RELATED LITERATURE
1st Journal Article by Michael Bengston, M.D.,(April 8, 2006)
Source: http://psychcentral.com/lib/2006/undifferentiated-
schizophrenia/
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-undifferentiated-
schizophrenia.htm
Undifferentiated schizophrenia is a mental disorder which is part of
the family of disorders broadly known as “schizophrenia.” There are a
number of subcategories of schizophrenia including paranoid
schizophrenia, catatonic schizophrenia, disorganized 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_causes-
undifferentiated-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 stress-
reduction 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.
