RELATED LITERATURE
1st Journal Article by Michael Bengston, M.D.,(April 8, 2006) Source: http://psychcentral.com/lib/2006/undifferentiatedschizophrenia/ The undifferentiated subtype is diagnosed when people have symptoms of schizophrenia that are not sufficiently formed or specific enough to permit classification of the illness into one of the other subtypes.
The symptoms of any one person can fluctuate at different points in time, resulting in uncertainty as to the correct subtype classification. Other people will exhibit symptoms that are remarkably stable over time but still may not fit one of the typical subtype pictures. In either instance, diagnosis of the undifferentiated subtype may best describe the mixed clinical syndrome.
How is it diagnosed? Undifferentiated schizophrenia is a difficult diagnosis to make with any confidence because it depends on establishing the slowly progressive development of the characteristic “negative” symptoms
of
schizophrenia
without
any
history
of
hallucinations,
delusions, or other manifestations of an earlier psychotic episode, and with significant changes in personal behaviour, manifest as a marked loss of interest, idleness, and social withdrawal.
2nd Journal Article by S.E. Smith (September 8, 2010) Source: http://www.wisegeek.com/what-is-undifferentiatedschizophrenia.htm Undifferentiated schizophrenia is a mental disorder which is part of the family of disorders broadly known as “schizophrenia.” There are a number
of
schizophrenia,
subcategories catatonic
of
schizophrenia
schizophrenia,
including
disorganized
paranoid
schizophrenia,
residual schizophrenia, and schizoaffective disorder; undifferentiated schizophrenia is often defined as a form in which enough symptoms for a diagnosis are present, but the patient does not fall into the catatonic, disorganized, or paranoid subcategories.
Schizophrenia is characterized by a lack of grounding in reality, known as psychosis. People in a state of psychosis can experience hallucinations, delusions, and other events in which they break from reality. Individuals with schizophrenia experience psychosis and can also
develop symptoms such as disorganized speech, lack of interest in social interactions, a flat affect, inappropriate emotional responses to situations, confusion, and disorganized thinking.
Patients with undifferentiated schizophrenia do not experience the paranoia associated with paranoid schizophrenia, the catatonic state seen in patients with catatonic schizophrenia, or the disorganized thought and expression
observed
in
patients
with
disorganized
schizophrenia.
However, they do experience psychosis and a variety of other symptoms associated with schizophrenia, including behavioral changes which may be noticeable to family and friends. This mental disorder is challenging to diagnose, and it can take weeks or months to confirm a diagnosis of schizophrenia. During this process, other causes for the symptoms are ruled out, and the patient is observed to collect information about changes in the patient's personality, modes of expression, and mood. Family members and friends may also be interviewed and asked for information with a goal of painting a more complete picture of what is going on inside the patient's mind.
There
are
a
number
of
treatment
options
available
for
undifferentiated schizophrenia. Patients can discuss treatment options with their physicians, although it is important to be aware that it can take
time for treatment to be effective. Once patients start experiencing a change, they may require periodic adjustments to their medications and treatment regimen to respond to changes they experience over time. Undifferentiated schizophrenia cannot be cured, but it can be managed with a cooperative effort. It is important to be aware that managing schizophrenia requires a lifetime commitment which includes regular appointments with psychiatric professionals for evaluation. Patients may want to meet with several physicians to find a regular doctor they feel comfortable with, as every medical professional has a slightly different approach to schizophrenia treatment and it is important to have a doctor who is trustworthy to work with.
3rd Journal Article by Charles Pearson Source: http://www.ehow.com/about_5081978_causesundifferentiated-schizophrenia.html Schizophrenia is a serious mental disorder that causes sufferers to lose touch with reality. Schizophrenics have a difficulty interpreting actual senses and they also sense sights, sounds and smells that others cannot sense. Schizophrenia comes in a variety of forms and the causes of some
of these forms are somewhat understood. However, there are some patients who have schizophrenia symptoms that do not seem to fall into any particular category of the condition. Genetics 1. Undifferentiated schizophrenia seems to have genetic causes, since those with undifferentiated schizophrenia are 10 times more likely to have relatives who have had the condition. Researchers are beginning to suggest that those with a genetic predisposition to schizophrenia might not necessarily develop schizophrenia if they are not exposed to certain triggers. Migration 2. Schizophrenia is common among those who travel to different
countries have a higher chance of experiencing undifferentiated schizophrenia. Researchers theorize that the separation from family and the inability to adjust to a new setting with new prejudices contributes to the development of schizophrenia. Virus 3. One theory on the cause of schizophrenia is that the disease actually results from a virus that attacks and damages the hippocampus, a part of the brain that has to do with the processing of senses. Two viruses that might cause schizophrenia are herpes simplex and endogenous retroviruses.
Family 4. In Finland, researchers have discovered that 36 percent of children
in dysfunction families develop some forms of schizophrenia, while only 6 percent of children in healthy families develop this condition. When schizophrenia occurs, the sufferer may believe his delusions and resist treatment. Therefore, the family must play an active role in ensuring that the sufferer receive the treatment she needs. Other Triggers 5. Individuals born in cold and urban environments are more likely to develop
undifferentiated
schizophrenia.
Those
infected
with
influenza, poliovirus, CNS, respiratory diseases and Rubella have a 10 to 50 percent higher chance of developing schizophrenia. During the prenatal stage, those children subjected to famine, motherly depression, bereavement and flood are more likely to develop schizophrenia.
4th Journal Article by Mark Moran (September 18, 2009) Source: http://psychservices.psychiatryonline.org/cgi/content/abstract/60/ 8/1059 Hospital discharge records of people with a primary diagnosis of undifferentiated schizophrenia showed higher proportions of all comorbid psychiatric conditions and of several general medical conditions than did those of people who did not have schizophrenia. The survey data confirm what has been reported before: that patient with undifferentiated schizophrenia have higher rates of morbidity associated with some general medical conditions. However, the study authors pointed out that virtually all existing studies of comorbid disorders in undifferentiated schizophrenia test hypotheses and have focused on a single comorbid condition in relatively small and nonrepresentative samples. The current study appears to be the first systematic analysis of comorbidity in general with schizophrenia in the U.S. hospitalized population. “Our study is hypothesis-generating rather than hypothesis-testing, with the main purpose of presenting a systematic review of comorbid conditions,” said coauthor Natalya Weber, M.D., M.P.H.“ Psychiatrists can
see in this very large and representative sample what conditions are more frequently
comorbid
with
a
primary
diagnosis
of
undifferentiated
schizophrenia compared to any other primary diagnosis among the U.S. hospital discharges.” Weber is health science administrator in the Division of Preventive Medicine at Walter Reed Army Institute of Research. Further, the proportion of discharges with comorbid psychiatric disorders was much higher among patients discharged with a primary diagnosis of undifferentiated schizophrenia. These conditions included (in descending order of morbidity ratios): mild mental retardation, personality disorders, affective psychoses, nondependent abuse of drugs, adjustment reaction, alcohol dependence, drug dependence, depressive disorder not elsewhere classified, and neurotic disorders. In addition, discharge records of patients with undifferentiated schizophrenia as the primary diagnosis were significantly more likely to list the following nonpsychiatric comorbid conditions (in descending order of
morbidity
ratios):
acquired
hypothyroidism,
obesity
and
other
hyperalimentation disorders, asthma, chronic airway obstruction not elsewhere classified, essential hypertension, and type 2 diabetes. The frequency of cardiovascular and metabolic conditions comes as no surprise and has been reported widely. Psychiatrist John Newcomer, M.D., who has specialized in the research and treatment of metabolic conditions in schizophrenia and who reviewed the report for Psychiatric
News, said the data likely underestimate the true prevalence of these comorbid conditions—a point the study researchers acknowledged. “The
very
nature
of
the
problem
with
this
diagnosis
[of
undifferentiated schizophrenia] is that the patients tend to receive a lower standard of medical care, so there is going to be massive under estimation,” Newcomer told Psychiatric News. “If someone has a comorbid diagnosis that means that someone had to see you and diagnose you and engage you in treatment. We are worried that this is a significant underestimation of the true prevalence [of medical comorbidity].” Weber acknowledged in an interview that she and her colleagues had expected to see much higher rates of metabolic and cardiovascular disease. “We can only speculate that the conditions are under diagnosed in patients with undifferentiated schizophrenia.” One finding that was somewhat surprising was the frequency of comorbid epilepsy. “It is of interest that epilepsy was twice as prevalent among
discharges
with
schizophrenia,”
the
authors
wrote.
“This
association has no clear pathogenic mechanism and has been reported in only a few previous studies.” Also noteworthy was the frequency of contact dermatitis and other forms of eczema. Weber told Psychiatric News that these are typically caused by contact with detergents, oils, solvents, drugs, plants, solar radiation, and other environmental agents.
“We
can
speculate
that
these
skin
diseases
could
be
disproportionally present in patients with undifferentiated schizophrenia due to their higher exposure to these harmful environmental agents as a result of substandard living and working conditions, lower-paid manual jobs, and homelessness,” she said.“ Although these conditions were found a few times higher among discharges with a primary diagnosis of undifferentiated schizophrenia, they are quite rare—less than 1 percent of all comorbid conditions.”
5th Journal Article by Joan Arehart-Treichel (August 6,2010) Source: http://archpsyc.ama-assn.org/cgi/content/short/2010.63 Cognitive
therapy
interventions
appear
to
improve
cognition
moderately in people with undifferentiated schizophrenia. And they may to do so by changing areas of the brain damaged by the disease. As psychiatrists well know, psychotropic medications are of only limited value in improving cognition in people with undifferentiated schizophrenia. So scientists have been working diligently to develop effective
cognitive
remediation
programs
for
such
individuals—for
example, drill-and-practice exercises or computer-based neurocognitive training.
And it looks as if such programs can lead to moderate cognitive improvement, a meta-analysis published in the December 2007 American Journal of Psychiatry showed. As the lead investigator, Susan McGurk, Ph.D., of the Dartmouth Psychiatric Research Center, and colleagues wrote: “The effects of cognitive remediation on cognitive performance were remarkably similar across the 26 studies included in the analysis despite differences in length and
training
methods
between
cognitive
remediation
programs,
inpatient/outpatient setting, patient age, and provision of adjunctive psychiatric rehabilitation.” Matcheri Keshavan, M.D.: “Our observations provide a neurological basis of understanding how psychosocial treatments such as cognitive remediation work.” But what is it that makes such programs effective? They prevent or reverse undifferentiated schizophrenia-induced damage to the brain, a study by Matcheri Keshavan, M.D., a professor of psychiatry at Harvard Medical School, and colleagues suggested. The report of their findings was published May 3 in the Archives of General Psychiatry. The researchers selected as their subjects 53 symptomatically stabilized but cognitively disabled outpatients fairly early in the course of schizophrenia or schizoaffective disorder. That is, most had experienced their first psychotic symptoms within the previous five years. Subjects' average age was 26.
The subjects were randomized to receive, over the next two years, either a cognitive remediation program called cognitive enhancement therapy (CET) or a control regimen called enriched supportive therapy (EST). CET included 60 hours of weekly computer-based neurocognitive training in attention, memory, and problem solving as well as 45 weekly sessions designed to address key social-cognitive deficits that can limit functional recovery from schizophrenia, such as difficulties in managing emotions, trouble communicating nonverbally, a lack of foresight, or a lack of perspective. The researchers had previously found that CET could produce strong and lasting improvements in cognition in subjects who had undifferentiated schizophrenia for many years. Subjects in the EST group met individually with a therapist to learn and practice a variety of stressreduction and illness-management techniques designed to forestall relapse and enhance adjustment to their illness. The researchers used structural MRI scans to evaluate the brain topography of all subjects at the start of the study, a year later, and at the end of the study two years later. They then compared subjects' brain-scan results. By the end of the study, the cognitive-therapy group had a significantly greater preservation of gray matter in several brain regions known
to
be
impaired
by
undifferentiated
schizophrenia—the
hippocampus, parahippocampal gyrus, and fusiform gyrus—than the control group did. And crucially, the researchers noted, “These differential effects of CET on gray-matter change were significantly related to improved cognitive outcome, with patients who experienced less gray-matter decline and greater gray-matter increases also demonstrating significantly greater cognitive improvement over the two years of the study.” Summary The studies and articles explained and shows hospital discharge records
of
people
with
a
primary
diagnosis
of
undifferentiated
schizophrenia showed higher proportions of all comorbid psychiatric conditions and of several general medical conditions than did those of people who did not have schizophrenia. Patient with undifferentiated schizophrenia show high rates of comorbid illness, metabolic conditions were common but so were such medical conditions as epilepsy and viral hepatitis. The general medical conditions included acquired hypothyroidism, obesity, epilepsy, viral hepatitis, type 2 diabetes, essential hypertension, various chronic obstructive pulmonary diseases, and contact dermatitis and other forms of eczema, according to data from the National Hospital Discharge Survey reported in the August Psychiatric Services by researchers in the Department of Epidemiology at Walter Reed Army Institute of Research.
I agreed to Newcomer told Psychiatric News that very nature of the problem with this diagnosis [of undifferentiated schizophrenia] is that the patients tend to receive a lower standard of medical care, so there is going to be massive under estimation.
Base on the study I have read
there is no such thing that I can disagree because it is explain vividly and true
thing
that
happened
most
in
patient
with
undifferentiated
schizophrenia. The significant of these studies for clinicians and student as nursing was that individuals with undifferentiated schizophrenia have more than their share of associated, and often serious, medical conditions and thus require especially careful medical attention. This may help to timely diagnose
and treat
comorbid
conditions
and
perhaps
take
some
preventive measurements in those who are predisposed to them.” The article explained that cognitive therapy interventions appear to improve
cognition
moderately
in
people
with
undifferentiated
schizophrenia. And they may to do so by changing areas of the brain damaged by the disease. As psychiatrists well know, psychotropic medications are of only limited value in improving cognition in people with undifferentiated schizophrenia. So scientists have been working diligently to develop effective
cognitive
remediation
programs
for
such
individuals—for
example, drill-and-practice exercises or computer-based neurocognitive training.
I agreed to the researchers noted that differential effects of CET on gray-matter change were significantly related to improved cognitive outcome, with patients who experienced less gray-matter decline and greater gray-matter increases also demonstrating significantly greater cognitive improvement over the two years of the study. There was no reasoned to say I disagreed because it explained properly understood that it provide a neurological basis of understanding how psychosocial treatments such as cognitive remediation work. The significance of this study for a student as nurse we can gave well care to our patient especially in mentally ill patient (patient with undifferentiated schizophrenia) who needs cognitive remediation that will benefit in cognition by preventing or reversing gray-matter loss. As student nurses it is crucial in our lives how people with these kinds of disorders go about. They need our understanding, acceptance, and non-judgmental approach. We should never label patients. We don’t say a Schizophrenic patient but instead, we say, “a patient with schizophrenia.” Respect is vital is this field. Having this disorder does not make them less of a human. And like us, they share equal rights and privileges and we ought to give what is also due to them.
