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The Distortion of Consciousness
Published in Max R. Bennett, The Idea of Consciousness, 2020
To be schizophrenic, as defined by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, is to experience symptoms that last for at least six months and include at least two of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms. Negative symptoms include restrictions in the range and intensity of emotional expression (affective flattening), in the fluency and productivity of thought and speech (alogia), and in the initiation of goal-directed behavior (avolition). The term ‘negative’ is used to contrast these aspects with the positive aspects which produce something, namely hallucinations. The kind of delusions that are most common are those associated with some kind of persecution, such as being spied on, ridiculed or tormented in some way, and often involve grandiose misconceptions. The most common type of schizophrenia is the paranoid type, in which the delusions are accompanied by auditory hallucinations and, to a much lesser degree, visual hallucinations. Most importantly, such schizophrenics do not have disorganized speech, and do not possess disorganized or catatonic behavior, nor do they exhibit flat or clearly inappropriate feeling or emotion. Neuroscientists can therefore investigate paranoid schizophrenia with hallucinations in a single sensory modality in a way that is not further complicated by these other conditions. Because every individual’s own stream of consciousness is so intensely personal, the condition of auditory hallucinations in which two or more voices are conversing with one another, or maintaining a running commentary on the thoughts within consciousness, is of particular interest. This chapter considers the possibility of gaining insights into the mechanisms by which this comes about; that is, the mechanisms which generate voices distinct from those ordinarily known as ‘our own thoughts’.
Mental health within society and societies
Published in Mary Steen, Michael Thomas, Mental Health Across the Lifespan, 2015
Nicholas Procter, Amy Baker, Monika Ferguson, Kirsty Baker
Schizophrenia is a psychotic disorder characterised by changes in one or more of the following domains:Delusions: fixed beliefs that are not amenable to change in light of contradictory evidence. Themes may be persecutory, referential, somatic, religious or grandiose in nature and are deemed bizarre and not reflective of the cultural norms with which that person identifies.Hallucinations: uncontrollable perceptual experiences that occur without an external stimulus, most commonly in the form of an auditory experience. This symptom may be described as a voice or voices that are perceived as distinct from the person’s own thoughts. It is important to note that hallucinations may be a normal experience in certain cultural contexts, such as the phenomenon of mediums who receive information from spirits of the deceased in the form of auditory or visual perceptions that are not available to others (Roxburgh and Roe 2014).Disorganised thinking: this is reflected in the person’s speech, which can be confusing as the person switches between topics or gives unrelated answers to questions asked. The symptom must be severe enough so as to substantially impair effective communication.Grossly disorganised or abnormal motor behaviour: this may be evident in persons with unpredictable agitation or playful, childlike behaviours that lead to difficulties in functioning or completing activities of daily living. In contrast to this, catatonic behaviour is characterised by a marked decrease in reactivity to the environment which may result in bizarre posturing, mutism, staring or grimacing.Negative symptoms: these are characterised by diminished emotional expression in the face and behaviours that would usually occur when interacting with others. Avolition can be observed in people who have difficulty in motivated self-initiated activities, resulting in the person sitting for extended periods of time, or having difficulty interacting with their environment (APA 2013).
Mindfulness-based psychoeducation for schizophrenia spectrum disorders: a qualitative analysis of participants’ experiences
Published in Contemporary Nurse, 2021
Angie Ho Yan Lam, Sau Fong Leung, Wai Tong Chien
Schizophrenia spectrum disorders (SSDs) is among the leading causes of disability and affects more than 21 million people worldwide (Chong et al., 2016; World Health Organization, 2017). Patients with this condition frequently experience a wide range of symptoms, including positive, negative, and cognitive symptoms. The positive symptoms are also known as psychotic symptoms, which include delusions, hallucinations, and disorganized speech and grossly disorganized or abnormal motor behavior. Negative symptoms include diminished emotional expression, avolition, alogia, asociality and anhedonia (American Psychiatric Association, 2013). Patients can also experience cognitive dysfunction involving attention and memory impairment and executive dysfunctions in abstract thinking and concept formation (American Psychiatric Association, 2013). These symptoms tend to be chronic and contribute to a wide range of impairments, social dysfunction and a high risk of relapse in the community (Guo et al., 2010; Saha et al., 2007). Antipsychotic drugs have been proven effective against psychotic symptoms but are limited in their ability to improve negative symptoms and cognitive performance (American Psychiatric Association, 2010; Chien et al., 2013; Kahn et al., 2015). Therefore, it is important to use psychosocial intervention in conjunction with pharmacotherapy to improve patients’ clinical and functional outcomes (American Psychiatric Association, 2010; National Collaborating Centre for Mental Health [UK], 2014).
Characterization of deficit schizophrenia and reliability of the bidimensional model of its negative symptomatology
Published in Nordic Journal of Psychiatry, 2020
Álvaro López-Díaz, Clara Menéndez-Sampil, Ana Pérez-Romero, Fernanda Jazmín Palermo-Zeballos, María José Valdés-Florido
Table 3 summarizes the PCFA for the negative symptoms assessed by the SDS. The KMO measure was 0.744, which was above the acceptable 0.70, and Bartlett’s test of sphericity was significant (p < 0.001), indicating that the six SDS symptoms were suitable for factor analysis. The PCFA resulted in a two-component solution with eigenvalues greater than 1 which explained 74.2% of the variance. One factor contained diminished emotional range, restricted affect, and poverty of speech and accounted for 55.7% of the variance while the other factor included diminished sense of purpose, diminished social drive, and curbing of interests, explaining 18.5% of the variance. The Cronbach’s alpha coefficient for Factor 1 was 0.85 and for Factor 2 was 0.76, indicating good internal consistency. Both factors, as explained above, were interpreted as ‘Expressive deficit’ and ‘Avolition–apathy’, respectively.
Negative symptom configuration in first episode Schizophrenia: findings from the “Parma Early Psychosis” program
Published in Nordic Journal of Psychiatry, 2020
Lorenzo Pelizza, Giulia Landi, Clara Pellegrini, Emanuela Quattrone, Silvia Azzali, Pietro Pellegrini, Emanuela Leuci
In more recent years, convergent evidence in schizophrenia suggested that a 2-factor solution is more likely when symptoms that are not conceptually correlated to negative symptomatology (e.g. alogia) are excluded [9]. The two independent domains that have been more commonly isolated are: (a) “Expressive Deficits” (i.e. restricted affect, diminished emotional range, poverty of speech) and (b) “Avolition/Apathy” (i.e. curbed interests, anhedonia, diminished sense of purpose, diminished social drive) [9,10]. It has been hypothesized that each factor could have distinct pathophysiological and clinical correlates. Specifically, avolition/apathy seems to be associated with impairments in different aspects of motivation, while expressive deficits with neurocognitive and/or social cognition abnormalities [43,45].