Data from a PET study25 suggests the less the frontal lobes activated (red) during a working memory task, the greater the increase in abnormal dopamine activity in the striatum (green), thought to be related to the neurocognitive deficits in schizophrenia.Actress Clara Bow was diagnosed with schizophrenia in 1949.
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Schizophrenia

Schizophrenia is a severe mental illness characterized by persistent defects in the perception or expression of reality. A person experiencing untreated schizophrenia typically demonstrates grossly disorganized thinking, and may also experience delusions or auditory hallucinations. more...

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Although the illness primarily affects cognition, it can also contribute to chronic problems with behavior or emotions. Due to the many possible combinations of symptoms, it is difficult to say whether it is in fact a single psychiatric disorder; and Eugen Bleuler deliberately called the disease "the schizophrenias" (plural) when he coined the present name.

Diagnosis is based on the self-reported experiences of the patient, in combination with secondary signs observed by a psychiatrist or other competent clinician such as a doctor of psychology. There is no objective biological test for schizophrenia, though studies suggest that genetics and biochemistry are important contributing factors. Current research into the development of the disorder often focuses on the role of neurobiology, although a reliable and identifiable organic cause has not been found. In the absence of objective laboratory tests to confirm the diagnosis, some question the legitimacy of schizophrenia's status as a disease.

The term "schizophrenia" translates roughly as "shattered mind," and comes from the Greek σχίζω (schizo, "to split" or "to divide") and φρήν (phrēn, "mind"). Despite its etymology, schizophrenia is not synonymous with dissociative identity disorder, also known as multiple personality disorder or "split personality"; in popular culture the two are often confused. Although schizophrenia often leads to social or occupational dysfunction, there is little association of the illness with a predisposition toward aggressive behavior.

Overview

Schizophrenia is often described in terms of "positive" and "negative" symptoms. Positive symptoms include delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. Negative symptoms are so named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation. Some models of schizophrenia include formal thought disorder and planning difficulties in a third group, a "disorganization syndrome."

Additionally, neurocognitive deficits may be present. These may take the form of reduced or impaired psychological functions such as memory, attention, problem-solving, executive function or social cognition.

Onset of schizophrenia typically occurs in late adolescence or early adulthood, with males tending to show symptoms earlier than females.

Psychiatrist Emil Kraepelin was the first to draw a distinction between what he termed dementia praecox ("premature dementia") and other psychotic illnesses. In 1911, "dementia praecox" was renamed "schizophrenia" by psychiatrist Eugen Bleuler, who found Kraepelin's term to be misleading, as the disorder is not a form of dementia, premature or otherwise.

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Infections in schizophrenia caregivers
From Townsend Letter for Doctors and Patients, 5/1/05 by Robert A. Anderson

A nurse interviewer, blind to the patient's symptoms, caregiver burden, and psychosocial status, administered the Health Review questionnaire to 70 schizophrenia caregivers. A second interviewer, blind to caregiver health status and patient symptoms, assessed caregiver resources (e.g., active coping and social support), vulnerabilities (e.g., anger expression and passive coping) and burden. Concurrently, independent patient raters, blind to caregiver health and psychosocial status, assessed caregiver stressors. Other appropriate psychological assessment instruments evaluated the severity of positive (e.g., hallucinations and delusions) and negative (e.g., anhedonia and asociability) symptoms. Measures of stressors, resources, and vulnerability factors accounted for 29% of the variance in infectious illness. Positive patient symptoms and dissatisfaction with social support were highly predictive of infectious illness episodes. Caregivers whose stress ratings placed them in the uppermost quartile were at four times the risk for infectious illness vs. those in the lowest quartile.

Dyck DG ET AL. Predictors of burden and infectious illness in schizophrenia caregivers. Psychosom Med 1999 Jul-Aug; 61(4):411-19

COMMENT: Schizophrenia caregiving is another clinical situation which is highly stressful and in this study, schizophrenia caregiver stress levels were highly predictive of susceptibility to infectious illness. Although not part of this research, practitioners aware of this relationship would do well to assist caregivers in highly stressful circumstances (managing schizophrenics, Alzheimer's patients and other highly asocial patients) in recognizing their stressful circumstances, arranging for respite intervals, and using other lifestyle tools (better nutrition, exercise, meditation, positive social contacts) to minimize the downside effects of the unavoidable stressor experience.

Robert Anderson is a retired family physician whose practice took a holistic turn as decades passed. He has authored five major books, Stress Power!, Wellness Medicine, The Complete Self-Care Guide to Holistic Medicine (co-author), Clinician's Guide to Holistic Medicine (McGraw Hill, 2001), and The Scientific Basis for Holistic Medicine, (6th edition 2004), available from American Health Press, holos@nwi.net. Anderson was the founding president of the American Board of Holistic Medicine, past president of the AHMA, former Assistant Clinical Professor of Family Medicine at the University of Washington and is currently an Adjunct Instructor in Family Medicine at Bastyr University.

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group

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