UQx PSYC1030.3x 2-4-1 Course of Schizophrenia


The media can portray people diagnosed with
Schizophrenia as violent, crazy, and in need of institutionalization. As a matter of fact, violence is not in itself
a symptom of Schizophrenia. Schizophrenia is an episodic illness, with
the majority of people with schizophrenia experiencing more than one psychotic episode. There are typically three phases to a psychotic
episode in schizophrenia. To begin with, there’s a prodromal phase. Generally, this is characterised by a decline
in functioning. During the prodromal phase, negative symptoms
such as lack of motivation, social withdrawal, and a decline in self-care appear. A person might stop showering, putting on
deodorant, that sort of thing. They might start spending a lot more time
in their bedroom, and may not be able to summon up the motivation to join their family or
friends for meals. The prodromal phase is essentially the lead
in to the active phase of the episode. Unfortunately, the prodromal phase – at
least for the very first episode of a person’s illness – is something that usually we can
only diagnose retrospectively. The first time a person experiences a psychotic
episode, it’s often unclear exactly what is going on. Sometimes this is because family and friends
think that the negative symptoms that make up the prodromal phase fall within the broad
parameters of what is developmentally normal. Let me tell you about a case to explain what
I mean. I worked with a young man who developed schizophrenia
at the age of 18. He had been brought into the emergency department
of the hospital after being picked up by police wandering naked and confused on the streets. When I talked with his parents the next morning
about what had been going on in the months and weeks prior to this incident––which
was the first psychotic episode he had experienced––they said to me… “Yes, you know, now that you’re asking
us these questions, we’re realising that he has been acting differently for the last
couple of months. He has withdrawn more from the family. He has been spending a lot of time in his
bedroom, and his bedroom smells disgusting. He’s got half-eaten sandwiches in his room
that have been there for more than a week. He never puts anything in the dishwasher so
it just stinks in there. We’re not even sure when he last had a shower”. “I have been worried”, mum went on to
say, “I guess I was just hoping that maybe he
was going through a phase, and that all of that stuff was something that lots of 18-year-old
boys do.” Sadly, that’s a really common theme you
hear from parents. So, we typically identify the prodromal phase
of a first episode retrospectively, once the person has moved into the active phase of
the illness. The prodromal phase may last for days, weeks,
or months. Generally speaking, a shorter prodrome, or
a more acute onset, is associated with a better prognosis or outcome. A longer, more chronic onset, or prodrome
is associated with a worse prognosis. In the active phase, the positive symptoms
begin to appear. However, each person’s symptom profile is
different, with some people having a symptom profile that is dominated by positive or negative
symptoms and others having a symptom profile that is more of a mixture of positive and
negative symptoms.. Importantly, a predominance of negative symptoms
compared to positive symptoms tends to be a poor prognostic indicator. The last phase of the episode is the residual
phase where the person presents as significantly more well compared to the active phase. The positive symptoms have typically remitted––usually
with the help of medication––but some negative symptoms remain. For example, difficulty concentrating and
listlessness. In many ways, the residual phase is similar
to the prodromal phase.

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