The split world of Schizophrenia

The mental disorders of psychosis and schizophrenia have always been discussed interchangeably even in the medical circles, but there exists a clear delimitation between the two.

Psychosis refers to a group of symptoms that indicate loss of touch with reality and usually presents with symptoms like delusions which is a strong false belief, hallucinations. 

It is characterised by seeing and hearing things that are not present, and can occur in a number of mental health disorders including; substance use, severe depression, schizophrenia and other medical issues.

Schizophrenia on the other hand is a distinct mental disorder characterized by the mentioned psychotic symptoms among others. This leading to disorganised thought processing, emotional responsiveness, perceptions and social interactions, all these leading to impaired functioning in daily life.

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The term Schizophrenia was coined by Swiss Psychiatrist Eugen Bleuler in 1908, he combined the two Greek words ‘schizein’ meaning split and ‘phren’ meaning mind or soul in a bid to describe the fragmentation of the mental functions of thoughts emotions and perceptions.

Colloquially in Swahili culture those exhibiting the symptoms of this condition are referred to as ‘watu wa akili mbili’ (two minded or split mind).

The symptoms of this disorder have led to many myths and misconceptions about the origin of this conditions from witchcraft, curses, bad parenting, urban living and purely genetics.

Even though some of them like parenting, urban living and genetics have some predisposing, we now know that there are a myriad other factors that can lead to this condition.

The myths and misconceptions have led to these patients being labeled dangerous, untreatable, ‘mad’ or ‘crazy’ hence negatively influencing public opinion and social attitudes towards them, and eventually affecting how their care is designed and rolled out.

Schizophrenia symptoms are grouped into positive, negative and cognitive symptoms. Positive symptoms present with distortions or exaggerations of normal functions hence resulting in hallucinations, delusions, disorganized speech. 

This speech is either incoherent, jumbled or confused, abnormal motor behavior characterized by unusual movement, repetitive actions and catatonia. Catatonia is remaining motionless for prolonged periods.

The negative symptoms present with loss of normal or reduced functioning. It is characterized by social withdrawal with minimal desire for interactions with others, anhedonia which is the inability to experience pleasure from activities one enjoyed previously; Alogia which is poor speech with minimal verbal output; Avolition which is loss of motivation to initiate and maintain purposeful and meaningful activities. Finally there is affective flattening, indicated by reduced emotional expression and lack of facial expressions.

The cognitive symptoms indicate impaired thinking and reasoning. This presenting with memory issues affecting working memory and one’s ability to recall information, attention deficits leading to inability to perform tasks and focusing and poor executive functioning leading to difficulty in thought organization, decision making and planning.

Predisposing factors to schizophrenia includes genetic factors indicating a big heritable component, neurodevelopmental factors play a role with changes in brain chemistry and structure affecting one’s functioning, and environmental factors have also been implicated especially during prenatal and early childhood.

 The writer is a licensed psychologist/psychiatrist clinical officer and lecturer KMTC Meru Campus