More than ten years ago, I suffered from delusions (I didn’t know these were delusions), cognitive impairment, depression and severe negative symptoms (lack of emotions, not enjoying anything). Since I had a turbulent relationship with my psychiatrist who also didn’t warn me about the possibility of having schizophrenia, I relied mainly on a featured article (sic!) on Wikipedia. And I am not concealing that I have also read something on the internet about the disease. But they all led me to the wrong pathways.
So you don’t have hallucinations and delusions (I actually thought – and yes, it is crazy – that my negative symptoms are because of OCD not being in full swing, therefore antidepressant medication makes it less prominent)? It is not schizophrenia according to Wikipedia! “In about 75% of cases, schizophrenia onset occurs with slowly mounting depressive and negative symptoms that involve increasing functional impairment and cognitive dysfunction. Less than 10% of cases start with positive symptoms only. Reports on the duration of the prepsychotic prodromal stage vary widely. Because of differences in study designs and nonrepresentative populations, mean values range from a few months to 9 years.“ If I had been given this information (that I found later in professional textbooks) that is – in my humble opinion – one of the most important, I would have gone to my psychiatrist and urged him to medicate me – despite having been very paranoid. No such information can be found on Wikipedia in their shitty (pardon my French) article.
Once again: “Approximately 80 – 90% of patients with schizophrenia report a variety of symptoms, including changes in perception, beliefs, cognition, mood, affect, and behavior that preceded psychosis, although approximately 10 – 20% develop psychotic symptoms precipitously without any apparent significant prodromal period (Yung & McGorry, 1996a). The typical pattern is that the non – specific symptoms and negative symptoms develop first, followed by attenuated, or mild, positive symptoms, together with distress and decreased functioning (Häfner et al., 1998). Schizophrenia – Weinberger” No such information is ever mentioned in this wannabe independent encyclopedia.
“The onset of schizophrenia usually occurs with depressive and negative symptoms, and functional impairment during a prepsychotic prodromal phase that on average lasts for several years, followed by apsychotic prephase, defined as the period between the first positive symptom and the maximum of positive symptoms, lasting on average for 1 year.” Do you think this is included? No way!
What about this? Can you please find this in their article which is – and I cannot still believe – featured: “As expected, the course of the negative factor was fairly independent of the two other factors and in all studies showed a high degree of stability over the illness course (Figure 11.2). The positive factor showed a lower degree of stability and was partly correlated with the disorganization factor.”
What about positive symptoms: “The frequency of psychotic relapses is difficult estimate, because their number varies depending on the patients’ living environments and can be triggered by stressful life events and stressful home environments, and because precise information on antipsychotic treatment is not available.”
Prognosis? None of it: “Schizophrenia is on average not a progressive illness characterized by deterioration and social decline after the first illness episode. “
And what about the 5-factor model (evidence-based) that includes depression? Are you joking? On Wikipedia? “Marengo and colleagues (2000) included the depression factor in addition to the three other factors and did follow-ups at 2.0, 4.5, 7.5, and 10.0 years after first admission. In agreement with more recent studies, the authors concluded that “depression constituted an independent and stable dimension of schizophrenia” (p. 61) over the entire course of the illness. These findings underscore the heterogeneity of the symptom dimensions subsumed under the disease concept of schizophrenia.”
More than normal deteriorating cognitive functions in the elderly? Forget about it! “There is some evidence, however, such as that from Harvey (2001), that a proportion of “poor outcome” chronically institutionalized older adult patients with schizophrenia may be prone to show greater than age-normal declines in cognitive functioning. The specific factors responsible for decline in this subgroup remain an area of ongoing research.”
Childhood prognosis? Sorry! “A number of long – term follow – up studies of child and adolescent – onset schizophrenia all describe a typically chronic, unremitting long – term course with severely impaired functioning in adult life (Werry et al., 991; Schmidt et al., 1995; Eggers & Bunk, 1997; Hollis, 2000; Lay et al., 2000; Jarbin et al., 2003; Fleischhaker et al., 2005). “
Prognosis in general? No way! “About one – fifth of patients in most studies have a good outcome with only mild impairment, while at the other extreme about a third of patients are severely impaired, requiring intensive social and psychiatric support. Second, after the first few years of illness there is little evidence of further progressive decline. Third, child and adolescent – onset schizophrenia has a worse outcome than either adolescent – onset affective psychoses or adult – onset schizophrenia. Fourth, social functioning, in particular the ability to form friendships and love relationships, appears to be very impaired in early – onset schizophrenia. Taken together, these findings confirm schizophrenia presenting in childhood and adolescence lies at the extreme end of a continuum of phenotypic severity.”
“Good prognostic factors include:
Absence of family history
Good premorbid function – stable personality, stable relationships
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative, motivation
Nevertheless, it should be remembered that schizophrenia continues to have a poor prognosis in some patients.
Slow, insidious onset and prominent negative symptoms are associated with a worse outcome.
Mortality is 1.6 times higher than the general population.
Shorter life expectancy is linked to cardiovascular disease, respiratory disease and cancer.[5]
Suicide risk is 9 times higher.
Death from violent incidents is twice as high.
36% of patients have a substance misuse problem and there are high rates of cigarette smoking”
“The duration of untreated psychosis (DUP) — in most studies about 1 year — and the duration of untreated illness (DUI) — from first symptom to first contact — depend on help-seeking behavior and the availability of appropriate treatment.
“DUP and DUI have been found to predict an unfavorable course of the first episode of schizophrenia, including delayed or incomplete remission, reduced level of global functioning, longer duration of hospitalization, and higher treatment costs. In addition, over the long-term DUP and DUI tend to be associated with a higher risk and a greater severity of relapses, more days in the hospital, poorer global functioning, poorer quality of life, and a greater burden on the family. There is some evidence that DUP and DUI predict the course of different dimensions of the illness. Prolonged DUP (maximum of psychotic symptoms) has been found to predict psychotic symptoms but not negative symptoms. In contrast, prolonged DUI (maximum of negative symptoms) has been found to predict more negative symptoms, social impairment, and downward social drift. The finding that duration of each symptom dimension significantly predicts the severity of that same symptom dimension is in line with the relative independence of the positive and negative symptoms in the long-term course of schizophrenia.”
While Wikipedia editors may have high IQs, it says nothing about their inability to mention IQ deficits in schizophrenia: “Furthermore, they also demonstrated that the change in cognitive ability at first onset of schizophrenia approximated about 11.5 IQ-equivalent points.”
Their article is written in a way that tells you everything but nothing in final. Empty phrases at best. Their super-duper featured article doesn’t have more information than it has. Even the most important things are omitted. But it is just all about mainstream science, no reinventing of the wheel.
So thank you so much, Dear Wikipedia, I suffer from schizophrenia and could have known earlier, therefore less suffering. So if you are able, not paranoid to tell your medical doctor or psychiatrists what is going on, please prefer this method instead of Wikipedia!
Sources: Schizophrenia (Daniel R. Weinberger, Paul Harrison; 2011); Clinical Handbook of Schizophrenia (Kim T. Mueser, Dilip V. Jeste; 2008)
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