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Treatment History of Paranoid Schizophrenia

Treatment History of Paranoid Schizophrenia


Today schizophrenia has become a frightening diagnosis. According to the translation from the Greek language schizophrenia means a 'separated or split mind'. This does not mean that a patient is suffering from a multiple personalities disorder, but usually it means that the mind has lost its integrity and a person sick with schizophrenia can not see the difference between the hallucinations and delusions he suffers and the real world.

Scientifically this disease is defined as a mental disorder that causes severe hallucinations and the deformation of reality perception as well as the self – expression problems. The schizophrenic disorder results in patient's social dysfunction meaning that he or she is unable to normally function as a member of the society and is in need of constant medical treatment and care. Usually people sick with schizophrenia are unable to create families or work on a regular full time job as this disorder deprives people of logic thinking, making decisions and simply seeing the world as mentally healthy people do. Severe hallucinations and various fears as well as aggressive, anxious and socially unacceptable behavior may occur very often. These and other serious effects are the signs of the disease.

But there are so many signs and mental conditions caused by schizophrenia that even today there does not exist an objective way to diagnose it. Some scientists even suppose that it is a number of mental disorders that take place. This is why it is so hard to treat schizophrenia and the severe cases are absolutely incurable. The foundation for diagnosis is usually the symptoms which include physical and emotional disorders. At times only the patient himself can share and clarify some additional information about the delusions and hallucinations he has. As no objective way to diagnose this disease exists, the diagnosis has to be set by a very qualified psychiatrist or clinician as the diagnosis will define the further treatment and its possible positive or negative effect. As schizophrenia includes a number of various experiences and disorders it is very often confused with the multiple personalities disorder as well as the severe depression or some emotional states that cause anxiety and multiple fears that make patents emotionally and mentally instable. Sometimes schizophrenia can be defined by the so called "positive" and "negative" effects it has on the personality. In the first case the symptoms include various types of psychosis, thought disorders and hallucinations or delusions. In this case the patient"s intellectual abilities may be normal or sometimes even above average. The symptoms of the second condition include depressive states, slow or disorganized speech, and suppressed emotions. These are considered negative as they prove a slow development or an absence of normal human abilities and reactions such as speech, perception, reaction and others. The theory of the "positive" and "negative" symptoms was first suggested by Eugene Bleuler. He also systemized some symptoms of schizophrenia and included flattened affect, a dysfunction of ideas perception, autism and ambivalence as the possible signs of the illness. A so called "disorganization syndrome" may also take place and that means that the patient is unable to plan events and his life in general. Other symptoms may be represented in weak memory and slow reactions, the patient's inability to solve problems or conflicts or set goals. Sometimes the patient does not have the understanding of social concepts and as a result he is unable to follow the rules of the society or any type of a community. Diagnosing schizophrenia is a very disagreeable issue and it is a matter of constant debates as it is usually scientifically rather invalid. It's hard for the clinicians to provide convincible medical proofs of the sickness. It is obvious that if there is no test for diagnosis or at least a number of common signs according to which schizophrenia could be defined, there exists a wide rage of conditions between the normal state and a schizophrenic disorder and all of those conditions are very individual and specific. Still most scientists believe that the schizophrenic disorder results from a combination of brain dysfunction and lots of stress and both inner and outer pressure that the patient's life may contain. This theory is very widely spread and has gained the name of 'stress-vulnerability' model and right now the efforts of the scientists that study this model are aimed at discovering to which level does each of those conditions impact the development of schizophrenia.

Though the illness is hard to diagnose the American Psychiatric Association and the World Health Organization have created a number of criteria which have to be present for diagnosing schizophrenia. These criteria include the characteristic symptoms represented by a number of "positive" and "negative" signs listed above, social instability, and the last symptom is that the anxiety and disorder signs have to take place for a period of time longer than six months.

One of the most common signs of schizophrenia and the most striking one is hallucinations. These are the sufferings caused by an unusual perception of the world. There exist different kinds of hallucinations including visual, auditory, tactile, gustatory and olfactory. Visual hallucinations means that people see things that none else does, the auditory ones can be represented by hearing voices that come either from the inside or the outside space. In different cases patients believe those voice ordering them what to do or just trying to control their mind. Tactile means feeling or sensing some abnormal influences. Gustatory hallucinations bring the sense of taste and the olfactory provide smelling effects. All these kinds of hallucinations become the cause of anxiety and unpredictable or sometimes even violent behavior with schizophrenic patients.

Another characteristic feature of schizophrenia is mental delusions. These differ from hallucinations greatly as they are represented by the patient's beliefs or thoughts which are false and unsupported. The ill person truly believes these delusions and shows no will to consider the facts that destroy the false thoughts. These delusions take various forms. For example a patient may believe that someone is trying to harm and hurt him or someone is following him or that the staff of the psychiatric hospital is in a conspiracy against him. The delusions and hallucinations that patients posses vary from case to case, but the common feature is that these symptoms create a separate world in the patient's mind. This world isolates the person from the rest of the society and often becomes the cause of fear and anxiety.

The issues that can cause schizophrenia also vary greatly. One of the causes that can contribute to the disorder's development is the environment that a person is surrounded with. It has been scientifically proven that the family issues including violence in the family, bad parenting or childhood stress issues can cause future mental illnesses' development. Depending on the outside pressures the signs of schizophrenia can show both in childhood and the adulthood. The most common time for the breakdowns is late teens when the academic pressures lead to mental disorders and schizophrenia development. The genetic factor also exists so it is possible to inherit the illness from parents. Right now the scientists are doing a research on the schizophrenia's genetic background trying to discover if there exist genes that cause the disorder and if those genes are possible to suppress in order to cure the patient. Schizophrenia can also be caused by psychological or neurobiological influences. Early brain development plays a great role in the possibility of future illness's possession. Problems may occur if a pregnant woman is starving or is under a great physical or psychological pressure and if the woman has stressful emotions or a severe shock state. The future brain development is also of great importance as it has been proven that the brain of the schizophrenia sick person has some structural differences from a normal brain. Neurophysiology and brain functions may also be uncommon for the ill person. The disorders that can cause schizophrenia are most commonly found in the frontal lobes, hippocampus, and temporal lobes of the brain. Other causes of the illness may take place and differ from case to case but the ones listed above are the most widely spread cases.

In the present time the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) separates schizophrenia into five different types each one of which has certain symptoms and treatment specifics. They are: the catatonic type, the disorganized type, the paranoid type, the residual type and the undifferentiated type.

The most widely spread one is the paranoid schizophrenia type. This shows the most severe mental disorder as the patients who suffer from paranoid schizophrenia express constant delusions and share the fact that they hallucinate. Paranoid schizophrenia sick people express excessive violence and rude behavior. They can be extremely dangerous to the society and their family members. The other problem with this type of the disease is that it can never be cured but only the symptoms’ reduction is possible. Some patients spend their entire lives in psychiatric hospitals in constant treatment and attentions but the signs never leave.

To make an example of the paranoid schizophrenia treatment I would like to discuss the history of a patient named Tom, whose story is told by Michael D. Rosberg. Doctor Rosberg was a young clinical intern when he first met Tom. The patient who at the time was forty years old had a long and rather serious history of paranoid schizophrenia. Tom spent more that twenty years of his life in different hospitals and mental institutions. The constant violent behavior and aggression he expressed toward the other members of the society did not allow doctors to let him live in special care centers longer than two or three months. After certain calm periods of adjustment to the new environment passed the new breaks and anger fits started to occur over and over again.

Tom had a rather spread schizophrenia cause as the roots of his illness go to the family environment. His mother suffered from chronic alcoholism for most of her life and Tom’s father was a very violent and aggressive man. So the atmosphere of rude and unstable family environment caused the development of mental problems when Tom was a child. When the patient shared his childhood memories to his physician Tom said that his parents caused his insanity and than left him when the illness occurred. The first break took place when the domestic pressure and constant violence were combined with the problems in high school. This combination was too much for a teenager and Tom's mind could not cope with it anymore. It is important to note that neither the chronic alcoholism nor the domestic violence can be the cause of schizophrenia itself but social pressures of that kind can contribute to the early development of the illness.

The reason for Tom's long hospitalizations was his extremely violent behavior which was probably the consequence of the childhood abuse by his father. Whenever the patient was sent to the boarding house he started expressing uncontrollable rage and anger which scared both the hospital staff and his neighbors. The last hospitalization was caused by a break that was triggered by Tom's schizophrenic delusions. He attacked his roommate stating that he was trying to control Tom’s mind and behavior. Tom believed that he was absolutely normal and mentally healthy but he was made to look like a schizophrenic by the people inside his head who were affecting his mind. Tom believed that there was a conspiracy aimed at making him look insane. The patient's reaction to those delusions was acting out angrily and causing harm to people who surrounded him. A very strange condition was that Tom was completely aware of his actions. He was so smart that he could give a sober analysis to his behavior and he realized it was unhealthy but Tom was unwilling to admit that the delusional voices were false and that he himself was in control of all actions.

At the time when Tom became doctor Rosberg's patient his physical and mental conditions were very disappointing. It was obvious that Tom was unorganized, unwilling to cooperate both with his physician and the society in general, he was trying to isolate himself from the surrounding world which in Tom's vision was dangerous and hostile. The reason for this isolation was the previous treatment in mental institutions. As Tom had a long history of severe schizophrenia previous physicians didn't make much effort to help him and instead of encouraging the patient to get better and to stop the illusions doctors punished and isolated him when the rage breakouts occurred. That only made the patient's condition worse as Tom convinced himself that his therapist wants to harm him. That stopped Tom from cooperating with his doctor as his only desire was to protect himself.

The patient had a short adjustment period at the hospital but as soon as he felt more or less familiar with the place and the staff the new fits of rage began. Tom expressed various conditions: he could either sit alone for hours not making a single move or a sound, or sometimes he started expressing violent and insane thoughts out loud not minding the other patients who surrounded him, or screamed in the sky or yelled at someone when there was none around. Such mental state is called active psychosis. Tom's violent fits of rage that occurred almost every day were very dangerous for both the staff and the patients as he was verbally rude and started throwing things at people whenever something disappointed him. Doctor Rosberg described the patient's condition saying that "Tom seemed an extremely angry, delusional, disorganized man, who withdrew into his own thoughts in response to internal cues. Clinically speaking, Tom's mental status at admission revealed loose associations with occasional lapses into blocked thought processes. He admitted to paranoid delusions, perhaps best described as a feeling of alienation and an amorphous sense of peril". Tom needed to be constantly looked after and he needed some effective treatment as the regular drugs used for schizophrenia control did not help much.
Highly concerned by the matter of Tom's social isolation doctor Rosberg decided to try a different approach. He decided that the treatment would become more effective if the patient stopped being as hostile toward him and expressed some cooperation instead. Doctor Rosberg started spending time with Tom and providing treatment by constantly talking to his patient. When this therapy began Tom was having constant psychotic fits but the doctor continued his sessions and expressed only friendly and caring feelings toward the patient. It was obvious that the reason for Tom's constant hospitalizations was not his schizophrenic condition but mostly his hostility which was caused by the childhood problems and the domestic violence in the family and later the bad treatment by the staff of the hospitals that Tom stayed in. Doctor Rosberg decided to create a friendly relationship that in future would help both him and his patient when the fits of rage and psychotic states occurred. The doctor stated that the most effective thing was not deserting or isolating Tom when he started acting out, but staying by his side and providing therapy that would help him cope with the aggression caused by paranoid schizophrenia. Doctor Rosberg did his best to help Tom set free from the delusions that made the patient believe that the world wants to harm him. The most difficult issue in Tom's delusions was not trusting anyone and blaming others including his therapists and some demonic powers for trying to make him miserable and unhappy. Work with Tom took much of doctor Rosberg's time as he considered a vital factor of the treatment to provide all the necessary time and understanding to his patient. That's why he had to work with Tom both during the day and late in the evening, in his office, the recreation room, Tom's room and literary whenever and wherever he could. And with a lot of time, patience and determination the therapy finally started to give result. Tom's violence seemed to reduce and the patient started expressing cooperation and willingness for his state to improve, which was a huge break through in the history of Tom's treatment. He still suffered a severe schizophrenia but something changed in him and he decided to give a chance to his doctor.

Tom's treatment now consisted of individual psychotherapy sessions with doctor Rosberg, group therapy sessions that he visited every day which impacted on his social behavior changes and taught Tom to live in a community, movement therapy which improved Tom's physical condition greatly. When Tom learned to control his fits of rage and stopped acting out his therapist included daily walks, visits to the museums, movies, libraries, outings to the mountains and parks. These events also improved Tom's social reactions and considering the fact that Tom possessed high intellectual abilities, he rather enjoyed reading.

So step by step Tom's condition improved significantly especially his self awareness and his attitudes toward people. Tom was treated by doctor Rosberg for several years and his condition improved to the level when he was moved to a boarding and care home. After that Tom was never moved to the psychiatric hospital again.

Today a cure from schizophrenia does not exist. The reason for this is not a lack of research in both genetic and pharmaceutical fields as this research is constantly progressing. The problem is that schizophrenia contains a number of symptoms and disorders each one of which represents a clinical case that needs treatment. All of the symptoms can not be cured, but they can only be reduced. The problem is that in stressful situations the illness with it's psychotic attacks will return over and over again. As the history of treatment of Tom's paranoid schizophrenia shows, human experience and personal approach have an even more impact full treatment effect than the other methods.
Another treatment method is the usage of the antipsychotic medications that don't cure schizophrenia either but that remove hallucinations and some other symptoms and make patients more adequate and self aware. In 1990 a new group of drugs called "atypical antipsychotics" was introduced. These medications effectively help reduce schizophrenia signs. The most significant and widely used of these drugs are clozapine (Clozaril®), risperidone (Risperdal®), olanzapine (Zyprexa®). The medications listed above are proven to improve patient’s mental condition. But after the usage of those drugs a patient may suffer some severe side effects including problems with red blood cells and other unhealthy conditions. Antidepressants are also very often used to improve the emotional state of the patient. These exist cases when the usage of medications only worsened the schizophrenic condition of the patient. This is why these medications and any other treatment has to be necessarily provided by a qualified specialist who is well familiar with schizophrenic disorder and in each case individual approach is needed as that is the method that gives the most significant result.

As Tom’s case proves it is important not to isolate the patient and punish him for the sickness breakouts, but to encourage him for cooperation and self improvement.

Another important factor of the treatment is a complex approach. The more symptoms a patient shows the more treatment methods have to be included. At first certain medications are necessary to be given to bring to norm the patient's mental processes and brain activity and to reduce hallucinations, delusions and paranoia. The antidepressants will improve the emotional state and remove violence and anxiety symptoms. Constant psychiatric sessions with a qualified physician who is dedicated to his patients and whom patients respect and express willingness to cooperate with are one of the most significant factors. Group therapy needs to be provided in order to improve social skills and to re – educate people who suffer from paranoid schizophrenia. As practice shows, reading, visiting museums and other types of spiritual development contribute to the faster symptoms’ reduction with patients. Movement therapy that would include such modern trends as yoga or dance simplified for people with limited physical abilities would help patients learn more about their body and of the opportunities it gives. And through physical exercise mental processes would improve faster. This type of exercise would be interesting, developing and calming for the patient. Another feature of the complex treatment should be some exercises that develop stability, memory and organization with patients who suffer the symptoms of disorganized schizophrenia and anxiety. This complex treatment is aimed at preparing the person sick with schizophrenia to live outside the psychiatric hospital and not to create danger to their family members and the society. The complex treatment method combined with the cooperation of both the patient and his family will make possible for the schizophrenic symptoms to reduce and for the person to live in a boarding house or with his family and suffer less.

The research that is constantly led to create a method or a schizophrenia cure is moving step by step and the affectivity of drugs constantly rises which opens new opportunities and gives new hope for people sick with schizophrenia.





Works Cited:
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http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec1.html

NIMH. Schizophrenia publications. http://www.nimh.nih.gov/publicat/schizmenu.cfm

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Rosberg D. Treatment resistance is not terminal, the case of Tom.

Posted by: Andrew Blanks

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