Wednesday, April 3, 2013

20. getting back on track, Schizophrenia



The temptation to shut this blog down is overwhelming. I enjoyed it when I started, thinking it would be easy to upkeep. But like I learned a while ago, it takes 10 straight weeks to make a certain activity a habit. I held out for about 2 or 3 before ennui set in. I just kind of want to sweep it under the rug and forget I ever started it. But darn it, I’m terrible at keeping my goals. I’m not going to let another one slide away from me just because I fell behind. So today? Schizophrenia.

Today I read a new article for a new class. The group project I’m working on is discussing various aspects of schizophrenia. This is a pretty grim disease to have, and learning about the symptoms and experiences people go through doesn’t make it seem any easier. In fact, we listened to a sample of what a person experiencing auditory hallucination might hear. It was pretty terrifying. Throbbing, mechanical sounds, the sudden sounds of flapping wings, lots of voices mumbling curse words or sharply demanding “What are you doing?” I couldn’t find that particular clip again on Youtube, but here’s another example. https://www.youtube.com/watch?v=yhT9djAEy8s. This one is much more about the loud, distracting noises with lots of very indistinct voices.

The auditory and visual hallucinations already seem hard enough to deal with. Just imagine having to deal with constant put downs in a job interview or on a date. But that’s just one symptom out several. Positive symptoms, or problems that one gains from the disorder, include delusions, thought disorders, and problems with movements. In extreme cases where a patient doesn’t get treatment, they can even become catatonic. Negative symptoms are normal behaviors or emotions being lost. People begin to have a ‘flat affect’ or seeming to lack feeling in their expressions and speech. They lose interest in things they used to enjoy and begin to withdraw socially.  All of this coupled with the fact that there is no way to cure schizophrenia, only ways to maintain it and keep it at a lower level. Schizophrenia is almost seen as a terminal illness to some people.

However, as with most psychological disorders, there is a range of severity. There are those who anti-psychotics don’t work and they have to be hospitalized for the remainder of their lives. There are also those that go on to be college professors, artists, and musician. If you’ve seen the movie A Beautiful Mind, you already know about John Nash, who struggled with schizophrenia but eventually won the Nobel Prize in economics. Really, with all the research we’ve done so far in different medications and therapies and programs for people with schizophrenia, why shouldn’t the prognosis be brighter?

The particular article I’m reading focuses on using cognitive behavioral therapy (CBT) to try and reduce the negative symptoms I talked about earlier. The researchers tried to reduce negative symptom by introducing five different modules that targeted negative behaviors: regaining initiative, increasing social activity, emotional participation, emotional expression, and speech activity. Ultimately, they found that CBT worked just as well as their control group, Cognitive Remediation. CR focused just on increasing mental faculties, like attention and working memory, rather than the emotional and social aspects of the CBT. They both reduced negative symptoms by about half a point on their measurement instrument, the Positive and Negative Syndrome Scale (or the PANSS).

Schizophrenia is a disorder with no easy answer. Even inconclusive studies like this one move the field further another inch. One day we’ll have preferred treatment outline that we expect for other disorders like anorexia or anxiety. I’ll be waiting for that day, when people with Schizophrenia can get a solid treatment plan and prognosis rather than struggling in the face of uncertainty.

Klingberg, Wolwer, Engel, Wittorf, Herrlich, Meisner, Buchkremer, & Wiedemann. (2011). Negative        symptoms of schizophrenia as primary target of cognitive behavioral therapy: Results of the  
randomized clinical TONES study Schizophrenia Bulletin 37(2) S98–S110, 2011

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