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ABNORMAL PSYCHOLOGY

GANGGUAN SCHIZOPHRENIA

    Harini ini kita akan cerita sedikit tentang psikologi abnormal yang juga adalah cabang psikologi yang mengkaji tingkah laku yang menyimpang dari norma, yang sering kali dikaitkan dengan gangguan mental. Salah satu gangguan mental yang paling kompleks dan sukar difahami ialah skizofrenia. Skizofrenia adalah gangguan mental kronik yang mempengaruhi cara seseorang berfikir, merasai, dan berkelakuan. Individu dengan skizofrenia mungkin kelihatan seperti telah hilang hubungan dengan realiti, yang boleh menyebabkan penderitaan yang besar bagi mereka dan orang-orang di sekeliling mereka. Dalam karangan ini, kita akan meneroka skizofrenia dari pelbagai sudut, termasuk simptom, punca, dan rawatannya. Untuk memberikan pemahaman yang lebih komprehensif, kita juga akan menyertakan contoh kes yang menggambarkan bagaimana skizofrenia mempengaruhi kehidupan seharian seseorang.

Simptom Skizofrenia

    Simptom skizofrenia biasanya dibahagikan kepada tiga kategori utama: positif, negatif, dan kognitif. Simptom positif merujuk kepada tingkah laku yang ditambahkan pada personaliti seseorang, seperti delusi dan halusinasi. Delusi adalah kepercayaan yang salah yang tidak sesuai dengan realiti, seperti kepercayaan bahawa seseorang sedang diawasi oleh agen kerajaan. Halusinasi, yang paling biasa ialah halusinasi pendengaran, melibatkan mendengar suara-suara yang tidak ada.

    Simptom negatif adalah pengurangan atau kehilangan keupayaan untuk berfungsi secara normal. Ini termasuk kekurangan motivasi, kemampuan emosi yang rata, dan pengunduran diri daripada interaksi sosial. Individu dengan simptom negatif mungkin menghadapi kesukaran untuk menjaga hubungan atau pekerjaan.

    Simptom kognitif melibatkan masalah dengan pemikiran dan ingatan. Ini boleh berupa kesukaran dalam memahami maklumat atau membuat keputusan, serta gangguan pada fungsi eksekutif yang melibatkan perancangan dan pengorganisasian.

Rawatan Skizofrenia

Rawatan skizofrenia biasanya melibatkan gabungan terapi ubat dan terapi psikososial. Ubat antipsikotik adalah pilihan utama dalam mengurangkan simptom positif seperti delusi dan halusinasi. Walau bagaimanapun, ubat ini seringkali mempunyai kesan sampingan yang ketara, oleh itu pengawasan perubatan yang ketat diperlukan.

Terapi psikososial, termasuk terapi kognitif-tingkah laku (CBT), terapi keluarga, dan pemulihan sosial, penting untuk membantu individu mengurus simptom mereka dan meningkatkan fungsi harian. Sokongan dari keluarga dan komuniti juga sangat penting dalam proses pemulihan.

Punca Skizofrenia

    Punca skizofrenia masih belum difahami sepenuhnya, namun para saintis percaya bahawa ia adalah hasil daripada gabungan faktor genetik, biokimia, dan persekitaran. Faktor genetik memainkan peranan penting; seseorang yang mempunyai ahli keluarga dengan skizofrenia mempunyai risiko lebih tinggi untuk mengembangkan gangguan ini. Penyelidikan juga menunjukkan bahawa ketidakseimbangan neurotransmiter, seperti dopamin, menyumbang kepada perkembangan skizofrenia.

    Faktor persekitaran seperti tekanan yang melampau atau pendedahan kepada virus tertentu semasa perkembangan janin juga boleh meningkatkan risiko. Selain itu, penggunaan dadah, terutamanya bahan-bahan yang mempengaruhi otak seperti ganja, telah dikaitkan dengan peningkatan risiko skizofrenia pada individu yang mempunyai kerentanan genetik.

Contoh Kes: Ahmad

    Ahmad, seorang lelaki berusia 25 tahun, mula menunjukkan tanda-tanda skizofrenia ketika dia berusia 20 tahun. Pada mulanya, keluarganya menganggap perubahan tingkah lakunya sebagai fasa sementara. Namun, Ahmad mula berbicara tentang konspirasi yang melibatkan jiran-jirannya dan merasakan bahawa orang-orang di televisyen sedang menghantar mesej rahsia kepadanya. Dia juga mendengar suara-suara yang menyuruhnya melakukan perkara-perkara tertentu.

    Keadaan Ahmad semakin buruk apabila dia berhenti dari pekerjaannya dan mula menarik diri daripada rakan-rakannya. Keluarganya membawanya ke pakar psikiatri, di mana Ahmad didiagnosis dengan skizofrenia. Dengan gabungan ubat antipsikotik dan terapi psikososial, Ahmad mula menunjukkan peningkatan. Dia belajar mengenal pasti dan mengatasi delusi serta halusinasinya melalui CBT, dan mula berinteraksi semula dengan orang-orang di sekelilingnya.

    Walaupun Ahmad masih menghadapi cabaran, sokongan yang konsisten dari keluarga dan komuniti, serta rawatan perubatan yang tepat, membantunya untuk menjalani kehidupan yang lebih stabil dan produktif.

    Skizofrenia adalah gangguan mental yang kompleks dengan simptom yang pelbagai dan punca yang multifaktorial. Walaupun begitu, dengan rawatan yang tepat dan sokongan yang memadai, individu dengan skizofrenia dapat menjalani kehidupan yang lebih baik dan lebih bermakna. Memahami skizofrenia secara mendalam bukan sahaja membantu dalam pengembangan rawatan yang lebih berkesan tetapi juga meningkatkan empati dan sokongan bagi mereka yang terkena kesan gangguan ini.

ABNORMAL PSYCHOLOGY

SCHIZOPHRENIA

Schizophrenia is a psychotic disorder characterized by major disturbances in thought, emotion, and behavior – disordered thinking in which ideas are not logically related; faulty perception and attention; bizarre disturbances in motor activity; and flat or inappropriate affect. 

Schizophrenia patients withdraw from people and reality, often into a fantasy life of delusions and hallucinations. 

Eugen Bleuler (1908), a Swiss psychiatrist has introduced the term schizophrenia. 

Schizophrenia comes from the combination of words (Greek) – “split” (skhizein) and “mind” (phren). 

 DSM-TR-IV: Table 13.1 (Diagnostic Criteria for Schizophrenia)

Clinical Description, Symptoms and Subtypes 

Mental health worker distinguish schizophrenia into 3 different dimensions: positive symptoms, negative symptoms and disorganized symptoms. 

Positive symptoms generally include the more active manifestations of abnormal behavior or an excess or distortion of normal behavior; these include delusions and hallucinations. 

Negative symptoms involve deficits in normal behavior in such areas as speech and motivation. o Disorganized symptoms include rambling speech, erratic behavior and inappropriate affect (for example, smiling when you are upset). 

A diagnosis of schizophrenia requires that 2 or more positive, negative and/or disorganized symptoms be present for at least 1 month. 

Positive Symptoms 

Between 50% and 70% of people with schizophrenia experience hallucinations, delusions or both (Lindenmayer & Khan, 2006). 

Delusions: 

❑ Delusion has been called “the basic characteristic of madness”. 

❑ Somatic (physical) delusion – believing, for example, that their bodies are rotting internally and deteriorating into nothingness. 

❑ Delusions of grandeur – believing, for example they are supernatural or supremely gifted. 

❑ Delusions of persecution – believing others are “out to get them”. 

❑ Capgras syndrome – the person believes someone he or she knows has been replaced by a double.

❑ Cotard’s syndrome - the person believes he is dead. 

❑ Why someone come to believe such obviously improbable things? 

❑ It can be summarized into 2 themes – motivational or deficit theories. 

❑ A motivational view of delusions would look at these belief as attempts to deal with and relieve anxiety and stress. A person develops “stories” around some issues that in a way helps the person makes sense out of uncontrollable anxieties in a tumultuous world. 

❑ Deficit view of delusion sees these beliefs as resulting from brain dysfunction that creates these disordered cognitions or perceptions.

Hallucinations: 

❑ The experience of sensory events without any input from the surrounding environment is called hallucination. 

❑ Auditory hallucination – hearing things that are not there (is the most common form experienced by people with schizophrenia). 

❑ Exciting research on hallucinations – using Single Photon Emission Computer Tomography (SPECT). 

❑ It was found that the part of the brain most active during hallucinations was Broca’s area. This is surprising because broca’s area is known to be involved in speech production, rather than language comprehension. Because auditory hallucinations usually involve understanding the “speech” of others, you might expect more activity in Wernicke’s area, which involves language comprehension. 

❑ These observations support the metacognition theory that people who are hallucinating are not hearing voice of others but are listening to their own thoughts or their own voices and cannot recognize the difference. 

Negative Symptoms 

Usually indicate the absence or insufficiency of normal behavior. They include apathy, poverty of thought or speech and emotional and social withdrawal – 25% people with schizophrenia display these symptoms. 

Avolition: 

o Prefix “a” meaning without and volition, which means “an act of willing, choosing or deciding.” 

o Avolition is the inability to initiate and persist activities. 

o People with this symptom show little interest in performing even the most basic day-to-day functions – including personal hygiene. 

Alogia

o Combination of “a” (without) and logos (“words”). 

o Alogia refers to the relative absence of speech. 

Anhedonia

o “a” (without) and hedonic (“pertaining to pleasure”). 

o Anhedonia is the presumed lack of pleasure experienced by some people with schizophrenia. o Lack of interest to activities such as eating, social interactions and sexual relations. 

Affective Flattening: 

o Imagine that people wore masks at all times: You could communicate with them verbally, but you would not be able to see their emotional reactions.

Disorganized Symptoms 

Disorganized Speech: 

o The person who have been diagnosed as having this symptom typically can share their thought with others, sometimes they jump from topic to topic. 

Inappropriate Affect and Disorganized Behavior: 

o Occasionally, people with schizophrenia display inappropriate affect, laughing or crying at improper time. 

o Sometimes they exhibit bizarre behaviors such as hoarding objects or acting in unusual ways in public. 

Schizophrenia Subtypes 

Paranoid Type (DSM-IV-TR: Table 13.2): 

➢ Preoccupation with one or more delusions or frequent auditory hallucinations. 

➢ They generally do not have disorganized speech or flat affect, they typically have a better prognosis than people with other forms of schizophrenia. 

➢ The delusions and hallucinations – grandeur or persecution. 

Disorganized Type (DSM-IV-TR: Table 13.3): 

➢ Show marked disruption in their speech and behavior; they also show flat or inappropriate affect, such as laughing in a silly way at the wrong times. 

➢ They also seem unusually self-absorbed and may spend considerable amounts of time looking at themselves in the mirror. 

Catatonic Type (DSM-IV-TR: Table 13.4): 

➢ In addition to the unusual motor responses of remaining in fixed positions (waxy flexibility – limbs and body position can be moved by others) and engaging in excessive activity. 

➢ They sometimes display odd mannerisms with their body and faces, including grimacing. 

Undifferentiated Type: 

➢ People who do not fit neatly into any of the subtype. 

➢ They include people who have major symptoms but who do not meet the criteria of paranoid, disorganized or catatonic types. 

Residual Type (DSM-IV-TR: Table 13.5): 

➢ People who have had at least 1 episode of schizophrenia but who no longer manifest major symptoms. 

➢ Although they may not suffer from bizarre delusions or hallucinations, they may display residual or leftover symptoms, such as negative beliefs, or they may still have unusual ideas that are not fully delusional. 

Other Psychotic Disorders 

Schizophreniform Disorder (DSM-IV-TR: Table13.6): 

❑ Some people experience the symptoms of schizophrenia for a few months only; they can usually resume normal lives. 

❑ The symptoms sometimes disappear as the result of successful treatment but they often do so for reasons unknown. 

Schizoaffective Disorder (DSM-IV-TR: Table 13.7): 

❑ People who had symptoms of schizophrenia and exhibited the characteristics of mood disorders (for example, depression or bipolar disorder). 

❑ Presence of mood disorder, delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms. 

Delusional Disorder (DSM-IV-TR: Table 13.8): 

❑ Is a persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia. 

❑ For example, a woman who believes without any evidence that coworkers are tormenting her by putting poison in her food and spraying her apartment with harmful gases has a delusional disorder. 

❑ This disorder is characterized by a persistent delusion that is not the result of an organic factor such as brain seizures or of any severe psychosis. 

❑ Individual with delusion disorder tend not to have flat affect, anhedonia, or other negative symptoms of schizophrenia; importantly, however, they may become socially isolated because they are suspicious of others. 

Brief Psychotic Disorder (DSM-IV-TR: Table 13.9): 

❑ Brief psychotic disorder – characterized by the presence of one or more positive symptoms such as delusions, hallucinations, or disorganized speech behavior lasting 1 month or less. 

Shared Psychotic Disorder (DSM-IV-TR: Table 13.10): 

❑ The condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual. 

Prevalence and Causes of Schizophrenia 

Cultural Factors: 

❑ Kraepelin, who was described as developing the modern-day view of schizophrenia, traveled to Asia at the turn of the last century to confirm that this unusual set of behaviors was experienced by cultures other than those of Western Europe. 

❑ People in extremely diverse cultures have the symptoms of schizophrenia, which supports the notion that is a reality for many people worldwide. 

❑ Schizophrenia is thus universal, affecting all racial and cultural groups studied so far. 

Genetic Influences: 

❑ Genes are responsible for making some individuals vulnerable to schizophrenia. 

Family Studies: 

❑ Gottesman (1991) summarized the data from about 40 studies of schizophrenia. 

❑ The risk of having schizophrenia varies according to how many genes an individual shares with someone who has the disorder. 

❑ For example – you have the greatest chance (48%) of having schizophrenia if it has affected your identical (monozygotic) twin, a person shares 100% of your genetic info. 

Twin Studies: 

▪ Nicknamed – “Genain” quadruplets. 

▪ Nora, Iris, Myra and Hester – represent the letters NIMH for the National Institute of Mental Health. 

▪ The women represent the complex interaction between genetics and environment. ▪ All were brought up in the same dysfunctional household. 

▪ Yet the time onset for schizophrenia, the symptoms and diagnoses, the course of the disorder, and ultimately their outcomes, differed significantly from sister to sister. 

Adoption Studies: 

❑ The largest adoption study is currently being conducted in Finland. 

❑ From a sample of almost 20,000 women with schizophrenia, the researchers found 190 children who have been given up for adoption. 

❑ If an adopted child had a biological mother with schizophrenia, the child had about a 5% chance of having disorder. However, if the biological mother had schizophrenia or one of related psychotic disorders the risk that the adopted child would have one of these disorders rose to about 22%.

Dopamine: 

❑ When drugs are administered that are known to increase dopamine, there is an increase in schizophrenic behavior; when drugs that are known to decrease dopamine activity are used, schizophrenic symptoms tend to diminish. 

❑ Taking these observations together, researchers theorized that schizophrenia in some people was attributable to excessive dopamine activity

Psychological and Social Influences: Stress: 

❑ One research study used a natural disaster – 1994 Northridge, California earthquake – to assess how people with schizophrenia would react to this stress when compared to those bipolar disorder and healthy controls. 

❑ Both patient groups reported more stress-related symptoms compared to the controls; however the people with schizophrenia reported lower level of self-esteem after the disaster.