Can this be Schizophrenia?

Margaret became worried about her 17-year-old son Adrian who repeatedly kept saying that he heard God’s voices. Adrian was regularly found locked in his room while isolating himself from family and friends. He often bunked school saying that he didn’t feel like going. He did not speak much to anyone except answering his mom’s questions. She sensed that he disliked when probed as he responded with cold and blank expressions. At times he got agitated when pressed to join the family for dinner or get involved in social gatherings. Margaret’s family was a devout church going Christians. She and her husband were active in church ministry. However, she was little perplexed when she heard Adrian make statements like “God spoke to me”, “He speaks to me with loud voices in my head” and “I am the Moses in the Old Testament.”

For about a year Adrian had been involved in his church youth group, and Margaret was happy about it. Nevertheless, some of the behaviors she noticed in him were not convincing enough. Adrian displayed mixed behaviors of social isolation and withdrawal while expressing himself with grandiose speech among his friends and church group. Margaret felt that Adrian’s behavior was not normal for a teenager of his age. Yet she had her own doubts. She additionally noticed that he not only displayed poor social interactions but also deteriorated in his personal hygiene and dressing. His memory and concentration depleted when asked to do simple tasks or even doing his daily routine. He appeared indifferent and distanced. Margaret grew anxious and worried about her son’s changed behaviors and perception. She felt that Adrian needed more prayer. She convinced herself saying that perhaps his changes were part of his adolescence phase.

What Margaret could be ignoring can be early signs of schizophrenia. Individuals with early signs of schizophrenia can exhibit signs of subjective experiences of thought, language, perception; disorders of thought, emotion and energy; and disturbances in social functioning (Larson, Walker, and Compton, 2011). During an early phase, the episode of psychosis may not be experienced by an individual in full swing. It may show up as an abnormal behavior or mild symptoms as seen in psychotic patients. Subthreshold psychosis (prepsychotic stage) varies in intensity, frequency, and duration which can be prevalent for a day or occasionally once or twice in a month and last for few minutes or lesser than a day to fall into diagnostic criteria (Larson, Walker, and Compton, 2011).

Further, the early signs of schizophrenia are termed as ‘prodrome’ indicating a set of precursor symptoms that tend to develop into a disorder (Drake, 2005). Like Adrian, prodromal individuals are predominantly adolescents and young adults who experience mild to moderate disturbances with perception, cognition, initiative, stress tolerance, the level of energy and will (Larson, Walker, and Compton, 2011). For instance, Adrian believed that he heard God’s voices (auditory hallucinations). He believed he was Moses (delusional personalized interpretation). He displayed mixed behaviors of withdrawal and broadcasting which are positive and negative symptoms that mark the distinctive symptoms of schizophrenia (Larson, Walker, and Compton, 2011). Most individuals with early signs may not even develop psychosis or may take more than a year for the symptom to achieve transition. Factors such as family history, disabling symptoms and changes in perceptual quality and cognition may serve as early signs of schizophrenia for early intervention (Drake, 2005).

References

Drake, R.J. (2005). Early Detection of Schizophrenia. Current Opinion in Psychiatry, 18(2):147-150.

Larson, M.K., Walker, E.F. and Compton, M.T. (2011). Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders. Expert Review of Neurotherapeutics, 10(8): 1347–1359.