission.
- In some cases, the condition may follow an acute onset, wherein apparent symptoms may be present within a few days. In such cases, symptoms typically develop over time following the sudden onset.
- Prior to the onset of symptoms, individuals typically endure a prodromal phase. This period often depressive symptoms including losing interest in their social activities, neglecting their appearance and hygiene and having a disrupted sleep cycle.
Variability
Gender and Sex-Related Differences
- Females who endure schizophrenia usually demonstrate more positive symptoms, increasing over their life.
- Females typically experience comorbid/co-occuring conditions.
- Compared to their male counterparts, females demonstrate a lower tendency to exhibit negative symptoms, disorganized thinking and social impairment.
Age-Related Differences
- The onset of the condition is rare in childhood. Nevertheless, children and adolescents who endure the condition typically experience issues across social, language, and motor development.
- Given their affinity for “magical thinking”, children are prone to demonstrate difficulty differentiating between the consequences of life events (such as being bullied) and voices they perceive originate from a monster or an imaginary friend.
Etiological Risk Factors
The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops.
Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis and outcome are not definitively based upon the presence of one, or even several, of the variables.
Personality Factors
A study investigating the relationship between the Big Five Personality Factors and Schizophrenia found the condition correlates with the following dimensions:
- Heightened neuroticism (including a vulnerability to emotional instability, and self-consciousness)
- Lower levels of openness (for instance, lower levels of receptiveness to new ideas and new experiences)
- Lower levels of agreeableness (for instance, lower levels of trust, altruism, kindness, the ability to put others above oneself)
- Lower levels of extraversion (lower levels of excitability, sociability, emotional expressiveness, and talkativeness)
Heritability
- Although Schizophrenia is theorized to run in families, heritable factors and genetic contributions remain a topic of debate.
Genetics
- Genetic mutations may lead to Schizophrenia
Neurobiological factors
- Gray matter changes, specifically symptom severity has been negatively correlated to grey matter volume.
- Deformation and a decline in the volume of the frontal lobe
- Changes in the surface of brain nuclei
- Infection
- Neurochemical mechanisms: for instance, imbalances in dopamine, serotonin, GABA and glutamate
Environmental factors
- Adverse childhood experiences
- Stressful life experiences
- Birth/obstetric complications
- Migration
- Social isolation
Consequences
Studies have suggested that many individuals with schizophrenia may have a compromised quality of life compared to community samples. Whilst not everyone experiencing this condition will experience functional disruptions, studies have highlighted various associated consequences. Individuals with schizophrenia have been observed to be at heightened risk for:
- Suicidal ideations
- Suicidal attempts
- Suicide
- A marked reduction in self-esteem
- Abandonment of self-care
- Difficulty maintaining employment
- Reduction in quality relationships
- Cognitive impairments that progressively worsen later in life along with neurodegeneration
A Gentle Reminder
We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.
Sources and Recommended Readings
Disclaimer
We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.
World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from https://icd.who.int/
Code for Schitzophrenia: 6A20
Jaya, E. S., Amelsvoort, T. van, Bartels-Velthuis, A. A., Bruggeman, R., Cahn, W., Haan, L. de, Kahn, R. S., Os, J. van, Schirmbeck, F., Simons, C. J. P., & Lincoln, T. M. (2021). The Community Assessment of Psychic Experiences: Optimal cut-off scores for detecting individuals with a psychotic disorder. International Journal of Methods in Psychiatric Research, n/a(n/a), e1893. https://doi.org/10.1002/mpr.1893
Jaya, E. S., & Wulandari, S. (2018). Psychotic experiences, depressive symptoms, anxiety symptoms and common mental health risk factors of urban and non-urban dwellers in Indonesia. Psychological Research on Urban Society, 1(1), 3–11. https://doi.org/10.7454/proust.v1i1.21
Scheunemann, J., Schlier, B., Ascone, L., & Lincoln, T. (2018). The link between self‐compassion and psychotic‐like experiences: A matter of distress? Psychology and Psychotherapy, 92(4), 523-538. doi: 10.1111/papt.12193
Wüsten, C., Schlier, B., Jaya, E., Alizadeh, B., Bartels-Velthuis, A., & van Beveren, N. et al. (2018). Psychotic Experiences and Related Distress: A Cross-national Comparison and Network Analysis Based on 7141 Participants From 13 Countries. Schizophrenia Bulletin, 44(6), 1185-1194. doi: 10.1093/schbul/sby087
Jaya, E. S., Ascone, L., & Lincoln, T. M. (2017). A longitudinal mediation analysis of the effect of dysfunctional self-related schema on psychotic symptoms via negative affect. Psychological Medicine, 1-11. https://doi.org/10.1017/S003329171700277X
Jaya, E., Ascone, L., & Lincoln, T. (2017). A longitudinal mediation analysis of the effect of negative-self-schemas on positive symptoms via negative affect. Psychological Medicine, 48(8), 1299-1307. doi: 10.1017/s003329171700277x
Lincoln, T. M., Marin, N., & Jaya, E. S.* (2017). Childhood trauma and psychotic experiences in a general population sample: A prospective study on the mediating role of emotion regulation. European Psychiatry, 42, 111–119.
Ascone, Jaya, E. S., & Lincoln, T. M. (2016). The effect of unfavourable and favourable social comparisons on paranoid ideation: An experimental study. Journal of Behavior Therapy and Experimental Psychiatry. doi: 10.1016/j.jbtep.2016.08.002.
Jaya, E. S., Ascone, L., & Lincoln, T. M. (2016). Social adversity and psychosis: The mediating role of cognitive vulnerability. Schizophrenia Bulletin. doi: 10.1093/schbul/sbw104
Jaya, E. S., Hillmann, T., Klaus, M. R., Gollwitzer, A., & Lincoln, T. M. (2016). Loneliness and psychotic symptoms: The mediating role of depression. Cognitive Therapy and Research. doi: 10.1007/s10608-016-9799-4
Sundag, J., Ascone, L., de Matos Marques, A., Moritz, S., & Lincoln, T. (2016). Elucidating the role of Early Maladaptive Schemas for psychotic symptomatology. Psychiatry Research, 238, 53-59. doi: 10.1016/j.psychres.2016.02.008
Schlier, B.,+ Jaya, E. S.+, Moritz, S., & Lincoln, T. M. (2015). The Community Assessment of Psychic Experiences measures nine clusters of psychosis-like experiences: A validation of the German version of the CAPE. Schizophrenia Research, 169(1–3), 274–279. doi: 10.1016/j.schres.2015.10.034 (+equal first author)