Schizophrenia
Case study:
SCHIZOPHRENIA: Jack
 
Jack, born in 1981, was the third of four brothers. Jack describes his
upbringing as happy although his family had several failed
businesses and not much money until his father eventually started a
successful business.
 
When Jack was 18 months old his mother became very depressed,
her fourth child having been stillborn. Devastated by the tragedy she
stopped eating and began drinking heavily. She eventually became
so depressed she could no longer function and had to be hospitalised.
During this time his father worked long hours and care of Jack and
his brothers fell to a series of nannies. Two years later his mother
gave birth to a healthy fourth child. She was restored to her former
self and told family members the child had been her ‘salvation’.
 
Throughout childhood Jack was a bright student at school, he was
happy motivated and typically finished top of the class. He was also
good at sports and he received much of his parent’s attention who
had high hopes for his future. However things changed for Jack
towards the end of High school when his father suffered a heart
attack. He could no longer concentrate on his studies and spent much
of his time praying for his father’s recovery. His father did recover
and Jack was convinced it was due to his prayers.
At the end of secondary school Jack received poor grades and
seemed to have lost his bearings. Eventually he stopped going out
and spent much of his time in front of a television set in his room.
However this was not due to laziness or lack of interest in people
but rather Jack was coming to believe that he had special powers.
He would closely observe the movements of every character on
screen trying to determine the extent of his influence. The more he
watched the more his suspicions were confirmed. His effect on the
characters was just too obvious to deny. Jack concluded that a
specific change had occurred. He had acquired the capacity to
control other people’s emotions and behaviour. Gradually, he
became convinced that not only people but objects such as traffic
signals and cars were responding to his influence. He concluded
that he, like God, must have a ‘life force’ in his breath and he
believed he had been selected for some sort of holy mission. With
this discovery Jack also became increasingly convinced that people
were talking about him behind his back. On a bus he believed that
passengers were engaged in conversation about him, while others
were glancing and pointing. This, he presumed, meant they knew
about his powers.
As Jack’s discovery of his special powers evolved into the hearing
of voices, then into his understanding that he would be the
Messiah, and finally into his realisation that others were talking
about him, he became more and more confused. One day after an
intense session in front of the television he began babbling
incoherently about “angels” and a “life force” in his breath.
Objectives

 According to DSM 5 the diagnosis for Jack is considered as schizophrenia.

 Psychological approach ( cognitive behavioral therapy) and social therapy will be discussed as supporting

theories for Jack’s condition.

 Family therapy and individual therapy and cognitive behavioral therapy (CBT) can be proposed as treatment

methods to Jack
Introduction

 Schizophrenia is classified as a psychotic disorder.

 People with schizophrenia have symptoms of psychosis. (Lavretsky H, 2008)

 It is a chronic, debilitating mental illness, it affects approximately 1% of the population. Owing to the

10% lifetime prevalence of suicide .(freedman R, 2003).

 Early recognition and appropriate treatment are imperative.(Siris, S. G, 2001).

 Schizophrenia typically presents in late adolescence and persists throughout the patient's life.

 Males typically experience symptoms 5 to 7 years earlier than females.(Tandon, 2009).

 The term of ‘schzoprenia’ was first used by Eugene Bleuler in 1911

Diagnostic Criteria
1. Presence of at least two of the following symptom types,

a. Delusions d. Disorganized behavior

b. Hallucinations
e. Negative symptoms
c. Disorganized speech

2. The symptoms are to be experienced for at least six months.

3. The person experiences significant problems with work and social functioning as a result of their symptoms.

4. The diagnosing clinician can determine that the symptoms the person has been experiencing are not caused by another

medical or psychiatric condition or substance use.

(American Psychiatric Association. (2013).

 Other Symptoms
.  Distractibility

 Anger

 Anxiety

 Depression

 Lack of insight

 Sleep disturbances

 Substance use (especially tobacco use)

Figure 1: Amy Morin, (2021)

https://www.verywellmind.com/idenSchizopheria in children verywell mind
tifying-schizophrenia-in-children-4155780
Symptoms of schizophrenia are referred to as positive or negative.

Positive symptoms Negative symptoms

Present in someone with schizophrenia that Present in someone with schizophrenia, that the person is

someone without schizophrenia or another mental experiencing an absence or reduction of certain traits that are

health condition would not experience. often present in healthier individuals

Examples Examples

 Delusions  Flattened affect

 Hallucinations  Anhedonia

 Disorganized speech  Reduced speech

 Disorganized behavior  Lack of initiative

(American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).).
 Types of delusion
Delusions
1. Persecutory delusion
Delusions are fixed false beliefs that
2. Referential delusion
don’t make sense in the context of a
3. Somatic delusion
person’s culture.
4. Erotomanic delusions
People with psychotic delusions can’t
5. Religious delusions
be convinced that their beliefs aren’t
6. Grandiose delusions
real.

(American Psychiatric Association. (2013).

(Jeniffer Caserella (2020)
Hallucinations
Hallucinations are false sensory experiences

that have no basis in the external world.

occur when the person is fully awake and not

under the influence of alcohol or illicit drugs.

(American Psychiatric Association. (2013).

Figure 2: hallucination dribblehttps://dribbble.com/tags/hallucinations

Types Of Hallucination

1. Auditory Hallucination : hearing voices in their head. The sound can sound like one voice or many. They

might whisper, murmur, or be angry and demanding

2. Visual Hallucination : seeing lights, objects, people, or patterns. Often it’s loved ones or friends who are

no longer alive. They may also have trouble with depth perception and distance.

3. Olfactory Hallucination : This can include good and bad smells and tastes. Someone might believe

they’re being poisoned and refuse to eat

4. Tactile Hallucination : This creates a feeling of things moving on your body, like hands or insects

(Jeniffer Caserella (2020)

Disorganized speech
Also known as loose association.

Words are not linked together based on the normal rules of language but may be strung together based on sounds,

rhyme, puns, or free associations.

Psychotically disorganized speech is obviously abnormal and can be difficult or impossible to understand.

(American Psychiatric Association. (2013).

Disorganized Behaviors
Behaviors that are not goal-directed and don’t make sense in context.

For Example,

1. Taking one’s clothes off to take a bath is sensible.

2. Taking one’s clothes off on a public bus is an example of disorganized behavior.

3. Laughing at inappropriate times or for no reason is a disorganized behavior.

Adopting strange postures or freezing can be examples of catatonic behaviors.

(American Psychiatric Association. (2013).

Cognitive symptoms are not used to diagnose It is a more common condition than people

schizophrenia. But some cognitive symptoms some might think.

are fairly common with the condition. People who develop schizophrenia can

Examples experience symptoms for the rest of their lives.

1. Difficulty maintaining attention - Symptoms can greatly impact someone's social

2. Memory problems abilities and work functioning.

3. Difficulty planning and structuring activities Often medication must be taken for the rest of

4. Lack of insight their lives.

(American Psychiatric Association. (2013).

Prevalence of schizophrenia in the world Prevalence of schizophrenia in Europe

Figure 3,4: Saloni Dattani, Hannah Ritchie and Max Roser (2021) - "Mental Health". Published online at

OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/mental-health' [Online Resource]

Socio-demographic Characteristics

Age
 Peak age of onset

 10-25 years in men

 25-35 years in women

 Women have a bimodal age distribution; Their second peak occur in middle age

 Onset after 45 years, considered as late onset schizophrenia.

 Onset before 10years and after 60 years is rare.

Gottesman, I. I., Shields, J., & Hanson, D. R. (1982).

Gender
Recent studies have challenged the classical view that incidence and prevalence rates of schizophrenia are similar in

men and in women. As regards disorder onset, most studies agree that it is earlier in men.(Usall J, et al, May-Jun;28

Male Female

 Earlier age of 1st hospitalization  More education

 Longer hospitalization  Better work records

 Higher relapse rate  Higher rates of marriage

 Experiencing More extra pyramidal
 Less response to antipsychotics
symptoms
 More aggression
 Prognosis is better than men
 Worse outcome
Socioeconomic Status
(Past/Present)
Lower economic status may cause
According to literature malnutrition., high level of
stress, secondary to poverty influence in high rates of
Marital status
People who are suffering with schizophrenia
have a Less interest to getting married due to
no need of a sexual partner or anhedonia
Fertility rates are less

schizophrenia among people in low economic status

and developing countries.

Bhugra, D., & Bhui, K. (2001).

Personal Information Occupation
Higher rates of stress from the occupation and
(Past/Present) its’ background can causes for influence of
 Genetic influence : increased risk among close relatives
schizophrenia
 Biological factors: brain structure and brain function

 Stress

 Disturbed family relationship

Case study :
Symptoms of Jack
1.Delusions
Jack concluded that he, like God, must have a ‘life
force’ in his breath and he believed he had been
selected for some sort of holy mission and convinced
that people were talking about him behind his back
and presumed, meant they knew about his powers.
2.Hallucinations
As Jack’s discovery of his special
powers evolved into the hearing of
voices.
3.Disorganized speech
One day after an intense session in front of
the television Jack began babbling
incoherently about “angels” and a “life
force” in his breath.
Approaches to support Jack’s diagnosis

1.Social Approach 2.Psychological Approach

 Family issues  Cognitive bias

 Poverty  Emotions

 School stress  Poor parenting

 Peers  Self esteem

 Abuse  perception

Nandini Karunamuni, 2020.

Treatments
Cognitive Behavioral Therapy
 Cognitive treatment is a type of treatment that targets thinking patterns (cognition), behavior and communication.

 Cognitive treatment focuses on the present rather than past experiences.

 Aims to teach clients problem-solving and rational skills that can be applied in everyday life.

CBT for schizophrenia

 Establishing a collaborative therapeutic relationship.

 Developing a shared understanding of the problem .

 Setting goals.

 Teaching the person techniques or strategies to reduce or manage their symptoms.

Dickerson, F.B. (2000).

 Treatments
The goal is not to “cure” schizophrenia

It improve the person’s ability to function independently, manage their schizophrenia, and to reduce

the distress they experience in their daily life.

 Cognitive restructuring,

 Behavioral experiments / reality testing,

 Self-monitoring and coping skills training

CBT for schizophrenia can focus specifically on psychotic symptoms but has also been shown to be helpful for

addressing depression and / or anxiety associated with psychotic symptoms.

Dickerson, F.B. (2000).

Individual Therapy
 One of the most researched models of therapy used in the treatment of schizophrenia is cognitive behavioral therapy,

(CBT).

 This model of psychotherapy addresses the connection between thoughts and behaviors.

 It helps people to learn that how negative patterns of thought in decision making.

 Since insights do not often present in those with schizophrenia, cognitive behavioral therapy can help clients gain a

greater sense of empowerment in regulating their emotions and behaviors.

 Speaking openly and honestly with your doctor is a great first step in understanding and ultimately managing

symptoms.
Social therapy
 Social therapy is a group-based intervention, involves teaching behaviors to interact successfully with other people.

 Social therapy encourages individuals to integrate into small groups, consider their role within a group and work

towards a shared goal.

 It aims to help the individuals to regulate emotions, build connections and develop social skills.

 Support from peers can be a wonderful, sharing information and feedback helps to remove a sense of isolation .

 Group therapy allows people to safely share their experiences with schizophrenia.

 Psychotic features such as delusions and hallucinations can significantly impact relationships, can feel unclear to the

person what is real and what isn't. by learning the building blocks of relationships can help for a better navigate

interpersonal dynamics.

Jodia clark,2020
Figure 5: Amy Morin, (2021)
https://www.verywellmind.com/idenSchizopheria in
children verywell mind tifying-schizophrenia-in-children-
4155780
Figure 6: statergic family therapy
https://www.google.com/url?sa=i&url=https%3A%2F
%2Fwww.slideshare.net%2FTurtleBG%2Fstrategic-
family-
therapy&psig=AOvVaw1Esdb4hfmKkfUZvRF_3EaM
&ust=1640241358644000&source=images&cd=vfe&
ved=0CAsQjRxqFwoTCMjp2a_l9vQCFQAAAAAdA
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Figure 7: Liang liu et al.2020) Map of thematic analysis https://www.frontiersin.org/files/Articles/517083/fpsyg-11-01318-
HTML/image_m/fpsyg-11-01318-g001.jpg
Family therapy Family therapy will,

Unfortunately, family members are often uninformed  Help to teach the building blocks of relationships and

about what the condition is and how to help a loved one distinguish behavior.

through the treatment process. Family therapy can be a  Help family members develop effective ways of

key component of the treatment process, since it can coping during a crisis.

offer space for healing of family dynamics. That time  Help to understand the recovery process.

can also be used for gathering information about  Improve communication skills between family and

schizophrenia, how to navigate challenges together and friends so they can understand the diagnosis better.

how to better express and meet needs of all involved.  Relapse prevention strategies.

Jodia Clark, (2020)

Conclusion

 Balanced approach

 Suggestions for the future: need for more information about the individual

 Monitor progress

 Changes in treatment (Positive changes, if the treatment is not effective)

 Cognitive behavioral therapy is the most common therapy used in the treatment of schizophrenia. It addresses the

connection between thoughts and behaviors, helping people to learn more about how negative patterns of their

thoughts.

 Because of insights do not often present in schizophrenia, cognitive behavioral therapy can help clients gain a

greater sense of empowerment in regulating their emotions and behaviors.

 References
1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

2. Amy Morin, (2021) https://www.verywellmind.com/coping-with-schizophrenia-2953094

3. Dickerson, F.B. (2000) Cognitive behavioral psychotherapy for schizophrenia: A review of recent empirical

studies. Schizophrenia Research, 16:71-90.

4. Freedman R. Schizophrenia. N engl J med. 2003;349:1738-1749.

5. Hallucination dribblehttps://dribbble.Com/tags/hallucinations

6. Jeniffer Caserella (2020) What Are the Symptoms of Schizophrenia?WebMD https://www.webmd.com/schizophrenia/

schizophrenia-symptoms

7. Jodia clark,2020 mar 03:how schizophrenia is trated, https://www.verywellmind.com/schizophrenia-treatments-2330662

 References
8. Lavretsky H. History of schizophrenia as a psychiatric disorder. In: mueser KT, jeste DV, editors. Clinical handbook of

schizophrenia. New york, new york: guilford press; 2008. Pp. 3–12.

9. conceptualization. Schizophrenia research, 110(1-3), 1–23. Https://doi.Org/10.1016/j.Schres.2009.03.005.

10. Nandini Karunamuni, Ikuyo Imayama, Dharshini Goonetilleke,Pathways to well-being: Untangling the causal

relationships among biopsychosocial variables,Social Science & Medicine,Volume 272,2021,112846,ISSN

0277,9536,https://doi.org/10.1016/j.socscimed.2020.112846.(

https://www.sciencedirect.com/science/article/pii/S0277953620300654.

11. Saloni Dattani, Hannah Ritchie and Max Roser (2021) - "Mental Health". Published online at OurWorldInData.org.

Retrieved from: 'https://ourworldindata.org/mental-health' [Online Resource]

 References
12. Siris, S. G. (2001). Suicide and schizophrenia. Journal of psychopharmacology, 15(2), 127-135.

13. Tandon, R., Nasrallah, H. A., & Keshavan, M. S. (2009). Schizophrenia, "just the facts" 4. Clinical features and

conceptualization. Schizophrenia research, 110(1-3), 1–23. Https://doi.Org/10.1016/j.Schres.2009.03.005.