symptoms
Motivation
Introduction
While many people with Schizophrenia lack interest as part of the core symptoms of this illness, many retain interests, but are plagued by a variety of issues that compromise their ability to explore and follow through with these interests.
Negative Symptoms
A significant number of people with Schizophrenia find that the negative symptoms of their illness are more limiting than are the positive symptoms (delusions, hallucinations or disorganized thinking or speech).
Negative symptoms include apathy or ambivalence, anergia or avolition, alogia, and restricted affect:
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apathy or ambivalence simply means that we are indifferent or do not care about things -
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anergia and avolition involve a lack of energy or difficulty starting or continuing activities
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alogic involves limited or absent speech and may reflect a reduction in thoughts
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affect is the display of emotions; people with Schizophrenia may have restricted (flattened) affect
Social Isolation
Social isolation is common in many people with Schizophrenia. If it is not compounded by other symptoms, it can be addressed by strongly encouraging sufferers to participate in activities that offer opportunities to socialize. The patients themselves must demonstrate some degree of willingness to participate, even if it does not seem attractive at first. With time, they often find that expanding their social network becomes more satisfying and attractive.
For patients who experience paranoia or anxiety, it is essential to make every effort to reduce those symptoms, as they have a direct negative effect on our ability to socialize.
Medications
Some medications, particularly older (typical) antipsychotics, may intensify negative symptoms. Some (including newer agents) cause excessive sedation which interferes with our ability to function.
Atypical agents in general appear to represent greater potential for treating negative symptoms and mood. While they are not without side effects, patients seem to find them more attractive overall in this respect.
Aripiprazole (Abilify) is sometimes activating or energizing. I have found this medication, used alone or added to current medications, to be helpful in this respect in select patients.
Clozapine may be better than other antipsychotics in terms of mood and cognitive functioning.
Comorbid Conditions and Paranoia
Depressive symptoms are common is people with Schizophrenia and should be treated aggressively due to the high rate of suicide in patients with this disease and because the symptoms of depression can themselves be quite limiting.
Newer, atypical antipsychotics, appear to be better at addressing the symptoms of depression than older (typical) agents were.
Often, it is necessary to add an antidepressant medication if the symptoms of depression are significant and do not seem to be substantially improved by the use of atypical agents alone.
Some patients may actually suffer from Schizoaffective Disorder or an atypical presentation of Bipolar Affective disorder and require mood stabilizing agents to adequately control their mood symptoms (including depressive symptoms).
Many people with Schizophrenia also experience anxiety symptoms or disorders.
Symptoms of paranoia may not be adequately treated.
Cognitive Impairment
Cognitive impairment limits anyone’s ability to fully participate in activities, whether they are recreational or any other activities. Cognitive impairment may be part of the illness and/or be a consequence of prescribed medications, including those used to control side effects.
Medical Health
A variety of medical conditions reduce energy and motivation. Everyone who suffers from Schizophrenia should obtain regular physical examinations and be seen routinely for the management of any other illnesses that they have.
Substance Use
Alcohol and other substances (especially cannabis) can reduce motivation and energy, produce or worsen cognitive impairment and intensify many of the symptoms of Schizophrenia.
While nicotine present in all tobacco products is attractive to people with Schizophrenia, the regular sustained use of these products (at least with respect to smoking) has clear negative effects on our cardiovascular and respiratory functioning that can include (but are not limited to) reduced energy and stamina.
Therapies
A variety of psychotherapies (especially cognitive-behavioral therapy) can provide added benefit to medications in treating depression associated with Schizophrenia, helping patients deal with the manifestations of their illness, and to better address other concerns.
More importantly, other forms of therapy, such as recreational and occupational therapy and social skills training, can be quite helpful in helping patients rediscover interests and in removing barriers to participation in social events and other activities.
Other therapies that should be considered for some patients include music and art therapy and pet therapy.
ACT (Assertive Community Treatment) offers a particularly potent combination of therapeutic interventions in a single package. Clients benefit from thorough attention to medications and side effects, individual and group therapies, and skills development. All of this can be obtained from a single group of invested familiar clinicians.
One notable advantage to this program is the intensity of treatment that can be offered and the frequency of contacts between the various clinicians and the client. ACT programing more closely resembles the level of services that clients receive when they are in the hospital.
Consider Everything
Don't exclude any measure that may be offered or recommended by any member of your treatment team or other people who are struggling to manage this illness. Make use of your family and friends to the extent that they are willing to be involved.
10 Things You Can Do?
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1.Push yourself to become more active. You will likely be rewarded by this commitment and effort.
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2.Explore and pursue available activities. Socialize, beginning with those people you are most comfortable with.
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3.Identify and eliminate or reduce any component of medication side effects that may be causing or worsening these symptoms. This should include a consideration of less sedating or even activating agents.
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4.Ask that you be assessed for cognitive impairment. If it is present, be sure that it is not related to medication side effects (especially anticholinergic side effects).
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5.Consider changes in your medication to include agents with less risk for side effects (sedation, anticholinergic side effects, or others) or ones that may be better at offering some degree of improvement in your symptoms, mood or cognition.
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6.Be sure that you have discussed the possibility of comorbid depression or another disturbance of mood, and uncontrolled symptoms of paranoia or anxiety with your doctor.
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7.Avoid illicit substance use and tobacco products.
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8.Be sure you have regular physical examinations and see your other doctors as needed.
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9.Consider, at least on a trial basis, all types of therapy that might have something to offer. Make use of your social network.
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10.Look into the availability of ACT programs in your community.
(Sources: The author’s knowledge base, unless otherwise noted.)
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