The proper function of a man is to live, not to exist. – Jack London
I never called my twins schizophrenic. I want my daughters to live a life just like everybody else does, with meaning and hope. To me, they are no different.
However to others, they are different.
Evangeline and Esther have to take medication on a daily basis. This is important in controlling the symptoms and eventually reaching the stage of remission whereby the symptoms will be so mild that they can literally lead a more or less normal life, or else they can relapse very fast.
But with Evangeline and Esther’s conditions, it is hard for them to keep up with the daily medications on their own. They tend to forget about it and sometimes even have difficulties in remembering whether they have taken it or not. So I will always keep pillboxes marked with the days of the week so as to help them as well as myself to keep track of medication schedules. This turns out to be useful most of the times.
Not surprisingly, they are uncomfortable with taking medications everyday. Their classmates often laugh at them. They are like labels which mark them as sick, different, abnormal, laughing stocks, weird… All these are too much for them bear. So once in a while they will refuse to take medications. And as a result of poor compliance, symptoms such as delusion and hallucinations resurface again. It is really heart-breaking for me to look at them suffering and find myself could do nothing about it.
Also, medications give them side-effects. The antipsychotic drugs they are taking now cause them to experience drowsiness, restlessness, muscle spasms, weight gain, tremor, dry mouth and blurring of vision. Though the effects reduce after lowering the dosage, but the problem with weight gain is really bad. Evangeline has gained almost 6 kg after one year of taking the drug. I am afraid that this may affect her health by increasing the risk of heart disease or diabetes. There are other health problems which are associated with excessive weight, such as lower back pain, cancer or breathing problems, I have read about in books. So currently, I am looking for suitable alternative drugs which may help to reduce the side-effects on them.
To an outsider, Evangeline and Esther are introverted and withdrawn despite the fact that they seem to enjoy each other’s company. Even though medication has helped to put their symptoms under control, it does not help to improve their social skills. They show a lack of interest in almost everything around them. Having to live in the hospital once in a while and being very much taken care of, they sometimes find difficulties in doing simples things such as boarding a public bus and ordering food. But they are sixteen now, and I am worried about their future if this continues.
In order to improve this condition, I often bring them out on weekends for family activities, like picnic and shopping trips, so as to expose them to the outside world where on one knows about their illness. This makes them to feel just like normal individuals and apparently they enjoy it.
I do not expect Evangeline and Esther to achieve great things in life. As long as they can enjoy life to the fullest, I am happy.
Wednesday, February 27, 2008
A Brief Introduction To Schizophrenia -- Diagnosis
Diagnosis
Diagnosing schizophrenia is difficult as there is no single symptom which is unique to the disorder. There are no tests that can positively identify schizophrenia in a person. Therefore, the diagnosis depends on excluding other causes that may bring about schizophrenia-like symptoms, such as: substance misuse, epilepsy, brain tumours and thyroid dysfunction.
There are two major systems currently used for the diagnosis of schizophrenia, the Diagnostic and Statistic Manual of Mental Disorders and the International Classification of Disease. These classifications have the effect of improving inter-rater reliability but they do not make diagnosis an objective activity.
Diagnostic & Statistical Manual of Mental Disorders (DSM-IV) Criteria for Schizophrenia:
A. Characteristics of Symptoms: two or more of the following, each present for a significant portion of time during a one month period (or less if successfully treated):
Ÿ Delusions
Ÿ Hallucinations
Ÿ Disorganised speech (e.g. frequent derailment or incoherence)
Ÿ Grossly disorganised or catatonic behaviour
Ÿ Negative symptoms, i.e. affective flattening, alogia or avolition
(Note: Only one "A" symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviour or thoughts, or two more voices conversing with each other).
B. Social/Occupational Dysfunction: for a significant portion of time since the onset of the disturbance, one or more major areas of functioning, such as work, interpersonal relations or self-care is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic or occupational achievement).
C. Duration: continuous signs of the disturbance persist for at least six months. This six month period must include at least one month of symptoms that meet criterion A (i.e. active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of disturbance may be manifested by only negative symptoms or two or more symptoms listed in criterion A present in an attenuated form, e.g. odd beliefs, unusual perceptual experiences).
Exclusion Criteria: the remainder of the criteria (D-F in the DSM-IV text) specify that the signs and symptoms above are not better accounted for by another disorder, either psychiatric (i.e. mood disorder, schizoaffective disorder or pervasive developmental disorder), substance abuse (e.g. amphetamine intoxication or withdrawal) or a general medical condition (e.g. hyperthyroidism).
International Classification of Disease (ICD-10) Criteria for Schizophrenia:
Either at least one of the syndromes, symptoms and signs listed below under (1) or at least two of the symptoms and signs listed under (2) would have been present for most of the time during an episode of psychotic illness lasting for at least 1 month.
1. At least one of the following:
Ÿ Thought echo, thought insertion or withdrawal and thought broadcasting.
Ÿ Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions or sensations, and delusional perception.Hallucinatory voices giving a running commentary on the patient's behaviour or discussing him/her between themselves or other types of hallucinatory voices coming from some part of the body.
Ÿ Persistent delusions of other kinds that are culturally inappropriate or implausible, such as religious or political identity, superhuman powers and ability etc.
2. At least two of the following:
Ÿ Persistent hallucinations in any modality, when accompanied by either fleeting or half-formed delusions without clear affective content or by persistent over-valued ideas or when occurring every day for weeks or months on end.
Ÿ Breaks of interpolations in the train of thought, resulting in incoherence or irrelevant speech or neologisms.
Ÿ Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
Ÿ Negative symptoms such as marked apathy, paucity of speech and blunting or incongruity of emotional responses (these usually result in social withdrawal and lowering of social performance). It must be clear that these are not due to depression or neuroleptic medication.
Ÿ A significant and consistent change in the overall quality of some aspects of personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.
Exclusion Criteria: The ICD-10 criteria specify that schizophrenia should not be diagnosed if the symptoms are better accounted for by a mood disorder, 'overt brain disease' or drug intoxication or withdrawal.
References:
Adapted from http://www.sfnsw.org.au/schizophrenia/diagnosis.htm. SFNSW Inc...Locked Bag 5014 Gladesville NSW 1675...ph: 02 9879 2600...fax: 02 9879 2699...Email: admin@sfnsw.org.au
Diagnosing schizophrenia is difficult as there is no single symptom which is unique to the disorder. There are no tests that can positively identify schizophrenia in a person. Therefore, the diagnosis depends on excluding other causes that may bring about schizophrenia-like symptoms, such as: substance misuse, epilepsy, brain tumours and thyroid dysfunction.
There are two major systems currently used for the diagnosis of schizophrenia, the Diagnostic and Statistic Manual of Mental Disorders and the International Classification of Disease. These classifications have the effect of improving inter-rater reliability but they do not make diagnosis an objective activity.
Diagnostic & Statistical Manual of Mental Disorders (DSM-IV) Criteria for Schizophrenia:
A. Characteristics of Symptoms: two or more of the following, each present for a significant portion of time during a one month period (or less if successfully treated):
Ÿ Delusions
Ÿ Hallucinations
Ÿ Disorganised speech (e.g. frequent derailment or incoherence)
Ÿ Grossly disorganised or catatonic behaviour
Ÿ Negative symptoms, i.e. affective flattening, alogia or avolition
(Note: Only one "A" symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behaviour or thoughts, or two more voices conversing with each other).
B. Social/Occupational Dysfunction: for a significant portion of time since the onset of the disturbance, one or more major areas of functioning, such as work, interpersonal relations or self-care is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic or occupational achievement).
C. Duration: continuous signs of the disturbance persist for at least six months. This six month period must include at least one month of symptoms that meet criterion A (i.e. active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of disturbance may be manifested by only negative symptoms or two or more symptoms listed in criterion A present in an attenuated form, e.g. odd beliefs, unusual perceptual experiences).
Exclusion Criteria: the remainder of the criteria (D-F in the DSM-IV text) specify that the signs and symptoms above are not better accounted for by another disorder, either psychiatric (i.e. mood disorder, schizoaffective disorder or pervasive developmental disorder), substance abuse (e.g. amphetamine intoxication or withdrawal) or a general medical condition (e.g. hyperthyroidism).
International Classification of Disease (ICD-10) Criteria for Schizophrenia:
Either at least one of the syndromes, symptoms and signs listed below under (1) or at least two of the symptoms and signs listed under (2) would have been present for most of the time during an episode of psychotic illness lasting for at least 1 month.
1. At least one of the following:
Ÿ Thought echo, thought insertion or withdrawal and thought broadcasting.
Ÿ Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions or sensations, and delusional perception.Hallucinatory voices giving a running commentary on the patient's behaviour or discussing him/her between themselves or other types of hallucinatory voices coming from some part of the body.
Ÿ Persistent delusions of other kinds that are culturally inappropriate or implausible, such as religious or political identity, superhuman powers and ability etc.
2. At least two of the following:
Ÿ Persistent hallucinations in any modality, when accompanied by either fleeting or half-formed delusions without clear affective content or by persistent over-valued ideas or when occurring every day for weeks or months on end.
Ÿ Breaks of interpolations in the train of thought, resulting in incoherence or irrelevant speech or neologisms.
Ÿ Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
Ÿ Negative symptoms such as marked apathy, paucity of speech and blunting or incongruity of emotional responses (these usually result in social withdrawal and lowering of social performance). It must be clear that these are not due to depression or neuroleptic medication.
Ÿ A significant and consistent change in the overall quality of some aspects of personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.
Exclusion Criteria: The ICD-10 criteria specify that schizophrenia should not be diagnosed if the symptoms are better accounted for by a mood disorder, 'overt brain disease' or drug intoxication or withdrawal.
References:
Adapted from http://www.sfnsw.org.au/schizophrenia/diagnosis.htm. SFNSW Inc...Locked Bag 5014 Gladesville NSW 1675...ph: 02 9879 2600...fax: 02 9879 2699...Email: admin@sfnsw.org.au
Subscribe to:
Posts (Atom)