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Dealing with Positive Symptoms of Schizophrenia

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Schizophrenia

Schizophrenia is a disorder of the brain that affects the actions, thoughts and perception of a person towards the universe.  People with schizophrenia have a changed reality perception. There is normally a huge loss of contact with realism. In most cases, they see and hear things that actually do not exist. Their speech is confusing, strange and they normally have a feeling that the other people around them are endeavoring to harm them. They may also have a feeling that other people are constantly watching them.  With such an obscure line between the imaginary and realism, Schizophrenia makes it tricky and even worse, frightening for the patient while negotiating the day to day life activities (Bell et al. 2007). In response to such threats as they see them, schizophrenia patients tend to withdraw from the external world or may be act out in fear and confusion.

Schizophrenia affects both women and men equally. It takes place at same rates in all racial groups around the universe. The symptoms that normally begin between the sixteen and thirty years are delusions and hallucinations. Symptoms in men tend to show up a little earlier than in their female counterparts. In most cases, it is not easy to get schizophrenia casualties over the age of 45. Schizophrenia hardly takes place in children although there is an increasing alertness of childhood-onset schizophrenia (Masi et al., 2006).  Diagnosing schizophrenia amongst teens can be difficult.  This so because the initial signs come along with a change of friends, problems of sleeping, irritability and drop in academic performance. Diagnosis is thus difficult because these behaviors are a common occurrence amongst teens. An amalgamation of factors can be used to determine schizophrenia amongst teens at the verge of developing the disorder. Such factors include withdrawal from other people and solitude, an increased abnormal thinking and suspicions and the psychosis history of a family.

Schizophrenia Symptoms

Schizophrenia symptoms fall into three broad classifications: negative symptoms, cognitive symptoms and positive symptoms. Well, this study narrows its research into the positive symptoms and seeks to establish how assessment of these symptoms can effectively be assessed and the most efficacious skills that a therapist can apply to assist in response to the positive symptoms of schizophrenia. 

Positive Symptoms of Schizophrenia

Positive symptoms are the psychotic behaviors that are not noticeable with healthy people. People having positive symptoms would in most cases lose touch with the reality that goes around the immediate environment (Warner, 2009). These symptoms are not persistent in a continuous manner. They may appear and disappear. On some occasions, they are severe while they may become hard to notice at other times. However, this depends on whether the person is getting treatment or not.  Therefore, successful evaluation and treatment calls for a proper understanding of the condition before the most amicable therapeutic skills can be applied. Generally, positive symptoms of schizophrenia include the following.

Hallucinations

Hallucinations are the things that an individual sees, smells, feels or hears that cannot be sense through either of these senses. The most common hallucinations in schizophrenia are voices which other people cannot hear. These voices may talk to the individual concerning behavior, orderliness in the person or danger that is looming in the person’s life. At times these voices can talk to each other. The problem may persist for a long time before it can be noticeable to friends and families. Hallucinations could also involve seeing objects and people that do not exist, smelling odors that are undetectable by others. They may also feel such things as invisible fingers pounding on their bodies when they are alone (Zullino et al. 2008).

Understanding hallucinations is the first step towards the implementation of any therapeutic action. It is imperative to understand that these are false perceptions and inaccuracies that affect people’s senses and cause them to see, touch and smell things that do not exist. In acute stages of schizophrenia, patients will insist of hearing voices that other people cannot hear. In some cases, non-word sounds, clicks and noises characterize these voices. These experiences act as disturbances in the lives of these individuals. All the same, the descriptions of these perceptions tend to be different (Bottas, 2009). In some occasions, they are encountered as very forceful and seemingly vital thoughts.

Occasionally, they appear to emanate from outside the self. They are heard as discussions between other commands, people and insults or compliments being addressed to the person. Dealing with such situations and conditions may require the directives of a professional therapist in order to administer the best treatment process. The voices interchangeably convey conflicting messages. At one point they could be voices of reassurance while on another occasion, they could be threatening (Greig et al., 2007). Understanding these different scenarios would contribute to effective treatment procedure and the provision of the most efficacious assistance to the affected individuals.

In most cases, the remarks that are received are not merely addressed to the individual but they appear to show concern on them in an obscure manner. The people who experience this define it like a tape that plays in their mind. Such experiences are so real that many of these affected individuals tend to believe that a broadcasting device has been implanted in their bodies. Some of them end up believing in a paranormal explanation for the peculiar sensation in their lives. When administering treatment or offering any form of assistance, it is important to work on an observable fact. Any form of assistance cannot be founded on guesswork. The therapist must engage on a process founded on facts and a thorough knowledge of the situation that the individual is experiencing (Cannon et al., 2008).

The therapist needs to look beyond the outward reactions seen in the individual.  The things that the person is experiencing are so real to the individual that they cannot be dismissed and alleged as imaginations. In times of convalescence, the schizophrenia patients manage their ‘voices’. Either to dismiss or summon these voices is at the patient’s disposal. They may chose to cope by ignoring them or handling them as caring supplements of their daily lives. However in times of acute sessions, the hallucinations, normally the same ones repeatedly take control and the person feels powerless and victimized (Zullino et al. 2008). The person feels at the mercy of a foreign company. The patients and the people close to them should recognize these hallucinations as indicators of illness.

Discussion concerning their plausibility and objective truth are not important at this stage. The experience is very true and very clear. Therefore, it should be acknowledged as such.  The attempts of any therapist efforts of setting the individual straight may amount to resistance, bad feelings and tension. It is however useful to seek clarification that other people do not have a sense of smell, hearing, feeling and seeing of the things the patient is experiencing. This assists to identify it as a unique experience of the patient concerning the acceptance of the experience as a symptom of schizophrenia. This would be useful in letting everyone agree to the inclination that something is taking place (Bottas, 2009).

Hallucinations react to any attempt of mitigating stress and an increase of antipsychotic prescription of medicine. Good therapeutic skills would exercise keeping the patient busy. It is a very important endeavor as it offers a kind of distraction that is very useful.  The competing stimuli can at times sink the voices.  Keeping the patient busy is very important in dealing with hallucinations. Anything that can keep the patient busy without coercion is considered a very useful effort in assisting the patient. The patient should be encouraged to discuss the moment these hallucinations take place and what they discuss with the therapist. This can help in clarifying the kind of stress that appears to bring the patient on (Greig et al., 2007).

Again, pointing out to the patient that he or she has some control over these hallucinations can be a very useful strategy while assisting the patient.  Habitually, instinctively, the patient has gotten the habit of listening for the voices he or she hears as though it was a passive recipient.  There is a lot of effectiveness if the therapist can direct the mind of the patient to different interests and assisting him or her recognize that there is no need to keep waiting for the incoming voices. These are the major techniques through which the patient can develop on their own with time and that need a fair amount of practice. The therapist should engage the individual in a discussion encouraging him or her not to despair. These discussions with the therapist bring on the reassurance that the close friends and family understand their situation. This is a very important aspect that can assist the patient to overcome these challenges. The constant talk concerning hallucinations can be infuriating. However, it is clear that the patient is already occupied with such bizarre events. Chronic hallucinations should be accepted as a part of the daily life. However, they are not normally sufficient reason to justify the participation in household duties and in other activities (Bottas, 2009).

Delusions

Delusions are another positive symptom of schizophrenia. These are false beliefs that are ideally not a part of the individual’s culture and that remain the same. They do not change at all. The individual believes in these delusions even after other people have proved to them that the beliefs are illogical and unsubstantiated. Individuals with schizophrenia can experience delusions that appear problematic. This may include a belief that neighbors can manage their behavior with waves of magnetism. Moreover, these individuals may also believe that individuals on television are making reference to them as they talk and make presentations (Warner, 2009).  They may also allege that radio stations are giving out news aloud to other people in accordance to their individual thoughts.

Some times, the patients believe that they are not themselves but other different individuals from those they were from the beginning.  They may see themselves as famous figures in history. At times, they may show paranoid delusions and may often believe that the other people are committed to harming them through harassment, cheating, spying on them, poisoning them or even planning harm against them or the people who under their care.  These are commonly referred to as persecution delusions. The therapist is also in a tricky position because he or she must remove the predisposition of the patient to such paranoid experiences towards the people in the surrounding (Zullino et al. 2008).

 The therapist ought to be in a position to analyze these misinterpretations and false beliefs. The significance of these false beliefs is very important otherwise they could be very consequential. For example, an individual could accidentally be bumped in the passageway and quickly come to a conclusion that it is a plot by the government for him or her to get harassed. He could be alerted by noise from an adjacent apartment at night and may ultimately decide that it was an intentional attempt by the neighbors to interfere with his or her sleep. Every person seems to misinterpret and personalize events and more in particular during stressing moments or fatigue.  However, what is characteristic of the schizophrenia and more particularly during an acute session is the predisposition to this conviction and the varying explanations for the experiences as not even valued (Greig et al., 2007).

Normally, attempts at discussion or reasoning concerning other possible meanings of the bumping scenario or the noise from the neighborhood can again amount to another conviction that the therapist must be in the plan also. The therapist is therefore left in a tricky position in handling such an issue. It is very imperative for the therapist not to directly tackle the convictions of the patient. Addressing these issues directly would pile on the situation and may not amount to any amicable solution. Making an argument with a delusion will only amount to more anger and extended mistrust. It would therefore be unwise for any therapist to engage in such a process. The beliefs are held tenaciously against each and every reason and they are typically beliefs that are not shared (Cannon et al., 2008).  They are held only by the patient. The direct indulgence and inclusion of another person in the matter including the therapist would amount to a disastrous moment.

Friends and families should initially realize that delusions are occasioned by illness. It would be very wrong for the therapist, friend and even the family members to assume that the person is being stubborn or acting in a stupid way. Instead, the close associates together with the therapist should take note of these delusions and analyze them in an effort of establishing the condition in the individual. Any effort made to assist the individual should not directly hit or react to the issues that the patient is presenting otherwise the process would be detrimental. The adamant delusions of the patient could be irritating. However, this is not a reason enough to react emotionally towards the delusions. Taunting and threatening the patient will also not be useful at this stage (Cannon et al., 2008). It will only add on to the danger. Assisting the patient will therefore require a disregard of any form of reaction towards the patient.

While making an effort to assist the patient, the skills of the therapist must demonstrate discretion. This is because there is always something concerning the delusional belief that people can empathize with. For example, getting bumped in passageways can be annoying. It must make someone feel as if nobody cares and no one is attentive to your importance to be offered an apology or be excused. Presumably, the conviction that an individual is at the core of a plot by the government should derive at least in some way from any fear that an individual is actually very irrelevant or lacking in value. Moreover, to be alerted from sleep during the night is a lousy experience. It is very hard to resume sleep. It takes away all strength. It may create a feeling that those in the neighborhood are not friendly. However, a normal personal must make an effort to stay healthy and strong.  Such kind of reasoning could be useful in persuading an individual to look out for medical attention and/or increase in the person’s prescription of medicine in order to help them become strong and strongly fend off any annoyances made by other people. This is a better approach other than telling the person that he or she is deluded and that it was better if he or she went to see a psychiatrist (Chwastiak and Tek, 2009).

Delusions make a person very slippery in dealing with him or her. Therefore, it would be important to reduce the stimuli that amount to the formation of delusion. If crowded passageways prompt experiences that amount to ideas of persecution, then the therapist should work on to help the individual avoid them. This includes any other thing that prompts persecution ideas while there are other alternatives. It is important that the individual is assisted to make use of these other alternatives available instead of directly confronting the situation. The emergence of ideas which are delusional whether grandiose or persecutory normally implies that there is a lot emotion and activity. This may even be the fact that there a lot of people within the environs (Warner, 2009).

Take an example where a schizophrenia patient says, “I think I am the President.” A reaction that would be considered unhelpful to this remark would be, “That is absolutely absurd. You are mad.” On the contrary, a helpful reaction to that remark would be, “You must be feeling very special and somehow different this day. Could be it is all the fuss around this place. Let us try a relatively low core routine for the next two days.”  When while on medication an individual keeps on making reference to left over delusions, a very useful reaction to that would be, “That is how you view things. I have explicated that I do not agree…we have to concur to differ.” This accepts the perception of the patient although stops meaningless discussion.

Thought Disorders

These are abnormal or dysfunctional thinking modes (Huang et al., 2007). One of these forms of disorder in thinking is commonly referred to as disorganized thinking. In such a case, the patient gets trouble while organizing thoughts and endeavors to arrange them in a logical order. They could talk in a way that is garbled making it hard for the listener to comprehend. Though blocking is also another form of thought disorder. It occurs when an individual can stop speaking all of a sudden amidst a thought. When the individual is asked the reason why he or she halted the speech, he or she may allege that the thought was removed from the head. Ultimately, the individual with a disorder in thinking could make up inane words in what many people could say that the person is talking nonsense (Dixon et al., 2010).

Talking nonsense normally takes place when the individual is in the active stage of schizophrenia. However, it can emerge again when the medications on the person are very low or the patient is in a high stress condition.  What the individual says can no longer be understood by the people around. The reason is that the sentences are not well connected in a logical sequence in a manner that brings out sense. Again, it could be due to the reason that there is no point in the stories that the patient tells. The person may also end up talking nonsense as a result of a high frequency in switching of topics taking place in the mind (Warner, 2009).

Words could take on very special implications in schizophrenia either due to the way they trigger private connections or due to the attention that is paid to personal sounds instead of the whole words. For example, a word like ‘psychiatry’ may sound like ‘sigh Kaya tree’ and the topic could instantly change from a discussion on issues of psychiatry to one that discusses mystical trees. Particular words could be shunned since they sound evil or may be harsh. In other occasions, intonations are modified due to the same reasons. On a different occasion, the language is utilized as an invocation to fend off any kind of threat. The difficulty that is experienced in making sense to other people is a sign of the acute stage of schizophrenia. It is almost difficult to converse with schizophrenia patients when they are at this stage and it can indeed be exasperating to the family members (Kneisl and Trigoboff, 2009).

In an effort of assisting the patient, non-verbal communication can play a very significant role. Communication by way of writing can be very useful. Thoughts tend to come out in a logical manner if they are put in writing.  The therapist, be it a friend, a family member or any other person must apply this skill with the seriousness that it deserves. It is not necessary for the therapist to forcefully listen and try to comprehend. This will certainly amount to irritation and headache. When communicating with other people, the therapist should however not speak as though the patient was not present. It would not be a wise idea to mimic or tease the patient. Many people make use of one section of the brain for any matter to do with language and the other section for movement or music or art. If the section meant for the language is disturbed, it could be a wise decision to pay attention on the other section and encourage the patient to either play an instrument, draw, dance, sing or exercise. These are very useful communication methods that can help the patient very much. Just like other positive symptoms of schizophrenia, the disturbances in thinking react to stress reduction and an increased antipsychotic medication.

Preoccupations

Preoccupations are ideas that are fixed. They may not necessarily be false like is the case with delusions. However, preoccupations are normally given a lot of value. The patient shows an extraordinary regard and importance to these ideas. They normally consume an inordinate amount of time while thinking about them. These ideas normally recur in the life of the patient. Typically, there is a continued growth in the patient’s worry. The worry is so involving until it ends up being unrealistic. A very common order of events is for the worry to consume a lot of time for the individual at the expense of doing the right thing.  The fact that the right thing has not been done is linked to the ill motive of other people. The patient may also rationalize the failure to do what was right as the wish of God. Alternatively, the patient may state that he or she is not in a fit position physically to tackle the task (Pharoah et al., 2010).

For instance, the patient may state a very unrealistic explanation that they cannot get up because they are paralyzed. Amazingly, they may allege that they cannot get out of the bed because it is the day of the Lord.  Other irritating predispositions are such as, “If I get up, I will feel bad.” These forms of explanations are very odd and funny claims to many people but to the patient, they are apparently acceptable. They do not seem to understand the reason other people regard their predispositions as excuses. The schizophrenia patients define the facts in a better way than any other form of explanation. The therapist should be careful when handling such a situation. These preoccupations sometimes have a character that is perplexing to them. They appear to be demanding a need for decoding and puzzling them out. It is therefore important not to personalize any irritation that comes from the patient (Nordgaard et al., 2008).

The schizophrenia patient uses a lot of time in such a kind of perplexing activity and that is the reason why they think they have tackled many mysteries that other people have not because they did not spent any time at it. When the patient is completely lost in thought, distraction is the last thing that they would expect from anyone. This sends a very important message to anyone who is willing to assist the patient. Intervening at such a point would produce disastrous results rather than useful efforts. The patients at that moment feel that they have important assignments to do. They will therefore not accept any conversation offer or any sharing of activities at such moments. Preoccupations are normally seen in the active stage of schizophrenia although could persist into the convalescent phase (Warner, 2009). They could be in form of daydreams.

Even though it would not be wise to interfere with the schizophrenic at that moment, it should not be used as an excuse to let the preoccupations control the patient’s life including the people that are in the neighborhood.  Distraction can be helpful but in an indirect manner as the therapist comes up with a daily structure or routine that does not allow a lot of time for thinking and sitting. The life necessities like food, fresh air, sleep, health, hygiene, exercise and social interactions should be maintained all through. Preoccupations should not be allowed to sidetrack the life of the patient. Increased medication could be needed at such an instance.

 ‘Secondary’ Positive Symptoms of Schizophrenia

These ‘secondary’ positive symptoms of schizophrenia may refer to those positive symptoms that are in essence not positive symptoms of schizophrenia but which occur along the main positive symptoms of schizophrenia. They may exist in the combination of some or all of the positive symptoms of delusions, hallucinations, thought disorder and preoccupations (Warner, 2009). They too have a huge impact in the life of the patient and the family members and therefore should be addressed in an effort of helping the patient.

Violent and/or Aggressiveness

Violence and/or aggressive behavior are not indeed symptoms of Schizophrenia but when they take place, they do so in line with delusions, jumbled thoughts, hallucinations and delusions. These may also be prompted through stress and subsides in the event of using antipsychotic medication appropriately in the correct amounts.  Violent behavior is in most cases frequent signs that have ideally nothing in particular related to schizophrenia. All the same, schizophrenics could also experience the same. This symptom counts in schizophrenia because the disease frightens families and patients and leads to much worry and dread. It is mainly noticeable in young men and can be precipitated through chemical and psychological stimulants.

Violence against other people can be said to be as a result of the misinterpretation by the patient concerning the reason and consequent feeling of being isolated. An individual in the acute phase of schizophrenia may not be in a position to overstate the misread and irritation of other people as vehemence.  The patient may however see derision in what is regarded as a joke. The patient senses himself in a looming danger when he actually is not and may even strike out in such situations. Violence against the individual’s self is very common and can be classified under depression. In an effort to prevent this violence in a schizophrenic, it would be prudent to avoid ridicule, mockery, insult, blame or any form of confrontation (Chwastiak and Tek, 2009).

The schizophrenic should be permitted to psychological distance and relative privacy.  If violence comes up, it is not wise however to allow it to intimidate others.  There is no defined way to handle such violence. The therapist’s discretion is needed in such an occasion. Important measures should be employed while ensuring the safety all people including the patient. This could require determination and assistances from neighbors and friends. It could require calling for the police if need be. The therapist must know if he or she was not around the scene. The patient through the therapist’s directives should be assisted to acquire self-control. Moreover, it is always important to keep an updated list of resources that could be useful in the community. This is important as the patient through experience would respond very well to specific neighbors and friends when he or she is distressed, potentially violent and frightened. These neighbors and friends could thus be useful and should be called upon in the event the violent behavior erupts. Anticipating such friends and being ready with an effective action plan would be a very good way of helping the patient and the community at large. Even though violence is a rare occurrence in schizophrenia, it may be a noticeable factor with some patients.  If that is the case, it is important to discuss suitable living arrangements and preventive measures as anticipated with the guidance of the therapist (Muller-Vahl and Emrich, 2008).

Movement Disorders/Restlessness

Movement disorders may emerge as body movements that are agitated. An individual having a disorder of movement repeats particular motions repeatedly. To the other extreme side of it, the patient may end up being catatonic. A catatonic person will hardly move and may not even respond to other people. Well, it may not be a common symptom but it existed when there was no treatment of schizophrenia. Anxiety, agitation, tension and restlessness all refer to more or less the same thing. However, these can be categorized as secondary positive symptoms of schizophrenia as they appear in connection to the main positive symptoms. They are normally occasioned by apprehension and fear as a way of reacting to frightening elements of delusions and hallucinations as well (Warner, 2009). If this is the case, calm and quiet reassurance is required. The patients who exhibit nervousness need somebody to offer stability and explanation. In the same manner, a schizophrenic would need this attention in order to reduce stress. Medication could also be useful in dealing with anxiety. Restlessness that starts after the patient has begun medication could be a side effect of the drugs (Cullen et al., 2008). 

If the patient experiences persistent body tremors, reference to the doctor may be important for the purposes of changing the drugs if need be or add another medicine to counteract the effect caused by the initial ones. The patient should not be given stimulants on this occasion. These include tea, cola drinks, cold tablets, coffee and chocolate as they worsen the situation. Sedative medication can be useful although it must only be applied under the doctor’s prescription. Understanding at this level is very much needed. It is not wise to criticize the patient. It would be useful to accompany the patient in walking, jogging and riding among other activities.

Conclusion

This research paper has dealt with the positive symptoms of schizophrenia highlighting on their probable cause, nature and treatment. The positive symptoms of schizophrenia can be harmful if the necessary clinical measures are not applied to assist the client. In most cases, it has been found that the schizophrenic situation cannot be confronted directly. A lot of discretion is needed by the therapist and the close associates when dealing with hallucinations, delusions, thought disorders and preoccupations in the lives of schizophrenic patients. It has also been found that there are other symptoms that are actually not positive symptoms but come in conjunction with a part or all of the positive symptoms of schizophrenia. The research paper has highlighted these symptoms as secondary positive symptoms of schizophrenia as their presence in the life of the patient can be very consequential if not addressed. Therefore, the positive symptoms of schizophrenia can easily be managed and controlled to assist the patient with the implementation of the effective and appropriate therapeutic skills.

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