By reading my biographical information, you can see that much of my nursing career has been devoted to psychiatric nursing. Before I became a psychiatric nurse, I had little understanding of what it is like to be severely mentally ill. I merely thought that some people were just ‘crazy’.
After I became more educated by nursing in the psychiatric medical field, my outlook totally changed. There are numerous mental illnesses that impact the lives of patients and their families. Today, I want to focus on schizophrenia.
Some of the specific classifications and medical definitions that I will present is taken from an article entitled “Types of Schizophrenia”. It was written by Arthur Schoenstadt, MD. The 2006-2010 copyright is held by Clinaero, Inc.
Dr. Schoenstadt identifies and defines 5 types of schizophrenia. They are listed below.
***Paranoid Schizophrenia – This is the most common type. People with paranoid schizophrenia usually experience delusions, auditory hallucinations, or visual hallucinations.
Delusions are thoughts that are not reality-based. For example, someone may feel that they are being monitored by the TV, that government officials are ‘spying’ on them via satellites, or that someone is attempting to poison them.
When the two jets crashed into the Twin Towers of New York City on September 11, 2001, many psychiatric patients (with which I had contact) experienced delusions regarding this incident. I can remember being told by numerous patients that they had ‘inside’ information about the crashes. They were insistent that this information needed to be made public.
Auditory hallucinations (AH) occur when people hear voices in their head that nobody else can hear. Sometimes the voices are friendly and provide entertainment. More often, they are not. The voices can be demeaning, threatening, harrassing, and overall frightening.
Visual hallucinations (VH) occur when people see things that nobody else is seeing. For example, they may report seeing people that are dead, threatening spirits (ghosts), spiders, snakes, etc.
***Disorganized Schizophrenia – People with this type of schizophrenia often have unusual thought processes. Their thinking may become so disorganized that it is difficult to connect their thoughts logically. Their speech may be garbled or hard to understand.
Another symptom is ‘thought-blocking’. This occurs during normal conversation when the person stops abruptly in the middle of a sentence. They are unable to continue the conversation since they can’t recall what it is that they were going to say.
When asked to continue, they may utilize a defense mechanism. To protect their dignity or attempt to minimize their disease process, they often choose to make up words that no one can understand. These words are called “neologisms”.
***Catatonic Schizophrenia – People with this type of schizophrenia may be clumsy and uncoordinated. They may exhibit involuntary movements, facial grimacing, or other unusual mannerisms. Often, certain movements are repeated over and over.
Catatonia is literally a state of immobility. This was more common before medications and other treatments for schizophrenia were available. Now the state of catatonia is seen less often.
During my years of psychiatric nursing, I was exposed to only one patient that was truly catatotonic. The patient was brought to the hospital by local police that had noticed someone walking in the middle of the road on a public highway.
The patient was unable to speak or acknowledge staff in any way. In order to keep the person’s nutritional status intact, staff had to become creative by spoon-feeding liquids and soft foods. When this method proved to be ineffective, an IV (intravenous line into a vein) was placed so that nutrition could be administered.
When the patient recovered sufficiently to be able to walk, staff would assist the person out of bed to walk around on the unit. The purpose of having patients ambulate is to prevent formation of blood clots and decubitis ulcers (commonly called bed sores). Also, walking keeps muscles from becoming inactive.
Staff began to encourage the patient to change clothes, bathe, etc. A closet in the room held the necessary supplies. When staff removed a shirt, the patient smelled cologne / perfume on the shirt. The state of catatonia immediately ceased, and the patient was able to recall interactions with staff during the catatonic state.
***Residual Schizophrenia – This diagnosis is given when people have experienced long-term schizophrenia. The person may no longer exhibit positive symptoms, such as halllucinations, delusions, disorganized speech, or catatonic behavior; however, negative symptoms are still present.
Negative symptoms refer to signs that are less prominent. Such signs would included a ‘flat’ affect (no facial expression and a monotonous voice). Also included could be a lack of pleasure in daily activities, known as anhedonia. The person might also be resisitive to interacting with others and choose to interact only when encouraged to do so.
***Undifferentiated Schizophrenia – This diagnosis is given when a person meets the criteria to be diagnosed with schizophrenia; however, the normal signs and symptoms exhibited are not consistent with any of the other four classes of schizophrenia.
People with schizophrenia usually have other family members that have also been diagnosed with the mental illness. There is a definite genetic ‘link’. Often, the disease will be diagnosed during the late teen years or early adult years.
A contributing factor to the onset of schizophrenia is extreme stress. An example of a situation like this would be choosing a college program – such as medicine, engineering, physics – that would require an extreme amount of studying and dedication. The body becomes so physically and mentally impacted that it cannot endure.
If you have a family history of schizophrenia or know someone that you feel might need help, it is vital to educate yourself about this disease.
A few years ago, the movie “A Beautiful Mind” was released. The lead role in the movie is played by Russell Crowe. It is a true study based on the life of a mathematician enrolled in an Ivy League college.
I attended the movie, along with some friends who also worked in the behavioral health field of medicine. I can remember watching the movie and wondering when the character was going to have his schizophrenic ‘break’.
As the movie progressed, I realized that the entire movie depicted the delusions of the mathematician. His roommate, friends, etc. did not really exist. These were visual and auditory hallucinations.
The mathematician was able to overcome his schizophrenia by learning to ignore the hallucinations. He had a son who later was also diagnosed with schizophrenia. (Remember that schizophrenia is often inherited). His son was attempting to utilize the same system.
Again, let me stress that people (who are often unfairly categorized as ‘crazy’) may actually be suffering from a mental illness that is treatable. The disease may be controlled by the proper medications and therapy under the supervision of a qualified mental health specialist.
If you suspect that you or someone that you know may be suffering from schizophrenia, do not suffer in silence. The following are local mental health facilities that can be utilized.
***Comprehensive Care provides treatment on a ‘sliding scale’ based on income. It is located at 1351 Newtown Pike in Lexington. Their phone number is 859-271-9448.
***St. Jospeh Behavioral Network is located at 861 Corporate Drive, Suite 103 in Lexington. Their phone number is 859-224-2002.
**Eastern State Hospital is located at 627 West 4th Street in Lexington. Their phone number is 859-246-7000.
Help is available. Take the first step by reaching out to someone who cares !!!