Academic journal article South African Journal of Psychiatry

Positive and Negative Symptoms of Schizophrenia as Correlates of Help-Seeking Behaviour and the Duration of Untreated Psychosis in South-East Nigeria

Academic journal article South African Journal of Psychiatry

Positive and Negative Symptoms of Schizophrenia as Correlates of Help-Seeking Behaviour and the Duration of Untreated Psychosis in South-East Nigeria

Article excerpt

Schizophrenia is a mental disorder that usually manifests as a predominant negative symptoms (PNS), severe psychotic illness with onset in early adulthood, characterised by bizarre delusions, auditory hallucinations, thought disorder, strange behaviour and progressive deterioration in personal, domestic, social and occupational competence, all occurring in clear consciousness. [1] It is among the leading causes of long-term disability in the world, [2] and is the single most important cause of chronic psychiatric disability, [1] contributing about 1.1% of the global disability-adjusted life years. [3] The presentation of schizophrenia in hospital is usually preceded by a period during which the psychosis may not be adequately recognised and treated. Duration of untreated psychosis (DUP) is understood as a period from the development of the first symptoms of psychosis to

the commencement of appropriate intervention measures, such as antipsychotic drug treatment. [4] DUP has been widely recognised in recent years as a potentially important predictor of illness outcome in schizophrenia, [5] which has raised the issue of the importance of early detection and intervention for people developing psychotic illness. [6] For instance, treatment delay has been reported to have deleterious effects, [7] with consequent worsening of the prognosis;[8] reducing delays in early detection and treatment might improve long-term outcome. [9,10] The significance of early detection of mental health disorders in the population, therefore, cannot be overemphasised in view of increasing the opportunity to benefit from professional intervention. [11]

The symptoms that manifest early in schizophrenia could influence the interpretation of the illness and, therefore, the type and time of help-seeking. For instance, positive symptoms could be more readily identified as indicating mental illness than negative symptoms, [12] and patients with PNS may more readily consult with a traditional healer first, which could lead to a long DUP. [13,14] Positive symptoms of schizophrenia reflect an excess or distortion of normal functions, while negative symptoms refer to a decrease in or absence of characteristics of normal function. Erritty and Wydell [15] noted that positive symptoms were perceived as more discernible signs of mental illness than negative symptoms by a lay population. It was also observed that rapid access to mental health services could occur when the first signs of psychotic features are severe, including aggressive or violent behaviour. [14,16]

Erritty and Wydell, [15] as well as Addington et al., [17] also opined that people generally do not confidently recognise some negative symptoms as signs of mental illness and would not necessarily consider professional healthcare a priority for these symptoms, but the reverse is most likely to be the case when there is a predominance of positive symptoms. This becomes more disheartening against the backdrop that people with a DUP <1 year show substantially greater negative symptom reduction, especially when DUP is <9 months, compared with those with a DUP of >1 year. [18]

There is no established treatment for primary negative symptoms, [19,20] even though some treatments such as antipsychotics, [21] and some psychosocial treatments such as cognitive behavioural therapy, [22] peer support groups, [23] music therapy [24] and body-oriented psychosocial therapy [25] have all been shown to have some positive effect on negative symptoms; however, positive effects are better felt when the DUP is <1 year, especially <9 months. [18]

Since there is no effective treatment for negative symptoms [19,20] and perceptions of the symptoms of schizophrenia can influence the time and the type of help-seeking (and with early treatment positively influence the outcome), [7,26] reducing DUP to <1 year may be, for now, the best way to ameliorate the problems. …

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