Schizophrenia: The Effects on Learning: Clinical Paper

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Schizophrenia is a disorder which affects approximately 1% of the world population, has a 10% suicide rate, an estimated $20 billion in lost productivity and $11.1 billion in medical costs in the United States in 1980 (Andreasen, 1995). The primary characteristics are disturbed language, communication, thought and perception (Davidson, 1993 p. 1). There are two distinct types of symptoms, the positive (abnormal activity, such as delusions and hallucinations) and the negative (lack of activity, such as avolition, affective blunting) (Andreasen, 1995). Davidson (1993, p. 2) also identifies three phases of the disease process, each of which presents its own unique problems. Onset begins with social skill deterioration, and difficulty completing everyday tasks. The acute phase encompasses such items as delusions, hallucinations, and distorted thinking. Finally, the remission phase is marked by the passing of the distortions, with a return to more normal functioning, although oftentimes not as effectively as before the onset. Depending upon the phase and severity of the disease, a patient may have severely different psychological fields as well (Anscombe, 1987). However, Green (1996) points out that in a literature review, it has been shown that the degree of psychosis does not act as an indicator of the subsequent recovery.

Schizophrenia can be expressed in a patient through positive and/or negative symptoms. Both positive and negative symptoms generally result in learning difficulties, though through different mechanisms. This specifically includes (for positive symptoms), derailment, tangentiality, incoherence, illogicality, circumstantiality, pressure, distractible speech and clanging (Andreasen, Arndt, Alliger, Miller, & Flaum, 1995). For negative symptoms, the effects include psychomotor poverty, amotivation, apathy, loss of self-esteem, and reduced concern for reward and reinforcements (Hogarty and Flesher, 1992).

The results of both spectrums are exhibited in learning deficits in different areas, including: decreased attention, poor abstract thinking, poor planning and problem solving, poor memory, decreased verbal skills, poor organizational skills (Davidson, 1993, pp. 4-5), selection between relevant and irrelevant stimuli, poor flexible shifting of attention, poor comparison of earlier stimuli to current stimuli, altered evaluative higher processes (Brenner, 1986, pp. 138-139), impoverished cognitive schema, visual impairments, and chunking impairments (Hogarty and Flesher, 1992).

Schizophrenia can also be defined as an inability to sustain an intentional focus to attention. This inability can lead to a lack of control over the mental processes. The patient is at times passive within their own mind. Additionally, according to Hogarty and Flesher (1992), it appears that the patient has an inability to “self-edit”, resulting in both verbal and internal established but inappropriate responses. A result of this inability to direct a train of thought, access to long-term memory is compromised (Anscombe, 1987).

(Brenner, Hodel, Roder, & Corrigan, 1992) provide the following pictorial description (Figure 1), which shows the “vicious circles” that serve to decrease cognitive functioning and the ability to learn

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Derek Wood is a Nationally Board Certified Psychiatric/Mental Health Nurse, and holds a Master's degree in Psychology. His experience in the online arena of mental health can be traced back to 1997, when he was a host for Online Psych on AOL. He joined Get Mental Help, Inc. as Clinical Content Director for Mental Health Matters. Derek, with his wife Lisa, developed the original version of psychTracker (then called A Mood Journal), after his diagnosis with Schizo-Affective Bipolar, when they could not find a system available that was robust enough to help him effectively manage his symptoms and accurately interpret his charting. Derek has worked in the field of mental health since 2001, as a Unit Manager of an adult long-term treatment facility, a charge nurse in an adolescent short-term inpatient facility and long-term residential facility, and as a School Psychologist. He has also written several articles which are being used as CEU for nurses and educators.

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