Cognitive Research And Reasons Schizophrenics Have Auditory Halucinati
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Cognitive Research and Reasons Schizophrenics
Have Auditory Hallucinations
Schizophrenia is a common illness. “Schizo”, Latin for “split” and “phrenic”, “mind” describes the split from reality experienced by the schizophrenic mind. The personality loses it unity and wholeness as a result of unorganized, incoherent thinking, shifting emotional moods and strange perceptions. It has approximately 1-% population prevalence in all cultures. Schizophrenia was once thought to be an artifact of Western civilization, but it is now known that this is not the case. It is likely a neurodevelopment brain disorder with both genetic and non-genetic causes, that best fits within the disease perspective. As well as being common, schizophrenia is a serious, chronic, often disabling illness. It can begin at any age, but most commonly does so in adolescence or early adult life. With such unorganized and incoherent thoughts, disorganized schizophrenics have difficulty communicating and are confused. They often withdraw and regress to silly, childlike behavior.
Schizophrenia starts early and is not fatal, but it is an enormous health care burden. Schizophrenic patients who were unresponsive to treatments ended up living out their lives in state hospitals, which are looked back upon as seen “warehouses.” After schizophrenic patients go through the de-institutionalization they are likely to be found as “street people” or found in jails. Patients with schizophrenia often neglect their medical problems. Schizophrenia is currently defined clinically, on the basis both of cross-sectional symptoms and symptoms that occur over a long period of time. There is no reliable lab test for it, and no definitive post-mortem diagnosis. Their overall death rate is double expected. Frequently, when schizophrenic patients take their prescribed medication they take other medication that either compound or negate their prescribed medication effects. There is currently no cure for the disorder, although medicines often help, especially with positive symptoms. Some positive symptoms include “Form” or disorganization of ideas and speech so that the listener cannot understand, or incoherence, “Content”, or bizarre and delusional ideas like “the Government is tapping into my head and reading my thoughts”. A lack of insight on their own problems of voices and delusions is another positive symptom of schizophrenia.
Cognitive deficits in schizophrenia are especially marked for conceptual tasks and those requiring shifts of attention or cognitive “set”. Schizophrenics do especially badly on abstract reasoning and problem-solving tests, and also do badly on tests of verbal memory and visual vigilance and attention. These cognitive deficits are also seen commonly in first degree relatives of patients with schizophrenia who themselves do not have schizophrenia, and may be a trait marker for the illness. Cognitive deficits are closely linked to negative symptoms of schizophrenia. Negative symptoms include “avolition” or self-neglect and apathy, “alogia” which is the poverty of speech and “anhedonia” defined as a lack of pleasure. Their cognitive deficits are especially marked in certain areas of cognition. It used to be believed that schizophrenic cognitive problems were an artifact of patients being distracted during testing, or part of a generalized deficit due to reduced motivation and/or sedation by medications used to treat the illness. Carefully controlled studies have shown that these explanations are insufficient to explain the cognitive problems.
The effectiveness of cognitive behavior therapy in schizophrenia has showed promise. This is being demonstrated in an increasing number of studies, where patient s treated appear to show reductions in symptoms over and above control groups, or people receiving supportive care or routine treatment. One of the larger studies to date with 60 participants to evaluate a cognitive behavioral therapy program which was intended to reduce the distress and interference arising from the experience of psychotic symptoms. Also, to reduce the emotional disturbance and modify dysfunctional schemas, and encourage the patients to help regulate their own risk of relapse and social disability.
The program involved improvement of talking about coping strategies and developing new ones – (e.g. activity scheduling, relaxation and skills training and encouraging clients to go shopping or socializing). Also, developing a shared model in collaboration with the client, discussing the nature of the symptoms and nature of their own illness. Modifying delusional beliefs and beliefs about hallucinations, by using gentle challenge and the possibility of alternative explanations, has showed tremendous promise for the cognitive-behavioral approach. Links between clients experience of voices and events earlier in their lives were explored. Beliefs held with less conviction were explored first, before tackling those held with greater conviction. Modifying dysfunctional schemas, and re-examining evidence for clients dysfunctional beliefs about himself or herself. Another program which seems to work is having schizophrenics work on their management of social disability and relapse – discussing relapse signatures, issues of stigma and the kinds of events that triggered psychotic symptoms and how they might be avoided. The authors conclude “talking to patients about psychotic symptoms and their meaning to the individual is a skill that clinicians working in this area should develop.” (Kinderman & Bentall, 1996)
Kinderman and Bentall studies showed that perhaps delusions of persecution arise as a result of trying to maintain a positive self-image. Delusions may arise from the discrepancy between how individuals perceive themselves and how they would like to be perceived. Persecutory delusions are a kind of external causal attribution, which is evoked for negative events. Thus, believing negative events are someone or something elses fault can have a positive function for the individual. Other reports on schizophrenia have suggested that paranoia is a form of camouflaged depression.
When people with persecutory delusions are compared to normals or depressed people they do indeed show a strong tendency to attribute negative events to external causes. They tend to personalize – they blame other people when things go wrong. (Garety & Freeman, 1999)
Schizophrenia is a uniquely human condition and a realistic model of