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| Identifying Psychosis |
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| It is sometimes quite difficult to be certain
exactly where the dividing line between neurosis and psychosis
actually is, and some psychotically ill individuals can be very
deceptive, often appearing to be quite intelligent and even
superficially charming. It is as wrong to assume that you can
recognise an individual with this illness by the appearance
or demeanour as it is to believe that they are always dangerous.
The term 'Schizophrenia' - probably the most
common form of psychosis - actually refers to not one, but
a group of psychotic illnesses which often start in adolescence
or young adulthood. There tends to be 'attacks' with gaps
in between, typically starting at about 15 years old; between
attacks the sufferer can seem quite normal, though the frequency
of attacks will tend to increase - slowly if their environment
is good (stable home, low excitation levels, low 'life-difficulties',
supportive relatives, etc.) but faster if not (Homeless,
frustration, angry/nagging relatives or companions, stress
of any sort).
There can be an inherited predisposition with some individuals
- the disorder definitely runs in families. Children who
have one schizophrenic parent have TEN TIMES the chance
of developing the disorder than if their parent had been
'normal'. During your information gathering, you should
always enquire as to the emotional and psychological health
of your client's parents. If they tell you that one of them
was excessively anything that could be taken to indicate
schizophrenia, then explore your client's psyche that much
more carefully.
The advice to the GP about diagnosing Schizophrenia
is that any one of the symptoms from the first group, below,
or two from the second group should have been present most
of the time for a period of no less than one month.
Group one
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Thought echo, withdrawal, insertion
or broadcasting
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Delusions of control or passivity
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Delusional perception
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Third person hallucinatory voices
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Persistent bizarre delusions
Group Two
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Persistent hallucinations in any modality
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Thought blocking and disorder
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Neologisms
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Catatonia
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Apathy, poverty of speech or thought
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Blunting of affect and social withdrawal
The 1992 classification of schizophrenia lists
five types: paranoid, hebephrenic, catatonic, residual and
simple, with Paranoid Schizophrenia being the most common.
There are around 10,000 new cases of schizophrenia
diagnosed every year; the risk of developing it during the
course of a lifetime is reported to be in the region of
1 in 100. In its full form it is very obvious but there
is a borderline 'grey' area into which many neurotics fit
just as easily as potential psychotics, and this is where
we have to be careful.
This bears repetition because it is so important:
you simply cannot tell whether or not an individual is schizophrenic
from the appearance alone; the psychotic often has a very
high IQ and will not infrequently be a 'high-flier' of some
sort in commerce or industry, or maybe running - or claiming
to run - a hugely successful business or two. That, in itself,
veers away from the norm and should prompt you to find out
more. Obviously, not all successful people are psychotic,
nor are all psychotic people successful, but the circumstance
of a genuinely intelligent, successful, smartly presented
and superficially charming psychotic is far from unknown.
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