Schizophrenia
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Our perception of schizophrenia is largely shaped by what we see in the movies. Is schizophrenia more than just a 'hallucination' disease? Check out this lesson to find out about the different types of schizophrenia.
In the 2002 movie 'A Beautiful Mind,' genius mathematician John Nash arrives at Princeton and befriends his roommate, Charles. Charles is funny, charming, the two get along well. It is very unsettling when, later on the movie, Nash is told that he never had a roommate at Princeton. He had a single room. Charles had been a hallucination, a symptom of the schizophrenia that Nash was beginning to suffer.
Schizophrenia is known as a psychotic disorder, characterized by patients who lose touch with reality. It's more common in men than in women and tends to develop in men at an earlier age, between 20 and 28, while in women it typically develops between the ages of 26 and 32. Reasons for this gender difference in onset, as well as in brain structure and response to treatment, are not well understood.
In the movies, these kinds of visual hallucinations are striking - but often overstated - representations of what it's like to live with schizophrenia. In reality, most patients, including Nash, experience auditory hallucinations only, though hallucinations may occur in any of the senses. They are known as positive symptoms of schizophrenia, or symptoms that are more than what a normal person experiences. Hearing a voice offering running commentary on your behavior (rather like the annoying 'director's commentary' on a DVD), or hearing several voices talking amongst themselves, are 'additional' sensations that most people don't have. Other 'positive' symptoms of schizophrenia include delusions - thinking you're someone you're not, thinking that the government is trying to take your refrigerator - and disordered thought or speech, which is what it sounds like: patterns of thought or speech that others can't follow or make sense of.
But there are also negative symptoms of schizophrenia, which are defined - not surprisingly - as symptoms that make a patient's experience less than other people's. One of these is blunted affect, or emotions that don't seem to run the full range or are experienced less intensely. Similar to blunted affect is anhedonia, or the inability to experience pleasure. Social withdrawal and lack of motivation are other negative symptoms, though perhaps consequences themselves of a blunted emotional experience and inability to experience pleasure. Some patients stop speaking entirely, known as alogia. Still others descend to a near-catatonic state, in which they are entirely unresponsive to the world around them.
Positive and negative symptoms appear in different balances across the five main types of schizophrenia. The paranoid type, which is what John Nash suffered from, is characterized by mainly positive symptoms: the hallucinations and delusions tend to be persecutory, where the patient feels that he is very important and people are out to get him. This type tends to have a later onset than others, and a better outlook in terms of maintaining normal life activities. The disorganized type of schizophrenia is largely dominated by negative symptoms; positive symptom disordered thought and speech accompanied by negative symptoms emotional flatness, anhedonia, and lack of motivation. The catatonic type has patients either entirely immobile, or in motion with no purposes. These patients sometimes exhibit waxy flexibility, which means they will not resist their arms or legs being moved, and will then remain in whatever position they're placed indefinitely. The undifferentiated type are patients who have symptoms of schizophrenia, but can't be classified into any of the other types. Residual type patients have positive symptoms, but at a very low intensity.
Like most psychological disorders, schizophrenia has a variety of potential causes. There is a genetic component; if one identical twin has schizophrenia, the other, who shares a genome, has a 48% chance of having it, too. A fraternal twin of someone with schizophrenia has only a 17% chance of having it. There is some evidence that too much of the neurotransmitter dopamine might contribute to the disease, as do certain brain structures, like larger fluid filled ventricles and smaller hippocampi.
So to sum things up, we've learned about schizophrenia, which has positive symptoms (things that most people don't experience but schizophrenics do) and negative symptoms (things that most people do experience while schizophrenics do not). Depending on which kinds of symptoms you have, you can be diagnosed with one of five types of schizophrenia: paranoid, disorganized, catatonic, undifferentiated and residual. So as you can see, there are lots of different ways that schizophrenia can manifest itself; it's not just John Nash seeing a roommate who doesn't exist.